Definition and characteristics
Melanoma is a type of skin cancer.1 In healthy skin, sun exposure causes cells below the surface called melanocytes to produce a pigment called melanin, which spreads across the exposed skin to form a tan. Suntan acts as a shield against harmful ultraviolet (UV) radiation from the sun. When melanocytes are exposed to too much UV radiation, the DNA that programs them to produce melanin pigment becomes damaged. This causes melanocytes to start mutating. If your skin is unprotected from the sun for a prolonged period, melanomas can form where melanin pigment has clustered and spreads as cancerous cells. This is known as more common in fairer-skinned individuals, whose melanocytes are less active; however, it is important to note that individuals of all skin types are susceptible to melanoma.2
Prevalence, types, and contributing factors
A global study published in 2020 estimated 325,000 cases of melanoma skin cancer and 57,000 related deaths that year, more common in males than females.3 As rates of skin cancer increase, the number of cases is forecasted to increase by up to half by 2040, as the chart below shows.3
Image source: Arnold M et al., 2022
The study found the highest rates of melanoma in Australia and New Zealand, followed by Western Europe and North America, with the lowest rates seen in Asian and African countries.
Melanoma can form anywhere on the skin, and there are four main types, shown in the infographic below:4
Image source: Parr-Reid, S. BioRender.
Melanoma skin cancer spreads more easily than other skin cancers.5 If melanoma spreads downwards, it may reach the bloodstream or lymph nodes in the immune system and move to other organs, known as metastasis.6 So, spotting the signs as early as possible is vital. With the types of melanoma skin cancer in mind, six key risk factors can increase the likelihood of a melanoma diagnosis:7
- Poor access to information regarding melanoma
- Family history of melanoma
- Excessive sunlight or outdoor time
- Transplant, blood cancer or immune suppression
- Red hair, fair skin, blue eyes and freckles
- Atypical mole syndrome
Image source: Parr-Reid, S. Canva
Sun protection measures
Seeking shade and avoiding peak sun hours
The simplest way to avoid skin damage from the sun is to limit the time you’re exposed to it. This applies all year round, as your skin can be exposed to UV rays known as UV-A and UV-B at any time of year, not just in the summer.7 For example, UV rays can reflect from surfaces such as water and snow. Most weather apps and websites give a UV rating, so if the UV rating is three or higher, you must limit time in the sun. Peak UV ratings are usually 9 am– 4 pm.
Wearing protective clothing and accessories
Umbrellas and parasols provide great sun protection. Long-sleeved shirts and long trousers or skirts help cover your body. The tighter fabric gives better protection, as does darker clothing. Hats are not only a great fashion accessory, but they help to cover your ears and forehead, areas that are more easily burnt. Just make sure the hat doesn’t have holes in it, for example, a straw hat.
Applying sun cream properly and regularly
When buying sun cream, it is easy to get lost in all the brands and numbers. Simply put, you want to block as many different types of UV from reaching your skin as possible, so using broad-spectrum creams is best, as these block both UV-B and UV-A radiation. Check the packaging to see if the cream is broad-spectrum. You may be used to hearing the abbreviation SPF, which stands for sun-protection factor. This is the ability of the cream to filter out UV radiation; the higher the SPF, the more UV it filters out. It is recommended that you use at least two tablespoons of sun cream at SPF 15 or higher, reapplying it after activities like swimming or physical activity that makes you sweat. As a rule, if you are in the sun for two hours or more, reapply your sun cream.
Sun cream is only effective for three years before it should be disposed of. It is best stored in cool places for freshness.
Self-examination and early detection
Conducting regular skin self-examinations
The more you check your skin, the more likely you are to catch skin cancer early when it is more treatable. You could do this whilst getting ready in the morning or before bed.
It’s recommended you check your skin once per month.10 It could just save your life!
All you need is a full-length mirror and a hand-held mirror.11 Take 10 with this step-by-step video to check your skin.
Recognizing ABCDEs of melanoma detection
Melanoma skin cancers are typically seen on or near moles – small and raised brown or flesh-colored patches of skin that form when clusters of melanocytes grow together.12 Moles differ from freckles, as freckles are not raised and form in healthy skin from a normal number of melanocytes. You can see if your skin is healthy using the ABCDE method:13
Image source: Collantes J and Marshall, E. BioRender.
