Understanding Melanoma
- Former Miss Universe, mom of two, and Puerto Rican model Dayanara Torres is looking back on her battle with stage three melanoma, a dangerous type of skin cancer she hopes others will check their skin for.
- The actress beat the disease after getting a cancerous mole and affected lymph nodes surgically removed, followed by radiation therapy and immunotherapy.
- Melanoma is the most dangerous form of skin cancer. It starts in the same cells that give your skin, hair, and eyes their color. In melanoma, the cells change in a way that allows them to spread to other organs.
- Changes to a mole you’ve had for a while or a new growth on your skin could be signs of melanoma, according to SurvivorNet’s experts. You’ll want to watch them and tell your doctor about any changes you notice.
The 50-year-old Puerto Rican actress and model—who has been in remission since March 2020 following radiation therapy and immunotherapy treatments—recounted her skin cancer journey during a recent interview with NBC 6 South Florida, admitted it “completely” changed her life.
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She continued, “Almost seven years passed before I actually went to check it, and it was already on my lymph nodes. So, that’s why it was stage three.
“I could have just taken it private, and with my family, and deal with it closed doors … but I decided to talk about it because I was learning in the process, I was learning so much … I was so wrong, like so many people thinking it was not scary or not dangerous, when it’s one of the worst, because once it reaches the lymph nodes it can go to any organ.”
As for people like Torres, who previously didn’t worry about skin cancer, she added, “We think we’re strong enough, or that it just won’t happen to us. Maybe it’s because I’m from Puerto Rico, an island, so there’s this mentality that it only happens to people with darker skin, or that it won’t happen if you’re not out in the sun much.
“But it happened to me. I have light skin. I’m never really in the sun.”
The avid sunscreen user, concluded, “I could’ve chosen not to speak about it. But I just felt the need to spread the word.”
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Earlier this year, Torres took to Instagram, a social media app she often uses to update her fans and offer insight into her health, “Six years ago today, I made the decision to talk openly about cancer and share my journey, my battle, my fears and my victories. I did it because I felt that, if my story could help someone else, it would be worth telling.
“Hearing someone else talk about their cancer experience is what led to me getting a checkup and finding out on time. That voice, that testimony, changed my life. That’s why I continue to believe in the power of sharing, informing, and remembering the importance of listening to our bodies.”
She admitted that if her story can help “motivate” another person to better focus on their health, then “this whole road has made even more sense.”
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Torres received her melanoma diagnosis back in February 2019, a time when she chose to go public with the “sad” news.
She said, “I have been diagnosed with skin cancer ‘melanoma’ from a big spot/mole I never paid attention to, even though it was new, it had been growing for years & had an uneven surface.
“My fiancé Louis had been begging me to have it checked & finally made an appointment himself… after a biopsy & a second surgery last Tuesday the results unfortunately are positive. Now we are waiting to see which treatment I will be receiving but they have already removed a big area from the back of my knee & also they have removed 2 lymph nodes at the top of my leg where it had already spread. Hoping it has not spread to any more areas or organs.”
Torres concluded, “But if I can help anyone along the way based on my experience, it would be to tell you… PLEASE, never forget to take care of yourself. If you see something or feel something different in your body have it checked… I had no idea skin cancer could spread anywhere else in your body.”
The actress ultimately beat the disease after getting the mole and affected lymph nodes surgically removed, followed by radiation therapy and immunotherapy.
Expert Melanoma Resources
- Advances in Uveal Melanoma Treatment: Immunocore’s Chief Medical Officer On Their New Standards For Survival
- Am I at High Risk for Melanoma?
- Atypical Moles Don’t Necessarily Mean You Have Melanoma
- Be Aware of the Side Effects of Targeted Therapy for Melanoma
- Blood Test Could Predict the Best Type of Treatment for Metastatic Melanoma
- Examining Your Skin for Melanoma: Remember ABCDE
- How is Melanoma Treated After Surgery? The Landscape of Therapies Explained
- Melanoma Relapse Treatment: Advances on the Horizon
- Immunotherapy for Melanoma Can Work, but Side Effects are a Risk
- Neoadjuvant Immunotherapy in Stage III Melanoma: Improved Outcomes with Response-Driven Approach
Understanding Melanoma
Melanoma starts in the same cells that give your skin, hair, and eyes their color. In melanoma, the cells change in a way that allows them to spread to other organs.
Changes to a mole you’ve had for a while or a new growth on your skin could be signs of melanoma.
You’re most likely to find melanoma on sun-exposed skin areas like your face, neck, arms, and legs. Surprisingly, you might also find them in other places as well, like:
- The palms of your hands or soles of your feet
- On your eyes or mouth
- Under your nails
The top way to protect yourself is by staying out of the sun, especially during peak hours, and avoiding unprotected sun exposure because ultraviolet (UV) radiation can lead to melanoma.
According to experts like Dr. Anna Pavlick, an oncologist at NYU’s Perlmutter Cancer Center, tanning beds pose ultraviolet radiation risks for skin cancer and should be avoided completely.
RELATED: How Do I Know My Skin Cancer is Gone?
Dr. Pavlick notes that people who are covered with moles stand a higher risk of developing skin cancer, especially people with dysplastic nevis syndrome, or “atypical” moles.
Atypical moles are those that are unusual-looking and, when seen under a microscope, they have irregular features. Although usually benign, a high number of atypical moles do signal an increased risk for melanoma, according to the Skin Cancer Foundation which says people with 10 or more atypical moles have 12 times higher risk of developing melanoma.
Warning Signs of Skin Cancer – Remember ABDCE
The most important thing to look out for when it comes to finding melanoma is a sudden, new spot on your skin or a spot that is quickly changing in size, shape, or color.
