About Melanoma
Melanoma is a personal journey, different for every patient and every friend or family member. It’s a personal disease, with different causes, symptoms, courses of progression, treatments and prognosis. It’s useful to know about the disease as you make your own personal journey with melanoma.
What Is Melanoma?
Melanoma is a type of skin cancer most commonly caused by damage to the DNA in a certain type of skin cells called melanocytes, often due to exposure to ultraviolet light.
This damage can cause skin cells to form cancerous tumours, but if caught early it is almost always curable. However, if left untreated, melanoma can spread, or metastasize, to other parts of the body – such as the brain, bones, liver, and lungs.
When melanoma cannot be fully removed by surgery (stage III unresectable), or has metastasized (stage IV), it is known as advanced melanoma and is the most serious form of skin cancer. Until recently, advanced melanoma was a disease with limited treatment options and a poor prognosis. In the last few years, however, significant advances in the molecular understanding of this disease have allowed the development of novel and promising treatments. However, advanced melanoma can still be much more difficult to treat than melanoma that remains localized.
Canadian Facts and Figures
- Melanoma is one of the top 10 cancers diagnosed in Canada, accounting for 3% of all new cancer diagnoses.
- It was estimated that 6,800 Canadians were diagnosed with melanoma in 2015. That’s an average of more than 18 Canadians diagnosed with melanoma every day.
- It is estimated that in 2015, 1,150 Canadians died from their melanoma.
- In Canada, the incidence of melanoma has been increasing significantly over the past several decades. From 2001 to 2010, the incidence of melanoma increased 2.3% per year for men and 2.9% per year for women.
The Stages of Melanoma
Dr. Mihalcioiu explains the different stages of melanoma.
Melanoma, like many cancers, is characterized into 4 main cancer stages Melanoma staging is based on the thickness of the cancerous tumour in the skin and whether and how far it has spread. Determining the stage of melanoma can include physical exams and biopsies, as well as imaging tests such as CT or MRI scans. The 4 main stages of melanoma are:



Resectable (removable) melanomas are cancerous tumours that have spread to lymph nodes, but can still be removed by surgery. There is no distant spread.

Unresectable (unremovable) melanomas are cancerous tumours that have spread beyond the skin to the lymph nodes, and surgery may not be able to remove all of the cancer. There is no distant spread.

Patients with unresectable Stage III melanoma and Stage IV (metastatic) melanoma are considered to have advanced melanoma.
Despite these staging definitions, not all melanoma cases are the same. Patients may have different genetic changes present in their tumour, also called mutations, making their disease uniquely personal.
Mutations in Advanced Melanoma : Not A “One Size Fits All” Disease
Advanced melanoma (unresectable or metastatic melanoma) varies from person to person due to changes in the genes that are unique to each person with the disease.
In fact, melanoma is one of the cancers with the highest frequency of mutations. There are several melanoma mutations that you can be tested for, and identifying your form may influence the choice of treatment to help you control this disease.
Mutations in Advanced Melanoma (Unresectable or Metastatic)



c-KIT –The c-KIT mutation can vary based on ethnicity. These mutations have been found in about 6%-7% of advanced melanoma in Caucasians, but are more common in Asian populations. c-KIT mutations are more likely to be found in melanomas that start on the palms of the hands, soles of the feet, under the nails, inside the mouth or nose or other mucosal areas and in areas that get regular sun exposure.

If a gene test was conducted, and no mutation was detected, the tumor may be referred to as "wild-type." Wild-type means that no specific gene mutation was identified in the melanoma tumor.
When it comes to advanced melanoma (unresectable or metastatic), knowledge is powerful. A genetic test can help identify if the tumour has a mutation. Genetic tests are performed on a sample of the tumour that has been removed by your doctor (also known as a biopsy).
Testing and Treatment
Over the past 40 years, research has significantly improved our understanding of advanced melanoma regarding the molecular and genetic changes of a person’s tumour. New diagnostic tools and treatment options are now available in the fight against advanced melanoma, but the battle continues.
One major advance has been specific genetic tests, which health care professionals can use to detect mutations and screen patients to assess their likelihood of responding to therapies. Until recently, advanced melanoma was a disease with limited treatment options and a poor prognosis. In the last few years, however, significant advances in the molecular understanding of this disease have allowed the development of novel and promising treatments.
Besides treatments that have generally been given a broad range of patients, there are now some specific therapy options to treat advanced melanoma in patients with certain genetic changes (mutations) in their tumour, but physicians must first identify if a mutation is present and which form it may be.
There are many different types of genetic tests available. Some tests can only detect the most common mutations while others are more sensitive and can detect additional, less common forms. BRAF testing can be done with tissue obtained from a sample, or biopsy, from the tumour.
Melanoma treatment guidelines recommend testing for patients with advanced melanoma in order to identify whether genetic changes (mutations) are present in the tumour. Identifying the form of your advanced melanoma is an important step to developing a personalized treatment plan with your doctor. Treatment selection is based on a range of factors including stage of disease, overall health and lifestyle.
Treatment options may include:





NOTE: This is not a complete list of side effects associated with the above types of treatment and others may occur. In addition, the side effects discussed may not apply to all treatments.