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Melanoma

Definition


Disease: Melanoma Melanoma
Category: Tumors

Disease Definition:

The most serious type of skin cancer that develops in the cells that produce melanin, the pigment that gives the skin its color, is melanoma. This type of cancer can also form in the eyes and in some rare cases, in the intestines or other internal organs. 

 

The risk of developing melanoma increases greatly by exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds, though the exact cause of all melanomas isn't clear.

 

Many melanomas can be prevented by avoiding excessive sun exposure. To help ensure that cancerous changes are detected and treated before they have a chance to spread, one should make sure that he/she knows the warning signs of skin cancer.
 

Work Group:


Symptoms, Causes

Symptoms:

Melanomas usually develop in areas of the body that have had exposure to the sun such as the face, back, arms and legs, despite the fact that this type of cancer can develop anywhere on the body. In areas that don't receive much sun exposure, like on fingernail beds, the soles of the feet and palms of the hands, melanoma can also occur.

 

The development of a new, unusual-looking growth on the skin or a change in an existing mole is usually the first symptom of melanoma. However, melanoma can occur on otherwise normal-appearing skin as well.

 

NORMAL MOLES:

Uniform colors like black, brown or tan, with a distinct border separating the mole from the surrounding skin are generally the characteristics of normal moles. They're round or oval in shape and 1/4 inch, or 6 millimeters (mm) in diameter, about the size of a pencil eraser.

 

People usually have between 10 and 40 moles, and many of these develop by the age of 20; some moles may even disappear with age, though they may change in appearance over time. Known medically as dysplastic nevi, some people may have one or more large (more than 1/2 inch, or 12 mm, in diameter), flat moles with a mixture of colors including tan, brown, and either pink or red, and irregular borders; these moles in particular are much more likely to become cancerous (malignant) than normal moles.

 

UNUSUAL MOLES THAT MAY INDICATE MELANOMA:

The characteristics of unusual moles that may indicate melanomas or other skin cancers follow the A-B-C-D-E guide:

 

  • A is for asymmetrical shape: Moles with irregular shapes, such as two very different-looking halves, should be looked for.
  • B is for irregular border: Moles with irregular, notched or scalloped borders (the characteristics of melanomas), should be looked for.
  • C is for changes in color: Growths that have many colors or an uneven distribution of color should be looked for.
  • D is for diameter: New growth in a mole larger than about 1/4 inch (6 millimeters) should be looked for.
  • E is for evolving: Changes over time, such as a mole that grows in size or that changes color or shape, should be looked for. Moles may also evolve to develop new signs and symptoms, such as new itchiness or bleeding.

 

Some of the other suspicious changes in a mole are:

 

  • Itching
  • Spreading of pigment from the mole into the surrounding skin
  • Bleeding or oozing
  • Change in texture; for instance, becoming hard or lumpy
  • Scaliness
  • In appearance, malignant moles vary greatly. While some may have only one or two unusual characteristics, others may show all of the Changes listed above.

 

HIDDEN MELANOMAS:

In areas of the body that have little or no exposure to the sun such as the spaces between the toes and on the palms, soles, scalp or genitals, melanomas can also develop. Because they occur in places most people wouldn't think to check, these are sometimes referred to as hidden melanomas. Melanoma is more likely to occur in a hidden area when it occurs in people with dark skin tones.
The following are included in the hidden melanomas:

Melanoma under a nail:

A rare form of melanoma that occurs under a nail, most often on the thumb or big toe, is subungual melanoma. In blacks and in other people with darker skin pigment, this type is especially common. A black or brown discoloration that's often mistaken for a bruise (hematoma) is usually the first indication of a subungual melanoma. If one develops a nail discoloration that doesn't heal after two months, spreads to involve the cuticle or that increases in size, he/she should see a dermatologist.

Melanoma in the mouth, digestive tract, urinary tract or vagina:

In the mucous membrane that lines the esophagus, anus, urinary tract, vagina, mouth and nose, mucosal melanoma may develop. Because mucosal melanomas can easily be mistaken for other, far more common conditions, they are especially difficult to detect.  Itching and bleeding, which are signs and symptoms that commonly result from a yeast infection or menstrual irregularities, may be the result of a melanoma in a woman's genital tract. Symptoms caused by hemorrhoids are similar to those of anorectal melanoma. Dentists are trained to spot melanomas that occur in the mouth. Melanomas in the vagina may be detected by regular pelvic exams.

Melanoma in the eye:

In the pigment-containing cells in the back portion of the eye (retina), ocular melanomas may sometimes develop. These melanomas are only detected during eye exams as they usually don't produce symptoms. A dark spot in the vision or a scratchy feeling under the eyelid, may be caused by melanomas that occur in the lining of the eyelid (conjunctiva) or the pigmented coating within the eyeball (choroid). To wear glasses rated to block 99 percent to 100 percent of ultraviolet A light when one is in the sun is the best way to prevent ocular melanoma, which has been linked to chronic sun exposure.
 

