To increase everyone’s awareness and understanding of melanoma, since 2019 we have worked in partnership with Melanoma UK to develop the ‘Melanoma: Let’s Get Under The Skin Of It’ campaign. The campaign has been developed by Novartis Pharmaceuticals UK Limited and reviewed and endorsed by Melanoma UK.
This is a campaign which aims to encourage people diagnosed with melanoma, their loved ones, their partners and carers to learn more about melanoma.
We hope that the Melanoma: Let’s get under the skin of it campaign will give people diagnosed with melanoma the confidence and support they need to speak to their doctor about their skin cancer, what gene mutations they have, and their BRAF status.
By providing the whole skin cancer community with more information, Melanoma: Let’s get under the skin of it will encourage us all to ask questions, and understand more about each personal diagnosis, and to ensure patients receive the right treatment.
Below you'll find helpful information that will support people with melanoma on their treatment journey.
If you would like further information about melanoma BRAF awareness day then click here.
If you get side-effects with any medication you are taking, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the information leaflet that comes in the pack. You can report side effects via the Yellow Card Scheme at https://yellowcard.mhra.gov.uk/ (UK). By reporting side effects you can help provide more information on the safety of your medication.
Understanding your melanoma diagnosis is the first step toward finding the right treatment. This section features useful information and downloadable resources to help you build a better understanding of your melanoma type and treatment.
Understanding Melanoma guide
We’ve created this guide to help you gain a better understanding of melanoma skin cancer. It features key facts, information about melanoma stages, appropriate treatment options, a glossary of terms and much more. This content is free to download for your learning and reference.
This infographic features the latest facts, statistics and information about melanoma. This content is free to download for your learning and reference.
What is melanoma?
Where do you get melanoma?
Melanomas can occur anywhere on the body but are often found on the chest and legs. The most common sign of melanoma involves the appearance of a new mole. However, in approximately 30% of cases, they appear on the site of existing moles.3
How many people get melanoma?
Melanoma is the fifth most common cancer in the UK, with over 40 cases diagnosed every day.4 The incidence of melanoma has risen dramatically over recent years, especially in younger people. In fact, melanoma is one of the most common cancers in people aged 15-34 in the UK.5
How serious is melanoma?
Melanoma is the most serious form of skin cancer because of its ability to spread to other organs more rapidly if it is not treated at an early stage.6
Can you recover from melanoma?
Melanoma skin cancer survival is improving and has doubled in the last 40 years in the UK.4 If detected early, melanoma is almost always treatable. Nine out of 10 people diagnosed with melanoma skin cancer in England and Wales survive their disease for 10 years or more.4
How do you get melanoma?
A person’s risk of developing melanoma depends on many factors, including age, genetics and exposure to risk factors (including some potentially avoidable lifestyle factors).7
How to find out if you have a melanoma
About half of all melanomas start with a change in previously normal-looking skin. This usually looks like a dark area or an abnormal new mole. Other melanomas develop from a mole or freckle that you may already have.8
Different ways of testing for melanoma
There are several types of further tests to help stage a disease, though you might only need one or two tests.9
CT scan: CT stands for computerised tomography. CT scans take X-ray pictures of your body to find out where the melanoma is and whether it has spread.10
PET-CT scan: A PET-CT scan combines a CT scan and a positron emission tomography (PET) scan. The CT scan takes a series of x-rays from all around your body. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal and gives detailed information about your melanoma.11
MRI scan: MRI stands for magnetic resonance imaging. It produces pictures from angles all around the body and shows up soft tissues very clearly. It can show up abnormal areas in the lymph nodes or other parts of the body.12
Lymph node ultrasound and biopsy: This test can help determine whether the melanoma has spread from the skin to the lymph nodes. Ultrasound scans use high frequency sound waves to create a picture of a part of the body. If the lymph nodes look abnormal, doctors (radiologists) use the ultrasound to help guide them as they take samples of cells or tissue.13
Sentinel lymph node biopsy: The most common place that melanoma skin cancer spreads to is the nearby lymph nodes. Your specialist might offer you a sentinel lymph node biopsy, if your melanoma is deeper than 1mm (stage 1B to 2C). This is a test to find the first lymph node or nodes that a melanoma may have spread to, and then check for cancer cells.14
Blood tests: Blood samples may be taken to check your general health, including how well your liver and kidneys are working, as well as check numbers of blood cells.15
The different stages of melanoma
The stage of a cancer is a term used to describe its size and depth of the melanoma (how deep in goes into the skin), and whether it has spread. Knowing the stage of a melanoma helps doctors choose the right treatment option.16
Melanomas are divided into four number stages according to the Breslow thickness, which states to what depth in millimetres (mm) tumour cells are present at the time of surgical excision. Below is a simple summary of the stages.16
You can learn more about each melanoma stage in the table below.