Seeking professional advice for suspicious moles
If in doubt, ask! Whilst it’s recommended that you visit your physician once every year for a skin exam, you can note anything suspicious during your skin self-examination to take to your healthcare provider. Ask to be referred to a skin specialist, called a dermatologist, for advice and support.
If you think you may have an unusual mole or area of skin and are worried about speaking to a specialist, it can help to take a friend or family member for support.
Avoiding indoor tanning
Risks associated with indoor tanning
Indoor or artificial tanning may include using a sunbed, where a person lies on their back or front in a rectangular electronic bed that produces mainly UV-A radiation and some UV-B radiation.14 This is often done to improve appearance or perceived health benefits such as increased vitamin D or acne treatment, which are unproven.15 The World Health Organisation’s International Agency for Research on Cancer classified sunbeds as a carcinogen, meaning using them significantly increases your risk of a range of skin cancers, including melanoma.
Promoting alternative tanning options
Tanning is seen as desirable. For some, it doesn’t come naturally due to having fairer skin and a lighter complexion. Thankfully, there are alternative tanning methods that don’t put your health at risk. Many supermarkets and pharmacies sell self-tanning kits such as lotions, gels, sprays, and bronzers.16 These are applied with a cloth or pad to the outer surface of the skin called the epidermis. They contain an ingredient called dihydroxyacetone (DHA), a plant sugar that reacts with the building blocks of skin proteins in the outer epidermis to form a tan-colored compound. DHA is resistant to water, soap, and sweat. The tan will eventually fade due to the normal shedding of dead skin cells called exfoliation, gradually carrying the tan color with them.
Healthy lifestyle practices
Balanced diet, hydration, and physical activity
Sun exposure is just one piece of the puzzle when it comes to skin health. Three other puzzle pieces are diet, physical activity, and hydration.
Some studies have suggested that eating lots of red meat may increase the risk of melanoma, as they contain compounds that trigger suppression of the immune system, making it harder to fight cancers.17 Scientists are not yet clear on the effects of antioxidants such as vitamins C and E from fruits and vegetables on melanoma risk, as evidence is mixed.18,19 Foods containing omega-3 fatty acids, such as fish and nuts, may protect against melanoma skin cancer, but there is no definitive evidence.20
Regular moderate physical activity is thought to be protective against melanoma skin cancer and other cancers, as it can help relieve oxidative stress, a process whereby lots of unstable DNA-damaging oxygen by-products known as reactive oxygen species (ROS) form when our cells respire.21,22 Moderate exercise promotes the removal of ROS in our skeletal muscles, heart, and liver.23 This should be accompanied by drinking plenty of water, especially on hot days.
Ask your healthcare provider if you have any questions relating to diet, hydration, physical activity, and melanoma, as they will be able to debunk any myths. The World Cancer Research Fund’s 2019 report on diet, nutrition, physical activity, and skin cancer summarises some key facts and myths about diet and lifestyle and skin cancer:24
- Myth: consuming coffee might increase the risk of melanoma in women
- Fact: drinking water containing arsenic metal from rocks or soil raises the risk of skin cancers
- Myth: drinking alcoholic beverages increases the risk of melanoma
- Fact: being tall increases the risk of melanoma
Avoiding smoking and excessive alcohol
Too much alcohol consumption and cigarette smoking are linked to poor health outcomes, such as many other cancers, heart disease, strokes, and early mortality, so they are not recommended.25–27 Some alcohols are considered more harmful than others; for example, there is thought to be a correlation between white wine and liquor consumption and melanoma skin cancer risk.19 This is believed to be because when these alcohols are digested in the body, more of a chemical called acetaldehyde is produced than other alcohols, which can damage DNA in cells such as in the skin, causing them to be more sensitive to sunlight. However, this theory is not supported, with scientists still trying to understand how these types of alcohol increase the risk of melanoma.
