Skin Cancer and Melanoma Awareness Month

More people are diagnosed with skin cancer each year than with all other cancers combined, making it the most common type of cancer worldwide. One in five Americans will develop skin cancer by the age of 70.¹ Fortunately, it is also one of the most preventable forms of cancer. Raising awareness can help improve outcomes. Each year, the month of May is dedicated to sharing the facts about skin cancer—particularly its most deadly type: melanoma.

In this article, we’ll take a deeper look at melanoma: what it is, how to help prevent it, and how it’s diagnosed. We’ll also look at tools that help your doctor assess your genetic risk of melanoma, match your tumor’s genomic profile to approved treatments, and monitor your response to treatment. Finally, we’ll share how to get involved to help save lives.

Melanoma 101 and the importance of prevention and screening

All three of the primary skin cancer types—basal cell carcinoma, squamous cell carcinoma, and malignant melanoma—are mainly caused by ultraviolet (UV) radiation from the sun and tanning devices. No one is immune. All ethnicities and skin tones are at risk for developing skin cancer.

Melanoma makes up less than 5% of all skin cancer, with 197,700 cases projected to be diagnosed in the US in 2022.¹ Although melanoma is curable when caught early, it is also the most dangerous skin cancer because it’s much more likely to invade nearby tissues and spread to other parts of the body.² Although melanoma is more common in males than females and among individuals of fair complexion, anyone can get melanoma.¹

What is melanoma?

Melanoma, also known as malignant melanoma and cutaneous melanoma, develops when melanocytes—the pigment-producing cells that give each person a unique skin color—become damaged and grow out of control. While most melanomas start on sun-exposed skin as a result of DNA damage from UV radiation, they can also develop in other areas of the body where melanocytes are present, including the eyes, palms, soles, or under fingernails.³

According to the National Cancer Institute, the percentage of people who will be alive five years after a diagnosis of melanoma is 93%,⁴ but this number varies greatly based on the melanoma stage and other factors like age and overall health.⁵

Note: these numbers are based on people diagnosed with melanoma between 2011 and 2017⁵. As treatments improve over time, melanoma survival rates may get better.⁴

How is melanoma diagnosed?

The most important warning signs of melanoma are any new spots on the skin that are changing in size, shape, or color, or sores that do not heal. Many doctors recommend doing a monthly full-body self-exam and paying particular attention to the areas where melanoma is most likely to occur: torso, head, and neck for males, and lower legs and torso for females. If you notice any concerning changes, it’s time to see your doctor.

Your doctor will do a physical exam, ask questions about your symptoms and risk factors, and check out any suspicious spots on your skin using the “ABCDE” criteria:⁶

• Asymmetry – Is one half of the mole or skin mark different from the other?

• Border – Are the edges irregular, ragged, notched, or blurred?

• Color – Are there different colors or shades?

• Diameter – Is the spot larger than six millimeters across (about a quarter-inch—the size of a pencil eraser)? Note that some melanomas can be smaller than this.

• Evolving – Has it changed in size, shape, or color over time?

If your doctor suspects the spot might be melanoma, they will order a skin biopsy, during which a part of the suspicious area will be removed and closely examined at a lab. If melanoma has spread to the lymph nodes or other organs, your doctor will order additional biopsies, imaging tests (such as a CT scan or an MRI), and/or blood tests.

Why melanoma prevention and early screening are essential

The good news is that melanoma is largely preventable by simply protecting yourself from damaging UV exposure. Unprotected skin can be damaged by the sun’s UV rays in as little as 15 minutes, and you still need protection even if it’s cool and cloudy.⁷ Remember that the sun’s rays are the strongest between 10 am and 2 pm. Stay safe by bringing some sun-protective clothing, a hat, sunglasses that block UV rays, and, of course, SPF 15+ sunscreen with both UVA and UVB (broad-spectrum) protection.