Stage 0 (otherwise known as 'in-situ')
Cancer cells are only located in the top layer of skin. Melanoma cells are contained in the area in which they started to develop and have not grown into deeper layers of the skin.16
Melanoma is only in the skin and no more than 2mm thick. There is no sign that it has spread to lymph nodes or other parts of the body. It may or may not be ulcerated.16
Melanoma is only in the skin, between 1 and 4 mm thick and may be ulcerated. There is no sign that it has spread to lymph nodes or other parts of the body.16
Melanoma that has spread to the lymphatic vessels or lymph nodes closest to the melanoma but not anywhere else in the body.16
Stage 4 (otherwise known as 'metastatic' or 'advanced')
Melanoma that has spread to distant areas of the skin, distant lymph nodes or that has spread to other organs such as the lungs, liver, bones or brain. This is called advanced or metastatic melanoma.16
Gene mutations in melanoma
Sometimes, changes occur within the DNA of melanoma cells. These changes are called ‘mutations’. Mutations can play a role in the progression of melanoma (how it grows).
Understanding the BRAF mutation
Is all melanoma the same? Multiple gene mutations can play a role in the progression of melanoma.
The three most common gene mutations involved in melanoma are BRAF, NRAS and c-KIT.17
The BRAF mutation is most common; 40-50% of melanoma patients have it.18 It causes an overactive BRAF protein to be produced which causes cells to grow and divide too fast.19
This guide focuses on BRAF gene mutations in people with melanoma. It describes in detail what a BRAF gene mutation is and who should be tested, with facts about melanoma and therapy options. This content is free to download for your learning and reference.
How is the BRAF mutation gene tested for?
Your doctor will collect a small biopsy from your melanoma or some cells from your lymph nodes to send to a laboratory.20
A pathologist at the laboratory will test your melanoma cells to see if they are BRAF positive or negative and send a report to your doctor.21
Your doctor will review the report and let you know if your melanoma is BRAF positive or not.
In melanoma, the only mutation for which targeted therapy is available is the BRAF gene. Drugs that target mutations in the BRAF gene are called BRAF inhibitors.
Over recent years there have been many advances in treatments for melanoma. Depending on the stage of melanoma there are now a range of treatment options available, meaning people have more flexibility when it comes to finding the right treatment option to suit their lifestyle.
This section aims to help patients understand their options so they can make informed decisions in partnership with their healthcare professional and find the treatment most effective for them and their melanoma.
Your doctor will work with you to develop a personalised approach that is specific for your needs and your type of melanoma. Talk to your doctor who will explain these various considerations so that you understand what each option will mean for you. The important thing is to learn as much as you can about each option and discuss them with members of your care team.
The main factors that will affect your treatment options are22:
Stage and depth of melanoma
Whether the cancer has spread
Rate of melanoma growth
Genetic changes in the melanoma
Your overall health
Factors related to lifestyle such as travelling, work and having children, as well as the distance to hospital and carer support, etc. should also be taken into consideration when choosing an appropriate treatment option.
Melanoma treatment options by stage23
Stage according to Breslow thickness16
Surgery is the main treatment. Doctors remove the abnormal mole or patch of skin and a small area of surrounding skin. You may need a second operation to remove a larger area of healthy tissue around where the melanoma in situ was. This is called a wide local excision. If your doctors are sure they removed enough tissue, this is all the treatment you need.
Surgery can cause scarring and some people may not be well enough to have an operation. As an alternative, you might have treatment with an immune response modifying cream which you apply on the affected area.
Surgery is the main treatment. Doctors remove the abnormal mole and a small area of surrounding skin. You usually have a second operation to remove a larger area of healthy tissue around where the melanoma in situ was. This is called a wide local excision.
For stage 1A melanoma, if your doctors are sure that they removed enough tissue, this is all the treatment you need.
For stage 1B and stage 2 melanoma, your doctor might offer you a test to check your lymph nodes. You can choose whether to have this test. The test is called a sentinel lymph node biopsy and you usually have it under a general anaesthetic.
Stage 2 or 3
You will have surgery to remove the melanoma. Then you have a wide local excision to remove more tissue in the area where the melanoma was.
