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Melanoma

There are two main categories of skin cancer, namely, melanoma (malignant melanoma) and non-melanoma. According to the World Health Organisation (WHO), the incidence of both non-melanoma and melanoma skin cancers has been increasing over the past decades, and WHO estimates that a 10 % decrease in ozone levels will result in an additional 300 000 non-melanoma and 4 500 melanoma skin cancer cases globally.

The National Cancer Registry (NCR) has reported the following incidence, namely that 22 712 South Africans were diagnosed with the most common skin cancers (basal cell carcinoma and squamous cell carcinoma) in 2019 and more than 2 166 were diagnosed with melanoma.

Melanoma among South African men is ranked 5th most prevalent cancer – 1 in 168 (NCR 2019) lifetime risk – and as the 6th most prevalent cancer among women – 1 in 266 (NCR 2019) lifetime risk – thus showing an overall increase in skin cancer numbers. This may be due to improved screening methods or an overall increase in these numbers.

Melanoma, is less common than other skin cancers, but it is the most dangerous.

Metastatic Melanoma

“Metastatic” means that the melanoma has spread to one or more parts of one’s body. It is also referred to as ‘advanced’ or ‘Stage IV’ Melanoma. Although it cannot be cured, it can be treated.

Melanoma starts in the cells that make melanin, the pigment that gives colour to one’s skin. It can spread anywhere in the body, but it first tends to go to the lymph nodes (a network of glands that fight infection) near where it formed.

From there it can travel to organs like the brain, lungs, liver, and bones, as well as other areas of the skin — including places far away from where it started (what doctors call the “primary site”).

Excessive ultraviolet (UV) radiation received as a child, increases the risk of melanoma later in life, though it may be possible to have a melanoma even if you haven’t had extreme UV exposure. Melanoma can happen after intense UV exposure (think of very bad sunburns), especially in people whose genes put them at risk for the disease. But it can also happen due to everyday UV exposure, without burning, over a long time.

The sun’s ultraviolet (UV) rays are the main cause. Artificial sunlight (such as from tanning beds) can also trigger melanoma of the skin. UV radiation damages the DNA in skin cells, prompting them to multiply rapidly and become cancer.

Anyone, regardless of skin tone can get a melanoma.

People most at risk include:

People with fair skin, especially with light hair and eye colour
People who have had many blistering sunburns, especially as a child or teenager
People with several large or many small moles, including beauty marks and brown blemishes
Unusual moles run in the family
Skin cancer (any type) has been diagnosed in a family member
People with weak immune systems

According to Krige (2010) there are distinct differences in melanoma of the skin between black and white populations regarding the incidence, anatomical distribution, histogenetic types of melanoma stage at presentation and prognosis*:

In South Africa, the incidence of malignant melanoma is 15 times less among dark skinned individuals than in among the white population.
In fair or light-skinned populations, more than 90% of melanomas occur in sun-exposed skin, whereas 60% of melanomas among Africans arise in non-sun-exposed skin, involving in particular, plantar, palmar, subungual (under the nail) and mucosal surfaces.
The volar and subungual areas are the most common anatomical sites of malignant melanoma in black populations, with 70% of melanomas found on the lower limb and 90% of melanomas on the leg occurring below the ankle.

*These views are supported by Hudson & Krige (1995)

Recent studies have provided evidence of a link between breast cancer and melanoma – the studies recommend:

All melanoma patients, with a history of breast cancer, should be referred to a breast clinic. Women above the age of 40 with melanoma, should undergo an annual mammography and those younger than 40 should be evaluated too.
All breast cancer patients should be made aware of the significance of changing moles and those with suspicious lesions, should be referred to a dermatologist for an evaluation.

Although less common than other skin cancers, melanoma is lethal. Some melanomas are extremely aggressive and progress very rapidly within a few months.

Early detection of melanoma is key to improved survival outcomes with 5-year survival rates being greater than 90%, if detected early.

Early detection is key when it comes to beating melanoma. Recognise changes in your own body by becoming familiar with it. Get into the habit of doing monthly skin checks using the ABCDE guidelines and get a friend or family member to check out of sight areas like the scalp, back and buttocks. Any irregularities should immediately be reported to a doctor or dermatologist.

