Malignant melanoma (black skin cancer)

and Martina Feichter, medical editor and biologist

Dr. med. Fabian Sinowatz is a freelancer in the medical editorial team.

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Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Black skin cancer (malignant melanoma) is an aggressive, very malignant skin tumor. Compared to other types of skin cancer, it spreads to other organs (metastases) relatively early. Malignant melanoma occurs most frequently between the ages of 45 and 60 years. However, younger people are also increasingly suffering from it. Read everything you need to know about malignant melanoma!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. D03C43

Malignant melanoma: symptoms

The earlier it is treated, the better the dangerous black skin cancer is curable. But how can you recognize malignant melanoma? It's not that easy, because black skin cancer is very diverse. Based on the appearance and the tissue (histological) characteristics, doctors differentiate between four main types of melanoma:

• Superficial spreading melanoma (approx. 60 percent of all melanoma cases)
• Nodular melanoma (approx. 20 percent of all melanoma cases)
• Lentigo maligna melanoma (approx. 10 percent of all melanoma cases)
• Acrolentiginous melanoma (approx. 5 percent of all melanoma cases)

The remaining approximately five percent of all melanoma diseases are less common:

• Amelanotic melanoma
• Mucosal melanoma
• Choroidal melanoma
• Unclassifiable malignant melanoma

To find out what the most common types of melanoma look like, see Skin cancer: symptoms.

Where does black skin cancer originate?

In men, black skin cancer very often forms on the torso (for example on the back), in women, on the other hand, more on the arms and legs. However, malignant melanoma can develop anywhere on the body, not just in sunlit areas. For example, the malignant skin tumor is sometimes found in the genital area, on the hairy scalp, on the soles of the feet or under a fingernail or toenail.

Malignant melanoma usually develops on previously inconspicuous skin. Newly created "dark spots" on the skin should therefore be closely monitored and, if in doubt, go to the dermatologist immediately.

Sometimes a malignant melanoma develops from areas of the skin that have already changed: Certain moles / birthmarks are more prone than others to turning into melanoma. There are also early forms of black skin cancer (melanoma in situ, lentigo maligna) that spread without treatment and become malignant melanoma.

The so-called ABCDE rule helps when assessing newly formed or already congenital skin spots.

Malignant melanoma: treatment

How a malignant melanoma is treated in individual cases depends, among other things, on the stage of the tumor. In all cases, however, the following applies: The tumor is completely surgically removed if possible, with a safety margin of one to two centimeters. This means that the surgeon cuts into healthy tissue so that as few cancer cells as possible are left behind.

In the early stages of black skin cancer, when the penetration depth is less than a millimeter, surgery may be sufficient treatment. This is the case in around two thirds of all melanomas. However, if the tumor has already penetrated the second layer of skin (dermis) and it can spread throughout the body, further (adjuvant) therapies follow in order to improve the chances of recovery. This can be, for example, radiation (radiation therapy). It is indicated if several lymph nodes are involved or if there are large lymph node metastases. The risk of a relapse can be reduced thanks to radiation.

Another treatment option for malignant melanoma is immunotherapy: After all visible cancerous growths have been surgically removed, the patient is given drugs that activate certain immune cells (killer cells) so that they eliminate cancer cells that are still present. For example, the active ingredient interferon-alpha can be injected (interferon therapy).

Another newer possibility of treating black skin cancer is targeted therapy: The patient receives drugs that specifically target the cancer cells. Healthy cells are spared, which is a major advantage over radiation therapy and chemotherapy (these do not differentiate between healthy cells and tumor cells). Targeted therapy is only possible if the cancer cells show certain genetic changes, which is the case in around 50 out of 100 melanomas.

Another treatment option is chemotherapy: It can be considered when immune or targeted therapies are out of the question because the patient does not respond to them.

You can read more about the therapeutic options for malignant melanoma under Skin Cancer: Treatment.

Black skin cancer: chances of a cure

Thanks to the improved early detection, the prognosis for malignant melanoma has improved significantly over the past few decades. Most of the time, black skin cancer is discovered at a very early stage today. It is then almost always curable. However, as the tumor grows and spreads, the chances of recovery decrease rapidly. If there are already metastases in the lungs, liver or brain, the prognosis for malignant melanoma is very poor.

In addition to the tumor stage, the type of black melanoma also influences the prognosis: some types of melanoma only grow superficially for a long time and are therefore usually easy to treat. Others are more dangerous because they quickly penetrate deeper tissue and spread through the body via blood and lymph vessels.

The chances of recovery from black skin cancer also depend on other factors, such as the patient's age and general health.

Black skin cancer: life expectancy

About two thirds of all melanomas are discovered early enough that they can be surgically removed and those affected are considered cured. Five years after being diagnosed with "black skin cancer", 93 percent of women and 91 percent of men are still alive. So much for the statistics. In individual cases, the life expectancy of a melanoma patient can be higher or lower. For example, if a malignant melanoma has already metastasized to the lungs or brain, the patient can die within months without treatment.

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