Keep in mind that identifying melanoma as early as possible makes a big difference, because localized melanoma is the easiest kind to remove during surgery and has the highest chance of being cured. If you notice a suspicious spot, don’t wait to contact your doctor—even localized melanoma surgery is sometimes challenging. If melanoma spreads beyond the skin, you will need to undergo additional treatment.

The role of genes in melanoma

Even though a large proportion of melanoma cases are thought to be caused by UV exposure, about 5-10% of melanoma cases involve changes—or mutations—in certain genes that can be passed down from generation to generation.^8,9 If you have such a change, your lifetime risk of melanoma can increase from 2.3% to 60-90%.^5,10 Some of these inherited genetic changes also predispose you to other types of cancer, such as pancreatic, breast, and lung cancer.¹¹

You may be more likely to carry a genetic change for hereditary melanoma if you have multiple first or second degree blood-related relatives with melanoma, a history of other specific cancers, or certain unusual types of moles.¹¹ If you’re concerned about your inherited risk of melanoma, your doctor can order a hereditary cancer test. A hereditary cancer test is a genetic test that looks for specific changes in your genes that are associated with higher risks of developing certain types of cancer, including melanoma.¹²

If your hereditary cancer test results show a genetic change that raises your risk of melanoma, your doctor and/or genetic counselor can recommend ways to stay extra vigilant about prevention. They may recommend more frequent skin checks or total body photography to watch for new or changing spots, on top of sun protection. Talking with your blood-related family members about their potential risk or encouraging them to get screened can also be helpful.

Empower^TM is a hereditary cancer test that requires only a blood or saliva sample. Like all hereditary cancer tests, Empower provides information about your likelihood of developing certain types of cancer. A positive result does not mean that you already have cancer. Your results tell whether your risk of developing certain types of cancer is higher than the general population. Results will help you and your doctor and/or genetic counselor create a plan for staying on top of your risk.

If you have been diagnosed with cancer, hereditary cancer testing can help you understand if a genetic change was involved in your cancer’s development. If a genetic change is found, Empower results can help inform your cancer treatment strategy.

Talk to your doctor or genetic counselor to learn if hereditary cancer screening is right for you. As part of Natera’s commitment to our patients, we offer complimentary genetic information sessions with board-certified genetic counselors to discuss your Empower results.

New tools for advanced and metastatic melanoma

If melanoma has affected the lymph nodes or other organs, it is considered advanced or metastatic. In this case, treatment may include more intensive surgery, chemotherapy, targeted therapy, radiation, immunotherapy, and/or clinical trials. Not all melanomas will respond to the same types of treatment, so it’s crucial that doctors look closely at your unique melanoma to determine the best course of action.

In recent years, the FDA approved new medications to treat melanoma. These include targeted therapies that attack molecules that help cancer cells grow, and immunotherapies, which use your own immune system to help kill cancer cells. These treatments represent significant leaps forward in advanced melanoma treatment and have led to substantial declines in melanoma deaths.¹³

To use targeted therapy or immunotherapy to treat a person’s melanoma, doctors need to know whether the cancer cells have specific genetic mutations that will respond to those treatments. Comprehensive genomic profiling (CGP) is a tool that detects these mutations in your tumor cells. Doctors use CGP to match you with the best treatment and, in some cases, refer you to clinical trials that may be able to help.

Altera^TM is a CGP from Natera that can help doctors select the best therapy for you. Altera works by sequencing your tumor tissue for known genetic mutations that may mean your melanoma will respond to certain treatments better than others. If such a mutation is found, your Altera report will provide your doctor a list of FDA-approved treatments and clinical trials to help them make important decisions about your care.

Advanced melanoma treatment response monitoring using ctDNA

Despite this tremendous progress in melanoma treatment, immunotherapy doesn’t work for everyone.¹⁴ If you are receiving immunotherapy, it is critically important for your doctor to monitor how you respond to it, so that they can understand how to best guide your care.

Signatera^TM is a test that can help refine your doctor’s understanding of your response to immunotherapy. Signatera works by measuring circulating tumor DNA (ctDNA)—small fragments of a tumor’s DNA that can appear in your bloodstream when cancer is present. Measuring ctDNA levels helps determine if there is any molecular residual disease (MRD) in your body.

