Dive into in-depth insights on melanoma with Meri Sehat. Discover prevention, detection, and treatment for a healthier life.

Melanoma

Humza Khizer

Overview

Melanoma is a type of skin cancer that starts in cells called melanocytes, which produce a pigment called melanin. Melanin gives color to the skin, hair, and eyes. When melanocytes start growing uncontrollably, they can form a lump or growth on the skin. 
&nbsp;

Melanoma is less common than other types of skin cancer, but it&#39;s more dangerous because it can spread to other parts of the body if not detected and treated early.

Around 70,000 new cases of invasive melanoma are diagnosed every year in the US. Even though it accounts for only 3% of all types of skin cancers, melanoma has the highest mortality rate. Moreover, it is one of the most frequently occurring cancers in individuals aged 20-30.

Melanoma in women aged 25-30 is the main cause of cancer-related death<a href="#accordion">[1]</a>. 
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Melanoma can be broadly categorized as cutaneous, mucosal, or ocular melanoma<a href="#accordion">[1][2]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Cutaneous Melanoma</h5>
	</li>
</ul>

It is further divided into the following types:

<ol>
	<li>Superficial Spreading Melanoma: This is the most common type of melanoma, accounting for nearly 70% of cases. It usually starts in a pre-existing mole, which grows outward on the skin&#39;s surface before it goes deeper. Mostly, this type appears on the limbs or trunk. 
	&nbsp;</li>
	<li>Nodular Melanoma: This accounts for 15-30% of cases. It is a more aggressive type that grows quickly as compared to the superficial spreading melanoma. It often appears on the head, neck, or trunk. 
	&nbsp;</li>
	<li>Lentigo Maligna Melanoma: Often found on the face of light-skinned women over 50, this type accounts for 4-10% of cases. It grows slowly and has a relatively low risk of spreading compared to other types of melanomas. It typically develops on the face, starting off as a Hutchinson&rsquo;s freckle.&nbsp; 
	&nbsp;</li>
	<li>Acral Lentiginous Melanoma: This type is more common in people with darker skin tones, affecting around 60% of dark-skinned individuals compared to only 2-8% of cases reported in fair-skinned patients. It usually occurs on the soles of the feet, palms, or under the nail beds, and is usually large in size, with the average diameter being 3 cm. 
	&nbsp;</li>
</ol>

<ul>
	<li>
	<h5>Mucosal Melanoma</h5>
	</li>
</ul>

This type develops in mucous membranes, such as in the mouth, nose, or genitals. It&#39;s quite rare (only 1% of cases) and very difficult to detect. The prognosis is poor, even when it&rsquo;s diagnosed and treated. 
&nbsp;

<ul>
	<li>
	<h5>Ocular Melanoma</h5>
	</li>
</ul>

This type occurs in the eye, specifically in the uvea and conjunctiva. It&#39;s also rare and may not show early symptoms. 
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Signs and Symptoms

Melanoma usually appears on the back and chest in fair-skinned men, whereas it appears on the lower legs in fair-skinned women. People with dark skin usually have it on the soles of their feet, their palms, and the skin under their nails.

It&#39;s important to note that melanoma can take on different appearances in different people. Generally, though, it can be identified using the ABCDEF technique: 
&nbsp;

A: Asymmetry (is one half of the mole different from the other?)

B: Border Irregularity (are the edges uneven or jagged?)

C: Color Variation Within The Same Mole (does the mole have uneven shades and colors?)

D: Diameter Larger Than 6mm (is the mole growing bigger than the size of a pencil eraser?)

E: Evolution (is the mole&rsquo;s appearance changing over weeks or months, or are there new spots on the skin around it?)

F: Feeling Or Sensation around the spot or mole changed (is the area around it showing signs of discomfort, such as itchiness, pain, bleeding, or crusting?) 
&nbsp;

Note: Remember, not all moles or spots with these characteristics are necessarily melanomas, but it&#39;s important to have any suspicious changes checked by a dermatologist. 
&nbsp;

Causes

The primary cause of melanoma is damage to the DNA within skin cells, mainly due to exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds.

This UV radiation can trigger changes in the DNA of skin cells, leading to uncontrolled growth and the development of melanoma. 
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Diagnosis

Regular self-exams of the skin can help an individual become familiar with existing moles, freckles, and other marks. This enables them to seek a professional evaluation promptly if they notice any changes in the size, shape, color, or texture of the moles or other marks.

During these exams, the dermatologist will examine the skin from head to toe, including areas that are hard to see on one&rsquo;s own. They may request the following diagnostic tests:

<ul>
	<li>
	<h5>Biopsy</h5>
	</li>
</ul>

During a biopsy, a small sample of the suspicious tissue is removed and examined under a microscope to determine if it&#39;s cancerous.

There are different types of biopsies, including shave biopsy, punch biopsy, and excisional biopsy, depending on the situation.

