How Dangerous is Melanoma? It’s All a Matter of Timing

Skin cancer holds the unfortunate distinction of being the world’s most common cancer. Though its prevalence around the globe is disturbing, there is some good news: When caught early, skin cancers are highly curable.

You might already know that catching a cancer early means a more favorable prognosis. But it can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Melanoma should never be underestimated, but treating a tumor early rather than after it is allowed to progress could be lifesaving.

Leland Fay, 46, understands better than most the seriousness of this distinction. When the Monument, Colorado native was diagnosed with melanoma in 2012, he was given a bleak prognosis due to the advanced stage of the tumor — it had already reached stage IV.

Leland hadn’t thought much of the little black mole on his head a few months earlier, when a dermatologist froze it off during a routine exam. But the mole resurfaced, bigger than it had been originally. After a biopsy and imaging tests, doctors told Leland it was melanoma, and that it had already spread. He could have as few as six weeks to live.

Luckily, with the help of several surgeries, immunotherapy, radiation and the “faith and support of family and friends,” Leland overcame the odds. He still goes in for treatments, but five years after his diagnosis, he is leading an active, full life. He recognizes, however, how different his journey could have been if the melanoma was caught earlier: “Better to have a little inconvenience with a biopsy than let melanoma advance.”

To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumor site.

Scratching the Surface

A melanoma in its earliest stages is localized. This means that the tumor’s malignant cells have not multiplied to the point that they extend beyond the skin. The very earliest melanomas (stage 0) do not even extend past the top layer of the skin, the epidermis. These tumors are called in situ, a Latin phrase that means “in (original) position,” and they are considered noninvasive. If a tumor penetrates deeper, into the dermis, it is considered invasive (stages I and II). On average, the estimated five-year survival rate for melanomas detected while still localized is very high: about 99 percent in the U.S.

Digging Deeper

The chances of curing a melanoma drop sharply once it spreads, or metastasizes, beyond the original tumor site. Normally, the first place a melanoma tumor metastasizes to is the lymph nodes, by literally draining melanoma cells into the lymphatic fluid, which carries the melanoma cells through the lymphatic channels to the nearest lymph node basin. Lymphatic fluid is an important part of the immune system that bathes the tissues, and is responsible for carrying foreign invaders like bacteria to the lymph nodes, where these invaders are destroyed by the lymphocytes, the white blood cells.  Unfortunately, when melanoma cells are carried to the lymph nodes, they can potentially be carried beyond the nodes to distant organs. Once a melanoma has metastasized beyond the original tumor site, either to the skin en route to the lymph nodes (“in transit” metastases) or to the lymph nodes themselves, it is considered a stage III melanoma. The five-year survival rate then drops to around 62 percent because of the high risk that the cancer can spread from the nodes throughout the body.

Once a tumor has spread to distant body sites such as organs, it is considered a stage IV melanoma, with an estimated five-year survival rate of only 18 percent in the U.S. These survival figures are improving every year because of new treatments (some therapies are keeping as much as 40 percent of stage IV patients alive for years), but they are no substitute for early detection.

Stop Tumors in Their Tracks

Every melanoma has the potential to become deadly, but the difference between an in situ melanoma and one that has begun to metastasize cannot be overstated. There is a drastic change in the survival rate for the various stages of tumors, highlighting the importance of detecting and treating melanomas before they have a chance to progress. It’s impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.

To be sure you’re spotting any potential skin cancers early, The Skin Cancer Foundation recommends monthly skin checks, and scheduling an annual total body skin exam with a dermatologist. These skin exams can help you take note of any new or changing lesions that have the potential to be cancerous, and have them biopsied and taken care of before they can escalate.

“Trust your instincts and don’t take no for an answer,” Leland says. “Insist that a doctor biopsy anything you believe is suspicious.”