Signatera builds a custom profile of your tumor based on its unique genomic mutations, and then requires only simple blood draws to detect and measure ctDNA. Changes in your ctDNA levels during immunotherapy can show how well your melanoma is responding to the treatment.

A clinical research study validated Signatera as a tool for evaluating how you respond to immunotherapy across 25 different cancers, including melanoma.¹⁵ Signatera is now covered by Medicare for use during immunotherapy for melanoma and all solid tumors.

Learn more and get involved to save lives together

If you’d like to deepen your understanding of melanoma prevention, screening, diagnosis, and therapy, there are plenty of comprehensive resources available online. Natera’s partners, including Melanoma Research Alliance, Melanoma Research Foundation, and AIM at Melanoma, offer additional research, information on clinical trials and the latest advancements in treatment, and a place to connect with the community. We’ve also included a few leading-edge sources of melanoma information in the Additional Resources section below.

If you’re interested in taking the next step and getting involved to help end melanoma, check out these upcoming fundraising events (this year, they may be held virtually or in-person, depending on COVID-19 guidelines):

• Steps Against Melanoma, an annual series of walks sponsored by AIM at Melanoma to support people living with skin cancer, share stories to spread awareness, and promote treatment and early screenings

• Miles for Melanoma, an annual series of walks held by the Melanoma Research Foundation in various cities across the US in an effort to raise money for melanoma prevention and treatment research

Disclaimer

These tests have been developed and its performance characteristics determined by the CLIA-certified laboratory performing the test. These tests have not been cleared or approved by the US Food and Drug Administration (FDA). CAP accredited, ISO 13485 certified, and CLIA certified. © 2022 Natera, Inc. All Rights Reserved.

Additional resources

National Cancer Institute

Skin Cancer Foundation

American Cancer Society

American Academy of Dermatology

Mayo Clinic

Empower information

Altera information

Signatera information for people on immunotherapy

References

¹Skin Cancer Foundation. Skin cancer facts and statistics. Accessed March 22, 2022.

²Cancer Research Institute. How is immunotherapy for melanoma changing the outlook for patients? Accessed March 22, 2022.

³American Cancer Society. What is melanoma skin cancer? Accessed March 22, 2022.

⁴National Cancer Institute. Cancer stat facts: melanoma of the skin. Accessed March 29, 2022.

⁵American Cancer Society. Survival rates for melanoma skin cancer. Accessed March 29, 2022.

⁶American Cancer Society. Signs and symptoms of melanoma skin cancer. Accessed March 22, 2022.

⁷Centers for Disease Control and Prevention. Skin cancer awareness. Accessed March 22, 2022.

⁸Rossi M, et al. Familial melanoma: Diagnostic and management implications. Dermatol Pract Concept. 2019 Jan; 9(1): 10–16.

⁹Sample A & He Y. Mechanism and prevention of UV-induced melanoma. Photodermat. Photoimmunol. Photomed. 2017;34(1):13-24.

¹⁰American Academy of Dermatology Association. Should I get genetic testing for melanoma? Accessed March 23, 2022.

¹¹Soura E, et al. Hereditary Melanoma: Update on syndromes and management - Genetics of familial atypical multiple mole melanoma syndrome. J Am Acad Dermatol. 2016 Mar; 74(3): 395–407.

¹²National Cancer Institute. Genetic testing for inherited cancer susceptibility syndromes. Access March 24, 2022

¹³National Cancer Institute. Deaths from metastatic melanoma drop substantially in the United States. Accessed March 22, 2022.

¹⁴Melanoma Research Alliance. Expanding the tool box: new melanoma treatment approaches being explored. Accessed March 23, 202.

¹⁵Bratman SV, et al. Personalized circulating tumor DNA analysis as a predictive biomarker in solid tumor patients treated with pembrolizumab. Nat Cancer. 2020;1;873-881.