Note: There&rsquo;s a small risk of infection after a biopsy. Inform your doctor if you develop a <a href="https://merisehat.pk/article/dengue-fever-questions-and-answers">fever</a>, or have continued bleeding, swelling, reddening, or an increase in pain at the site. Make sure to inform your doctor beforehand if you&rsquo;re taking any medications or blood thinners. 
&nbsp;

<ul>
	<li>
	<h5>Imaging Tests</h5>
	</li>
</ul>

In advanced cases where there&#39;s concern about cancer spreading, imaging tests like chest X-rays, ultrasound, lymphoscintigraphy, CT/CAT scans, MRI scans, and PET scans might be used to check for signs of spread to other parts of the body. 
&nbsp;

<h5>Stages Of Melanoma</h5>

Stages indicate how far the cancer has already spread and what sort of treatment will be suitable for it<a href="#accordion">[2]</a>. 
&nbsp;

<ul>
	<li>Stage 0 (Also called Melanoma In Situ) &ndash; This refers to cancer present only in the outermost skin layer.</li>
	<li>Stage 1 &ndash; Cancer is 2 mm thick. It may or may not be ulcerated. Also, it&rsquo;s not spread to any other sites.</li>
	<li>Stage 2 &ndash; Cancer is at least 1 mm thick. It can be thicker than 4 mm, too. It&rsquo;s not yet spread to lymph nodes or other sites and may or may not be ulcerated.</li>
	<li>Stage 3 &ndash; Cancer has spread to one or more lymph nodes but not to other distant sites. It may be thicker than 4 mm and ulcerated as well if the original cancer is not visible.</li>
	<li>Stage 4 &ndash; Cancer has spread to distant lymph nodes or organs, including the lungs, brain, or liver. 
	&nbsp;</li>
</ul>

Treatment

There are several treatment options available, and often a combination of approaches is used. 
&nbsp;

<ul>
	<li>
	<h5>Surgery</h5>
	</li>
</ul>

Surgery is often the first choice for early-stage melanomas. The surgeon removes the melanoma and a margin of healthy skin around it. The extent of surgery can vary, from a simple excision for small <a href="https://merisehat.pk/article/3d-printed-tumors-help-test-new-cancer-treatments">tumors</a> to more extensive procedures for larger or deeper melanomas.

If melanoma has spread to nearby lymph nodes, the affected nodes may need to be removed. This is done to prevent the further spread of cancer.

If the cancer involves a large area of the skin, a skin graft may be necessary. 
&nbsp;

<ul>
	<li>
	<h5>Immunotherapy</h5>
	</li>
</ul>

Immunotherapy boosts the body&#39;s immune system to fight cancer. Medications like checkpoint inhibitors (e.g., pembrolizumab, nivolumab) or interleukin-2 can help activate the immune response against melanoma cells<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Targeted Therapy</h5>
	</li>
</ul>

Targeted therapies are drugs that target specific genetic mutations present in melanoma cells. For example, BRAF inhibitors (e.g., vemurafenib, dabrafenib) target mutations in the BRAF gene, often seen in melanomas<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Chemotherapy</h5>
	</li>
</ul>

While less commonly used than in the past, chemotherapy drugs can be used to treat advanced melanoma. Chemotherapy attacks rapidly dividing cells, including cancer cells. 
&nbsp;

<ul>
	<li>
	<h5>Radiation Therapy</h5>
	</li>
</ul>

Radiation therapy uses high-energy rays to target and kill cancer cells. It&#39;s often used after surgery to eliminate any remaining cancer cells or in cases where surgery is not possible. 
&nbsp;

<ul>
	<li>
	<h5>Targeted Molecular Therapy</h5>
	</li>
</ul>

This approach uses drugs that target specific molecular pathways involved in the growth and spread of cancer cells.

The choice of treatment is highly individualized and depends on factors like the stage of melanoma, the patient&#39;s overall health, and specific genetic characteristics of the cancer cells. Patients need to have a thorough discussion with their healthcare team to understand their options and make informed treatment decisions.

Early-stage melanomas that are caught and treated in the early stages often have a high chance of successful treatment and cure.

According to the American Cancer Society, the survival rate is 98% when melanoma is diagnosed and treated before it spreads. This rate drops to 64% if the cancer has spread to nearby lymph nodes or deeper tissues. If the cancer goes further and affects distant tissues or organs, the survival rate is 23%<a href="#accordion">[2]</a>. 
&nbsp;

Melanoma, if left untreated or not caught early, can lead to several serious complications due to its ability to spread to other parts of the body.