It is a good idea to arrange an annual skin examination with a dermatologist.

CANSA is grateful for the successful collaboration and partnership between CANSA, Novartis South Africa and Stellenbosch University that led to an educational melanoma awareness video to share Survivors’ stories and what skin checks to conduct. Our gratitude to Drs’ Bianca Tod and Willie Visser from Stellenbosch University for their valuable educational input, and to Novartis South Africa for their continuous support of our SunSmart campaign and health awareness activities.

CANSA has partnered with Miiskin. You can download this free user-friendly app and leaflet for monitoring changes on skin, however it doesn’t replace a doctor’s visit and isn’t a diagnostic tool.

CANSA Screening:

Book a Clinical Mole Analysis: this is when a trained, professional nurse clinically assesses a mole according to globally accepted ABCDE screening guide.
Book a FotoFinder Mole Analysis: this is an enhanced clinical mole analysis to detect suspicious moles via a FotoFinder (electronic device) that measures the risk profile of the mole. (FotoFinder machines roam between Care Centres so booking is essential).

Bookings for screening may be made at your nearest CANSA Care Centre…

Infographic:

Melanoma Infographic (PDF)

Videos:

Webinars:

Melanoma Patient Webinar (23 May 2022)
Let’s Get Chatty about Melanoma Awareness and Skin Cancer Screening – recording available
Metastatic Melanoma Webinar – recording available

Fact Sheet:

CANSA Fact Sheet Malignant Melanoma (NCR 2019)

Online Support & Material

Find online resources, material and support group information…

Meet melanoma survivors and be inspired by their stories:

Nicole Capper:

Former Mrs South Africa, Nicole Capper, a skin cancer Survivor says, “As a cancer Survivor sun protection is a massive focus for me. Being diagnosed with malignant melanoma at 25 rocked my world, but I was lucky to have caught it early enough. We’re so aware of other potential health concerns and we make sure we visit specialists annually for other standard check-ups, and yet our skin is neglected for the most part, often until it’s too late. Sunscreen is always healthy. And regular dermatologist appointments should be mandatory. We owe it to our families and communities to stay healthy, and our skin is no exception.”

Naniki Seboni:

Naniki Seboni, from Soweto, shares her experience, “My melanoma was found on the lateral side of my left leg and had spread to my groin area. What I thought was a beauty spot or mole, ultimately grew to four times the size and had an irregular shape.” She always had a sensitive skin and as a child had a few bad sunburns. She was being treated by a neurologist due to anxiety and insomnia following the shock of her father’s death, when the neurologist noticed the mole and referred her to a dermatologist. A biopsy was done and Naniki was told she had stage 3 melanoma. She was shocked, saying, “If anything, if you have ever heard the word ‘cancer’, it’s really associated with white people…” Read more…

Katherine Burger:

Says Katherine, “Melanomas can look like any lump or bump, so that’s it’s so important to know our bodies and watch for changes. You should do a skin self-examination every few weeks. Most importantly, this is why EVERYONE should have an annual skin check by a dermatologist.” Read more…

Sonia Katzenberg

Sonia Katzenberg, Global Relay For Life Hero of Hope, a melanoma Survivor of over 15 years says, “I remember distinctly a couple of serious burns as a child. We fell asleep in the sun around the pool. So I didn’t take care of my skin. When we’re young we think we’re invincible but when it happens, and you come face to face with the statistical message you don’t want to hear that. Suddenly life becomes precious. I would never have thought that sunburn or sitting in the sun could have such far reaching and silent impact on one’s life.”

Julie George:

Julie George, melanoma Survivor states: “I think in the back of my mind I knew sunbeds were dangerous, but I never knew just how dangerous. I was completely ignorant of the nature of melanoma too. I wish I could have had a glimpse into the future back then, a real understanding of the dangers. I still find people today who don’t take it seriously. I think as I had, they have the ‘it won’t happen to me mind set.’ I am hoping my story will convince people that this is a very real, life threatening risk.”

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