Your doctor might offer you a test to check your lymph nodes.
You can choose whether to have this test. The test is called a sentinel lymph node biopsy and you usually have it under a general anaesthetic.
If your melanoma has spread to the lymph nodes, you might need a lymph node dissection. This is surgery to remove all the lymph nodes in the area near the melanoma.
For stage 3B or 3C melanoma, your doctor might offer you radiotherapy to the area where the surgeon removed the lymph nodes.
Stage 3 patients who have undergone resection may also be offered adjuvant therapy, which may include targeted therapy or immunotherapy.
Your doctor might also offer you the option of taking part in a clinical trial.
If surgery is not suitable for you, you might have one of the following:
chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
chemotherapy combined with an electric current (electrochemotherapy)
laser treatment using a carbon dioxide laser
cream to put on the skin (such as an immune response modifying cream)
immunotherapy (stage 3)
targeted therapy (stage 3)
You might have one or more of the following treatments:
You might have your treatment as part of a clinical trial.
Therapies for advanced melanoma
Physicians often recommend adjuvant therapy for patients with an advanced form of melanoma with involvement of lymph nodes or patients with metastatic disease who have undergone complete resection. Adjuvant therapy is the additional treatment given after the primary treatment for melanoma, usually surgery. The goal of adjuvant therapy is to try to reduce the risk of melanoma returning.24
There are two types of drugs used to treat advanced melanoma: targeted therapies and immunotherapies.
Your doctor may decide to treat you with one of these treatments before changing to another. Studies have not established which order of drug treatments is the most effective.
The table below summarises how both types of therapies work and their efficacy in treating advanced melanoma, as well as how they are taken and any potential side effects.
Targeted therapies at a glance
Immunotherapies at a glance
How do they work?
A BRAF mutation causes melanoma cells to grow and spread. Targeted therapies can be used to target this mutation to slow or stop cancer cells growing.25
BRAF inhibitors (drugs that work to stop BRAF mutations from causing tumours to spread further) were developed specifically to treat melanomas that have the BRAF mutation.
By stimulating different parts of the immune system to create either a general or specific response.
This response helps the patients immune cells attack melanoma cells to keep them from spreading, which can often shrink tumours.25
How effective are they?
Targeted therapies have been shown to shrink tumours in people with advanced melanoma with a BRAF mutation.
Immunotherapies have been shown to shrink tumours in both BRAF- positive and BRAF wild-type advanced melanomas.
There are a number of different types of immunotherapies available, each have different approaches and different effects.
CTLA-4 inhibitors and PD-1 inhibitors are two examples.
How do you take them
Targeted therapies may be taken alone or in combination with other targeted therapies.
They are often oral therapies that can be taken at home.
They often must be given as an intravenous (IV) infusion every few weeks at a medical centre.
Are there any side effects?
Just as there are with any kind of treatment, there are side- effects related to targeted therapies, with the symptoms dependent on the particular medicine your doctor prescribes you. If you experience severe side effects, therapy may need to be interrupted or stopped completely.
Just like with any kind of treatment, there are specific side effects that come with the use of immunotherapy. In some cases, immunotherapy can cause the body to develop an immune reaction against its own tissues. When this happens, therapy may need to be interrupted or stopped completely.
After your treatment, you will have regular follow-up appointments to check if:
There are signs of the melanoma returning
The melanoma has spread to any of your lymph nodes or other areas of the body
Living with melanoma
Patient Consultation Guide and Checklist
This consultation guide and checklist has been designed so you can get the most out of appointments with your healthcare professional. It provides advice on how to share the right information with your doctor, so you receive a treatment option that fits in with your lifestyle, as well as things to consider before, during and after your appointment. We recommend downloading and printing this guide and bringing it along to your appointments.
Supporting people living with melanoma
At Novartis, we’re committed to developing medicines to effectively treat stage 3 and 4 melanoma. We work together with patient advocacy groups to ensure patients are informed and kept up to date with the latest melanoma treatment and disease information.
Some of our work includes supporting patients by developing information leaflets, videos, animations and educational support to help them understand melanoma. We collaborate with patient advocacy groups to identify attitudes and opinions of patients and carers in relation to treatments and care.
Work with healthcare professionals
As well as furthering scientific research, we work together with the medical community. Some of our work includes:
Working to improve the understanding of the medical community and keeping them up to date with disease area and treatment knowledge
Working in partnership to further scientific knowledge, with organisations such as Melanoma Focus and NHS trusts
Partnering with the NHS to help improve melanoma services to patients