<ul>
	<li>Metastasis: Melanoma can spread from its original site to other parts of the body through the bloodstream or lymphatic system. Melanoma often spreads to nearby lymph nodes first. This can lead to swelling, discomfort, and a higher risk of further spreading. 
	Other sites of metastasis include the lungs, liver, brain, and bones. 
	&nbsp;</li>
	<li>Advanced Melanoma: If melanoma is not detected and treated early, it can progress to an advanced stage where it becomes more difficult to treat and has a poorer prognosis. 
	&nbsp;</li>
	<li>Recurrence: Even after successful treatment, there&#39;s a possibility that melanoma recurs, either at the original site or in other parts of the body. 
	&nbsp;</li>
	<li>Secondary Cancers: Some treatments for melanoma, such as chemotherapy or radiation therapy, can increase the risk of developing other types of cancer later on. 
	&nbsp;</li>
	<li>Emotional And Psychological Impact: Dealing with a melanoma diagnosis and its treatment can be emotionally challenging. Surgery, for instance, to remove melanomas can sometimes result in scarring or disfigurement. It may lead to anxiety, depression, or other mental health issues. 
	&nbsp;</li>
	<li>Functional Impairment: Advanced melanoma that has spread to other organs can cause functional impairments related to those organs. For example, brain metastases can lead to neurological symptoms, while bone metastases can cause pain and mobility issues. 
	&nbsp;</li>
</ul>

Here are some key factors that contribute to the development of melanoma<a href="#accordion">[1][3]</a>:

<ul>
	<li>Fair Complexion: People with lighter skin, blue skin, and red or blonde hair have low levels of melanin, the pigment that helps shield against the sun&#39;s harmful effects. It&rsquo;s more common in Caucasians than in those of Asian or African ethnicity. 
	&nbsp;</li>
	<li>Moles: Having a large number of moles can increase the risk of melanoma. Moreover, some types of moles, such as congenital nevi and those with irregular shapes or colors, can be associated with a higher risk. 
	&nbsp;</li>
	<li>Personal History: Having a history of melanoma or even severe sunburns, especially during childhood, increases the risk of melanoma. 
	&nbsp;</li>
	<li>Family History: The risk is higher if a close family member (parent, sibling, or child) has had melanoma. There may be genetic factors at play, including the CDKN2A and CDK4 genes. 
	&nbsp;</li>
	<li>Weakened Immune System: People with weakened immune systems, such as those with HIV or those who have had an organ transplant, are at a higher risk of melanoma. 
	&nbsp;</li>
	<li>Age: The risk of melanoma increases with age, especially after the age of 50. However, it can also affect younger people. 
	&nbsp;</li>
	<li>Gender: Men are more likely than women to develop melanoma. 
	&nbsp;</li>
	<li>Geography: People living closer to the equator or in regions with intense sunlight have a higher risk of melanoma due to increased UV exposure. 
	&nbsp;</li>
	<li>Xeroderma Pigmentosum (XP): This rare genetic disorder affects the skin&#39;s ability to repair DNA damage from UV radiation, greatly increasing the risk of skin cancers, including melanoma. 
	&nbsp;</li>
	<li>Other: A high density of freckles, a tendency to develop freckles after sun exposure, or the presence of actinic lentigines can add to the risk. 
	&nbsp;</li>
</ul>

Early detection and prompt treatment significantly improve the prognosis of melanoma. However, behavioral and lifestyle changes can help prevent it from occurring. 
&nbsp;

<ul>
	<li>Protect The Skin From The Sun&#39;s Rays, use sunscreen with SPF 30, and avoid tanning beds to limit UV exposure.</li>
	<li>Genetic Counseling and regular screening are necessary if someone in the family has melanoma, especially if it&rsquo;s atypical mole and melanoma syndrome (previously called dysplastic nevus syndrome).</li>
	<li>Keep Infants And Children In The Shade and out of direct sunlight as much as possible. 
	&nbsp;</li>
</ul>

Multiple clinical trials are studying therapeutic vaccines that can improve specific immune responses to the disease. Unlike vaccines that are given to prevent infections, these are intended to treat an existing condition.

According to research, vaccination can indeed help the immune system fight melanoma, even if it&rsquo;s at an advanced stage. However, these vaccinations have not been approved yet<a href="#accordion">[4]</a>. 
&nbsp;

Key Points

<ul>
	<li>Melanoma is a type of skin cancer that originates in melanocytes, the cells responsible for producing the pigment melanin.</li>
	<li>Melanoma has various types, including superficial spreading, nodular, lentigo maligna, and acral lentiginous. Each type has distinct characteristics and appearances.</li>
	<li>Excessive exposure to ultraviolet (UV) radiation from the sun and tanning beds is the primary cause of melanoma, damaging DNA in skin cells and leading to uncontrolled growth.</li>
	<li>The ABCDE rule helps doctors identify suspicious moles. Also, biopsies and sometimes imaging tests help determine the stage and extent of melanoma.</li>
	<li>Depending on factors like the stage of melanoma and the patient&#39;s overall health, treatment options include surgery, lymph node surgery, immunotherapy, targeted therapy, chemotherapy, and radiation therapy.</li>
	<li>If untreated or not caught early, melanoma can spread to other parts of the body (metastasis), leading to severe complications. It can also result in disfigurement, emotional impact, and recurrence.</li>
	<li>People who have fair skin, a history of sunburn, a weakened immune system, and certain genetic mutations are at a higher risk of developing melanoma. However, anyone can get melanoma, even people with darker skin tones.</li>
	<li>It&#39;s essential for everyone to protect their skin from excessive sun exposure, wear sunscreen, and keep an eye on any unusual changes in moles or spots.</li>
</ul>