Types of Melanoma

Melanoma of the skin can be classified according to various types, which tend to occur on specific sites of the body:

• Superficial (spreading) melanoma: the most common subtype, especially in younger people (less than age 50) and those with a lot of moles
• Nodular melanoma: often presents an elevated bump on the skin that may be  pink or brown and tends to grow and bleed
• Lentigo maligna melanoma: often seen in older people (> age 60) on chronically sun-exposed sites of the head (the scalp, face), neck, and arms
• Acral lentiginous melanoma: the most common subtype in darker-skinned people, who are at lower risk of more sun-related melanoma, occuring on the palms of the hands, soles of the feet, or beneath the fingernails or toenails
• Ocular melanoma: a rare subtype that develops in the eyes

Genetic subtypes of melanoma
Stanford has a specialized Skin Cancer Genetics clinic that evaluates individuals who may have a genetic predisposition to melanoma and other cancers. Based on your risk factors and family history, your doctor will discuss whether a referral to this clinic is recommended. In the setting of advanced (metastatic) melanoma, genetic tests are performed find specific gene mutations in melanoma cells. This information can be used to decide whether therapies that target these mutations can be used to fight the melanoma.

Melanoma is staged according to whether it involves the skin, the regional lymph nodes nearby the initial skin site, or other sites of the body. Melanoma has 3 major categories:

• Confined to the skin (cutaneous melanoma): About 80 percent of new melanoma patients come to the doctor with melanoma confined to the skin. For thin melanomas that do no involve regional lymph nodes, outpatient surgery is performed and results in high rates of cure.
• Melanoma involving the regional lymph nodes: Regional lymph node spread is most often detected with the sentinel lymph node biopsy performed at the time of wide local excision of melanoma on the skin. Newer targeted therapies and immunotherapies can be given in the adjuvant setting (after surgery) to promote cure.
• Advanced (metastatic) melanoma: Melanoma may spread to beyond the nearby lymph nodes to more distant parts of the body, including the lungs, liver, or brain. Treatment may include immunotherapy, targeted therapy with drugs that target certain mutations in a person’s melanoma, surgery and/or radiation therapy. Clinical trials are available for patients with metastatic melanoma.