As well as being linked to many health conditions, some studies have suggested that past smoking may lead to poorer survival outcomes for melanoma skin cancer.28 Those that persistently smoke are thought to be 1.8 times more likely to die from melanoma, and former smokers are considered 1.75 times as likely to die from melanoma than those who haven’t smoked at all.
If you are concerned, speak to your healthcare provider about your current and previous alcohol consumption and smoking habits to receive tailored advice for your health needs.
Education and Awareness
Promoting sun safety in Schools and Workplaces
Staying safe in the sun starts when you are young; schools are a great place to disseminate information on skin health and skin cancer prevention, as this infographic shows:7
Image source: Parr-Reid, S. Canva.
Here is a great example of a skin safety program that can be used in schools.
You spend a lot of time at work, so it’s important to look after your skin, especially when working outdoors. Simple ways to protect from skin cancers such as melanoma in the workplace include:7
Image source: Parr-Reid, S. Canva.
Here is a great example of an informative resource for skin safety in the workplace.
Engaging in public campaigns
Public health campaigns are a great way to empower collective action to support health and well-being. If you’re keen to support a melanoma skin cancer prevention public health campaign, here are some great examples. You might even want to start your own!
- Melanoma UK’s ‘National Melanoma Hunt’
- American Academy of Dermatology’s ‘Spot Skin Cancer
- Euromelanoma’s annual campaign
Melanoma is a skin cancer involving damage to melanocytes, cells that cause skin pigmentation. Melanoma is more common in those with fair skin and associated features and is caused by overexposure to UV radiation, particularly UV-A. Melanoma can be prevented through regular skin safety practices such as sun cream application and reapplication, shade seeking, covering up, and sunless tanning practices. These prevention methods are advised in public spaces such as schools and workplaces where collective action such as skin safety programs.Self-examinations of your skin once per month and yearly dermatologist visits are recommended to catch melanoma skin cancer early.
- Cancer Research UK. What is melanoma? [Internet]. [cited 2023 Jun 20]. Available from: https://www.cancerresearchuk.org/about-cancer/melanoma/about
- Cancer Research UK. Risks and causes of melanoma [Internet]. [cited 2023 Jun 20]. Available from: https://www.cancerresearchuk.org/about-cancer/melanoma/risks-causes
- Arnold M, Singh D, Laversanne M, Vignat J, Vaccarella S, Meheus F, et al. Global burden of cutaneous melanoma in 2020 and projections to 2040. JAMA Dermatology. 2022 May 1 [cited 2023 Jun 20];158(5):495–503. Available from: https://doi.org/10.1001/jamadermatol.2022.0160
- Cancer Research UK. Types of Melanoma [Internet]. [cited 2023 Jun 20]. Available from: https://www.cancerresearchuk.org/about-cancer/melanoma/stages-types/types
- Serrao EM, Costa AM, Ferreira S, McMorran V, Cargill E, Hough C, et al. The different faces of metastatic melanoma in the gastrointestinal tract. Insights into Imaging. 2022;13(1). Available from: https://doi.org/10.1186/s13244-022-01294-5
- Macmillan Cancer Support. Advanced melanoma [Internet]. [cited 2023 Jun 20]. Available from: https://www.macmillan.org.uk/cancer-information-and-support/melanoma/advanced-melanoma
- Heistein JB, Acharya U, Mukkamalla SKR. Malignant melanoma. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470409/
- British Association of Dermatology. Atypical mole syndrome [Internet]. [cited 2023 Jun 20]. Available from: https://www.bad.org.uk/pils/atypical-mole-syndrome/
- Centers for Disease Control and Prevention. Sun safety [Internet]. 2023 [cited 2023 Jun 20]. Available from: https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm
- Melanoma UK. Skin self examination [Internet]. 2016 [cited 2023 Jun 20]. Available from: https://www.melanomauk.org.uk/skin-self-examination