Dr. Cecelia Larocca, a dermatologist at Dana-Farber Cancer Institute, recommends implementing the ABCDE rule to determine if a mole requires further examination.
The ABCDE rule:
- A: Asymmetry of the mole, or when one half of the mole doesn’t match the other
- B: Border irregularity or Bleeding
- C: Color change either lightening or darkening of a mole
- D: Diameter greater than 6mm or enlarging moles
- E: Evolving size, shape or color.
WATCH: Dr. Cecila Larocca on the ABCDEs of checking moles for signs of skin cancer
Melanoma that moves into the body, away from the skin, becomes an entirely different treatment journey for patients.
Treatment options for melanoma that has spread include targeted therapy and immunotherapy, which give people a better chance of living a long and healthy life than ever before. If you’re diagnosed with melanoma, there’s a good chance surgery will be the treatment your doctor recommends.
Cancer removal usually leads to a cure in the early stages of the disease. After surgery, the removed tissue and lymph nodes are examined to measure the melanoma and determine if it has clear margins. Clear margins mean the cells around the area of tissue that was removed don’t contain any melanoma.
When no cancer cells are left around the removed area, your cancer is less likely to return.
Melanoma Treatment Options
Melanoma treatment has come a long way. Survival rates have risen dramatically, thanks to a “treatment revolution,” say SurvivorNet’s experts. With breakthrough treatments like targeted therapy and immunotherapy now available, people who are diagnosed today have a much better chance of living a long and healthy life than ever before.
If you’re diagnosed with melanoma, there’s a good chance surgery is going to be the treatment your doctor recommends. In the early stages of the disease, removing the cancer should lead to a cure. The question is typically not whether you’ll get surgery, but which kind you’ll have.
WATCH: Dermatologic Surgeon Dr. Nima Gharavi, On The “Gold Standard Treatment” For Melanoma
For an early-stage melanoma that is close to the skin surface, Mohs surgery might be an option. This technique removes skin cancer, layer by layer, until all the cancer is gone.
In general, stage I melanoma surgery consists of the simple, in-office removal of the cancerous cells by a dermatologist. If the cancer is thicker, your surgeon will remove it through a technique called wide excision surgery.
The removal of stage II and III melanomas are performed by surgeons or surgical oncologists, not dermatologists. You may also have a sentinel lymph node biopsy to see if the melanoma has spread to the first lymph node where it’s most likely to travel. If your cancer has reached this first lymph node, it may have spread to other neighboring lymph nodes, and possibly to other organs. Where the cancer is will dictate your treatment.
After surgery, the removed tissue and lymph nodes will go to a specialist called a pathologist, who will measure the melanoma and find out if it has clear margins. Having clear margins means the cells around the area of tissue that was removed don’t contain any melanoma. When there aren’t any cancer cells left around the removed area, your cancer is less likely to come back.
Once your cancer spreads, treatment gets a little more complicated, but there are still ways to stop it. New treatments have vastly improved the outlook for people with metastatic, or stage IV, melanoma.
Targeted drugs and immunotherapy have been shown to be more effective than chemotherapy. So, with many more choices, there is no standard treatment. Treatment will vary based on your condition and whether there is recurrent disease.
Research has found that immunotherapy drugs such as Keytruda (pembrolizumab) and Opdivo (nivolumab) helped some people live longer. Combining immunotherapy drugs Yervoy (ipilimumab) and Opdivo (nivolumab) has also extended survival. Opdivo (nivolumab) + relatlimab is a new therapy option added to the National Comprehensive Cancer Network guidelines in 2022. The combination of two immunotherapies is called Opdualag.
For those with the BRAF mutation, targeted drugs which shrink or slow the tumor can be a good option. This could include a combination of drugs, such as:
- Zelboraf (vemurafenib) and Cotellic (cobimetinib)
- Braftovi (encorafenib) and Mektovi (binimetinib)
- Tafinlar (dabrafenib) and Mekinist (trametinib)
- Zelboraf (vemurafenib) and Cotellic (cobimetinib) can also be combined with atezolizumab.
“Every patient is different and every situation is different,” says Dr. Anna Pavlick, medical oncologist at Weill Cornell Medicine. She emphasized that “there is no cookie-cutter recipe,” for treating stage IV melanoma.
There Is No “Cookie Cutter Recipe” for Treating Stage Four Melanoma
Dr. Pavlick also notes the importance of personalized care and treatment. “It really is a matter of looking at the tools we have so that we can pick the right tools to give the patient the best outcome.”
So, while there is no one-size-fits-all approach to treating metastatic melanoma, your doctor will work with you to develop a treatment plan that is tailored to your individual situation. Advances in research and technology are making the fight against metastatic melanoma more hopeful than ever.
Leading Experts Urge Us to Be Proactive
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care,” National Cancer Institute Chief of Surgery Steven Rosenberg told us in a previous interview, “because finding a doctor who is up to the latest of information is important.”
As we highlight in several areas of SurvivorNet, highly respected doctors sometimes disagree on the right course of treatment, and advances in genetics and immunotherapy are creating new options. Also, in some instances the specific course of treatment is not clear cut. That’s even more reason why understanding the potential approaches to your disease is crucial.
At the National Cancer Institute, there is a patient referral service that will “guide patients to the right group depending on their disease state so that they can gain access to these new experimental treatments,” Rosenberg says.
Cancer Research Legend Urges Patients to Get Multiple Opinions
Furthermore, getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you good advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
RELATED: Be Pushy, Be Your Own Advocate, Says Leading Expert
Bottom line, being proactive about your health could be a matter of life or death. Learn as much as you can from as many experts as you can, so that you know that you did your best to take control of your health.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
