What is melanoma skin cancer?

Melanoma is a type of skin cancer that develops in the melanocytes which are the cells responsible for producing melanin– the pigment that gives your skin its colour. While melanoma is less common than other types of skin cancer, it is the most serious form because it has a higher likelihood of spreading to other parts of the body (metastasis) if not detected early.

Melanoma is the most severe form of skin cancer due to its potential to spread quickly through various stages, from localised (Stage 0) to metastatic (Stage IV), where it affects distant organs and lymph nodes.

The occurrence of melanoma skin cancer is relatively rare in Singapore– with an incidence of 0.5 cases per 100,000 people. However, with the rising rates of skin cancer in Singapore and the aggressive nature of melanoma skin cancer (compared to non-melanoma skin cancer), it is important to be vigilant of skin changes and address signs of potential malignancy with early intervention.

Melanoma is categorised into different stages, ranging from Stage 0 (in situ), where the cancer is confined to the top layer of the skin, to Stage IV, where the cancer has spread to other organs or distant lymph nodes. The stage of melanoma is determined based on factors such as tumour thickness, ulceration, and the extent of spread, and it plays a crucial role in guiding treatment options.

Melanoma can develop on any skin surface, including areas not typically exposed to the sun, such as the soles of the feet, palms, or under the nails. It often appears as a new, unusual-looking mole or a change in an existing mole.

What causes melanoma skin cancer?

Melanoma skin cancer is caused by DNA damage in the melanocytes, the cells responsible for producing melanin, the pigment that gives skin its colour. This DNA damage disrupts the normal control mechanisms that regulate cell growth and division. Under normal conditions, cells grow and divide in an orderly way, but when the DNA in melanocytes is damaged, it can lead to mutations that cause these cells to grow uncontrollably. These mutations often affect genes that regulate cell growth and survival, such as the BRAF gene, which is mutated in about half of all melanomas.

The accumulation of such genetic mutations allows the melanocytes to evade the body’s usual defences against uncontrolled cell proliferation, leading to the development of a malignant tumour. Over time, these cancerous cells can invade surrounding tissues and potentially spread to other parts of the body, a process known as metastasis. The exact cause of the DNA damage in melanoma is complex and can involve multiple genetic and environmental factors, but the core mechanism revolves around the disruption of normal cell cycle control due to mutations in the melanocytes’ DNA.

What are the symptoms of melanoma skin cancer?

The symptoms of melanoma skin cancer usually manifest as changes in the appearance of the skin, particularly in moles or new skin growths. Key signs to watch for can be summarised using the ABCDE rule:

Asymmetry: one half of the mole or skin lesion does not match the other half in shape.
Border: the edges of the mole are irregular, ragged, notched, or blurred, rather than smooth and well-defined.
Colour: there is a variety of colours within the mole, including shades of brown, black, tan, red, white, or blue. The presence of uneven colouration can be a warning sign.

Diameter: the mole is larger than 6 millimetres across (about the size of a pencil eraser), although melanomas can sometimes be smaller when first detected.
Evolving: the mole changes over time in size, shape, colour, or elevation. New symptoms such as itching, bleeding, or crusting can also be signs of melanoma.

In addition to these changes, melanoma may also present as a sore that doesn’t heal or as a dark streak under a nail. It can appear on any part of the body but is most commonly found on the trunk in men and on the legs in women. Detecting these symptoms early is crucial for effective treatment, so any suspicious changes in the skin should be examined by a healthcare professional.

Common symptoms of melanoma include moles or skin lesions that follow the ABCD rule: asymmetry, irregular borders, varied colours, and a diameter greater than 6mm.

Who is at risk of melanoma skin cancer in Singapore?

In Singapore, several groups of people are at a higher risk of developing melanoma skin cancer due to various factors, including genetic, environmental, and lifestyle influences. Although melanoma is less common in Asian populations compared to Caucasians, it still poses a significant risk, particularly for certain individuals.

Individuals with fair skin: those with lighter skin tones, especially individuals of Caucasian or mixed heritage, are at a higher risk because they have less melanin, which provides some protection against UV radiation.
People with a family history of melanoma: a family history of melanoma increases the likelihood of developing the disease, as certain genetic factors can be inherited that predispose someone to melanoma.
Individuals with a history of sunburns: severe sunburns, especially during childhood or adolescence, can significantly increase the risk of melanoma later in life, as UV radiation damages the DNA in skin cells.
People with numerous or atypical moles: having many moles or atypical moles (dysplastic nevi) can elevate the risk of melanoma. Atypical moles are more likely to turn cancerous over time.
Older adults: the risk of melanoma increases with age, which makes older adults more susceptible to this type of skin cancer. However, melanoma can occur at any age.
People with a weakened immune system: individuals with compromised immune systems, such as those who have undergone organ transplants or are on immunosuppressive medication, are at higher risk because their bodies are less able to repair DNA damage caused by UV exposure.
Frequent sun exposure or use of tanning beds: regular exposure to intense sunlight or artificial sources of UV radiation, like tanning beds, can significantly increase the risk of melanoma, even in those with darker skin tones.

In Singapore, where sunlight is strong year-round, understanding these risk factors is essential for early detection and prevention of melanoma, particularly for those who may be more vulnerable due to their skin type, personal history, or lifestyle.

How is melanoma skin cancer diagnosed?