- American Academy of Dermatology. Find skin cancer: How to perform a skin self-exam [Internet]. [cited 2023 Jun 20]. Available from: https://www.aad.org/public/diseases/skin-cancer/find/check-skin
- Cancer Council. What are moles? [Internet]. [cited 2023 Jun 20]. Available from: https://www.cancer.org.au/cancer-information/causes-and-prevention/moles
- American Academy of Dermatology. What to look for: ABCDEs of melanoma [Internet]. [cited 2023 Jun 20]. Available from: https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes
- Calzavara-Pinton PG, Arisi M, Wolf P. Sunbeds and carcinogenesis: the need for new regulations and restrictions in Europe from the Euromelanoma perspective. J Eur Acad Dermatol Venereol. 2019 Mar [cited 2023 Jun 20];33:104–9. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jdv.15314
- Dessinioti C, Stratigos AJ. An epidemiological update on indoor tanning and the risk of skin cancers. Curr Oncol. 2022 Nov 17 [cited 2023 Jun 20];29(11):8886–903. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689757/
- Garone M, Howard J, Fabrikant J. A review of common tanning methods. J Clin Aesthet Dermatol. 2015 Feb [cited 2023 Jun 20];8(2):43–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345932/
- Gould Rothberg BE, Bulloch KJ, Fine JA, Barnhill RL, Berwick M. Red meat and fruit intake is prognostic among patients with localized cutaneous melanomas more than 1 mm thick. Cancer Epidemiol. 2014 Oct [cited 2023 Jun 20];38(5):599–607. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229370/
- Godic A, Poljšak B, Adamic M, Dahmane R. The role of antioxidants in skin cancer prevention and treatment. Oxid Med Cell Longev. 2014 [cited 2023 Jun 20];2014:860479. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984781/
- Minokawa Y, Sawada Y, Nakamura M. The influences of omega-3 polyunsaturated fatty acids on the development of skin cancers. Diagnostics (Basel). 2021 Nov 19 [cited 2023 Jun 20];11(11):2149. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8620049/
- Asian pacific journal of cancer prevention. Oxidative Stress and Skin Diseases: Possible Role of Physical Activity. [cited 2023 Jun 20]. Available from: https://journal.waocp.org/?sid=Entrez:PubMed&id=pmid:24568458&key=2014.15.2.561
- Shields HJ, Traa A, Van Raamsdonk JM. Beneficial and detrimental effects of reactive oxygen species on lifespan: a comprehensive review of comparative and experimental studies. Frontiers in Cell and Developmental Biology. 2021 [cited 2023 Jun 20];9. Available from: https://www.frontiersin.org/articles/10.3389/fcell.2021.628157
- Ji LL, Leeuwenburgh C, Leichtweis S, Gore M, Fiebig R, Hollander J, et al. Oxidative stress and aging: role of exercise and its influences on antioxidant systems. Annals NY Acad Sci. 1998 Nov [cited 2023 Jun 20];854(1 TOWARDS PROLO):102–17. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1998.tb09896.x
- Miura K, Green AC. Dietary antioxidants and melanoma: evidence from cohort and intervention studies. Nutrition and Cancer. 2015 Aug 18 [cited 2023 Jun 20];67(6):867–76. Available from: http://www.tandfonline.com/doi/full/10.1080/01635581.2015.1053499
- World Cancer Research Fund. What causes skin cancer? [Internet]. [cited 2023 Jun 20]. Available from: https://www.wcrf.org/diet-activity-and-cancer/cancer-types/skin-cancer/
- Centers for Disease Control and Prevention. Health effects of smoking and tobacco use [Internet]. 2022 [cited 2023 Jun 20]. Available from: https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm
- Global status report on alcohol and health 2018. Switzerland. World Health Organization; 2019.
- Pellegrini M, D’Eusebio C, Ponzo V, Tonella L, Finocchiaro C, Fierro MT, et al. Nutritional interventions for patients with melanoma: from prevention to therapy—an update. Nutrients. 2021 Nov 11 [cited 2023 Jun 20];13(11):4018. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624488/
- Mattila K, Vihinen H, Karlsson A, Minn H, Vihinen P, Heervä E. Smoking is an independent marker of poor prognosis in cutaneous melanoma. Acta Dermato-Venereologica. 2023 Feb 7 [cited 2023 Jun 20];103:adv00860–adv00860. Available from: https://medicaljournalssweden.se/actadv/article/view/3209