At NC Tan Surgery, our healthcare team utilises a combination of advanced techniques and personalised approaches to ensure accurate diagnosis. Here’s how we go about diagnosing melanoma skin cancer:

Assessing medical and family history: the initial step will be assessing your medical and family history. Once our specialists have a thorough understanding of your background, and history, it will be easier for them to navigate the diagnostic steps, and eliminate any other non-melanoma possibilities.
Comprehensive skin examination: our specialist begins with a thorough skin examination, where our specialists will closely inspect any suspicious moles, lesions or regional lymph nodes that were drained from the affected skin areas.
Biopsy recommendation: if a lesion appears suspicious, a biopsy may be recommended to obtain a small sample of the skin tissue for further analysis. Our specialist often performs excisional biopsy, which involves removing the entire lesion, so as to obtain critical information to aid in the follow-up treatment.
Laboratory examination: the biopsy sample is sent to a laboratory where a pathologist examines the tissue under a microscope to detect cancerous cells.
Quick and accurate results: we prioritise delivering quick and accurate biopsy results to reduce patient anxiety and start treatment promptly if needed.
Personalised treatment plan: if melanoma skin cancer diagnosis is definitive, our specialist will recommend the most suitable treatment options, ensuring personalised care in accordance to each patient’s needs.

melanoma skin cancer diagnosis singapore

A thorough physical examination is essential in diagnosing melanoma skin cancer.

What are the treatment options for melanoma skin cancer in Singapore?

At NC Tan Surgery, we offer a range of treatment options for melanoma skin cancer, depending on the stage of the cancer, the size and location of the tumour, and the overall health of the patient. Our goal is to provide effective, personalised care that maximises the chances of a successful outcome. Here are the treatment options:

Surgical excision: the primary treatment for melanoma is surgical excision, where the melanoma is removed along with a margin of healthy tissue to ensure all cancerous cells are eliminated.
Sentinel lymph node biopsy: if the melanoma is at a certain thickness or has certain high-risk features, our doctors may recommend a sentinel lymph node biopsy to check if the cancer has spread to nearby lymph nodes. This helps them determine the best course of treatment.
Mohs Surgery: one of the highly effective treatment options for melanoma skin cancer is Mohs Surgery. During this procedure, the cancer is removed layer by layer, with each layer being examined under a microscope immediately. This process continues until no abnormal cells are detected, which helps ensure that the entire cancerous growth is fully excised while preserving as much healthy surrounding tissue as possible. Mohs Surgery is particularly beneficial for melanomas located in sensitive areas, such as the face, where maintaining function and appearance is crucial.
Reconstructive surgery: in some cases of melanoma skin cancer, particularly when the cancer is located in areas like the scalp, face, or neck, reconstructive surgery may be necessary following the removal of the cancerous tissue. This procedure is often done in the same setting as Mohs Surgery or surgical excision, especially when the skin defect is large or in a cosmetically sensitive area. Reconstructive surgery involves resurfacing and repairing the affected skin, which helps restore both the appearance and function of the treated area.
Immunotherapy: for advanced melanoma, immunotherapy may be recommended to boost the body’s immune system to fight the cancer. This treatment involves the use of medications that help the immune system recognise and attack melanoma cells more effectively.
Targeted therapy: if the melanoma has specific genetic mutations, such as a BRAF mutation, targeted therapy can be used. These medications specifically target the cancer cells’ mutations, slowing down or stopping their growth.
Radiation therapy: in some cases, radiation therapy may be recommended to target and kill any remaining cancer cells after surgery or to treat melanoma that has spread to other parts of the body.
Ongoing monitoring and follow-up: after treatment, our team will provide regular follow-up care, including skin exams and imaging tests, to monitor for any signs of recurrence and to ensure your long-term health.

At NC Tan Surgery, we work closely with each patient to develop a treatment plan that is specifically suited to their individual needs, which helps us ensure the best possible care at every stage of the journey.

If you are concerned about melanoma skin cancer or have been recently diagnosed, schedule a consultation with NC Tan Surgery today to discuss your treatment options.

Frequently Asked Questions

Can melanoma come back after treatment?

Yes, melanoma can recur even after successful treatment, especially if it was not detected early. Regular follow-up appointments and skin checks are essential to monitor for any signs of recurrence.

What should I do if I notice a new or changing mole?

If you notice a new mole or changes in an existing one, such as changes in size, shape, or colour, it’s important to schedule an appointment with a medical specialist immediately. Early evaluation can help determine if the mole is benign or requires further investigation.

How can I reduce my risk of melanoma?

To reduce your risk of melanoma, practice sun safety by wearing sunscreen, avoiding tanning beds, seeking shade, and wearing protective clothing. Regular self-examinations and annual skin checks by a dermatologist are also recommended.

Is melanoma always related to sun exposure?

While excessive UV exposure is a significant risk factor, melanoma can also develop in areas of the body not typically exposed to the sun, such as the soles of the feet, under the nails, or even in the eyes. Genetic factors can also play a role.

What is the prognosis for melanoma?

The prognosis for melanoma depends on the stage at which it is diagnosed. Early-stage melanomas have a high cure rate, especially when they are confined to the outer layers of the skin. Advanced melanomas that have spread to other parts of the body are more challenging to treat but can still be managed with therapies like immunotherapy or targeted therapy.

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