Causes:

The most serious and deadly type of skin cancer is melanoma. Melanomas cause the greatest number of deaths, although they make up the smallest percentage of all skin cancers. The reason is that they're more likely to spread to different parts of the body, and the occurrence of melanoma is on the rise.

 

When something goes awry in the melanin-producing cells (melanocytes) that give color to the skin, melanoma occurs. Normally, skin cells develop in an orderly and controlled way; healthy new cells push older cells toward the skin's surface, where they die and are eventually sloughed off. DNA, which is the genetic material that contains the instructions for every chemical and biological process in the body, controls this process. New cells may begin to grow out of control and can eventually form a mass of cancerous cells when DNA is damaged.

 

What exactly damages DNA in skin cells and how this leads to melanoma is a matter of intense study. The result of a combination of factors that include environmental and genetic factors is cancer, which is a complex disease. Whether the radiation is from the sun or from tanning lamps and beds, the leading factor in the development of melanoma is still the excessive exposure to ultraviolet (UV).  

 

UV RADIATION AND MELANOMA:

The sun produces UV radiation. Ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC) are the three divisions of wavelength bands that the UV light is divided into. Atmospheric ozone, a naturally occurring substance that filters UV radiation, absorbs UVC radiation completely, meaning that only UVA and UVB rays reach the earth. UV radiation is also produced by commercial tanning lamps and beds.

 

Harmful changes in skin cell DNA is caused by UVB light; these changes include the activation of oncogenes, a type of gene that, when turned on, can change a normal cell into a cancerous one. Leading to melanoma, UVA light may be more likely to damage melanocytes. UVA radiation is mainly produced by tanning lamps and beds.

 

At the equator and at high elevations, UV radiation is most intense; however, the skin absorbs UV radiation whenever someone is outdoors unless he/she wears protective clothing and sunscreen, no matter where he/she lives.

 

OTHER CAUSES OF MELANOMA:

The UV light is not the cause of all melanomas, particularly those that occur in places on the body that don't receive exposure to sunlight. This means that other factors may contribute to the risk of melanoma.

 

The risk of skin cancer may be increased by the following factors:

Having fair skin:

The protection from damaging UV radiation is less when people have less pigment (melanin) in their skin. One is more likely to develop melanoma if he/she has blond or red hair, light-colored eyes, and freckles or sunburns easily, than is someone with a darker complexion. Fair-skinned people of Northern European ancestry are particularly at risk. Because Queensland, Australia, has unusually high levels of UV radiation and because most of its inhabitants are of English or Irish descent, it has the highest skin cancer rate in the world.

 

Melanoma can develop in people with darker complexions, including blacks and Hispanics, though it's less common. Melanoma is often diagnosed in the later stages for these people, when the lesions are deeper and more advanced. It's important that people of all ethnic backgrounds be aware of melanoma and take precautions against UV radiation because the survival from melanoma is strongly correlated to the spread and depth of cancer at the time of diagnosis. 

A history of sunburn:

The risk of developing skin cancer increases every time one burns his/her skin. It's important to protect children from the sun, not just with sunscreen but also with a hat, protective clothing  and dark glasses because the risk of skin cancer increases in people who have had one or more severe blistering sunburns as a child or a teenager. The greatest damage seems to occur before one becomes 18 although sunburns in adulthood also are a risk factor. Because the melanin in the skin of infants isn't yet fully developed, they're particularly vulnerable.

Sunny or high-altitude climates:

Living in a sunny climate exposes one to more UV radiation than does living in a cool, cloudy climate. Additionally, there is more exposure to UV radiation if one lives at a high elevation.

A family history of melanoma:

The chance of developing melanoma is greater in a person whose close relative such as a parent, child or sibling, has had this condition. Some families are affected by a condition called familial atypical mole-malignant melanoma (FAMMM) syndrome. Having more than 50 moles, some of which are atypical and a history of melanoma in one or more close relatives are included in the hallmarks of FAMMM. The risk of developing melanoma is extremely high in people with this syndrome.

Weakened immune system:

The risk of many diseases including skin cancer is great in people with weakened immune systems.  People who have chronic leukemias, other cancers or HIV/AIDS, and those who have undergone organ transplants or who are taking medications that suppress the immune system are included in this.

Exposure to carcinogens:

Several substances that may contribute to melanoma including the wood preservative creosote, radium, arsenic compounds in pesticides and coal tar, have been identified.

Rare genetic disorder:

The risk of developing melanoma increases greatly in people with xeroderma pigmentosum, which causes an extreme sensitivity to sunlight, as they have little or no ability to repair damage to the skin from ultraviolet light.
 

Complications

Complications:

None

Treatments:

Depending on the patient’s personal preferences, overall health, age and stage of cancer, the best treatment for him/her will be determined.

 

To understand the different treatments and the potential risks and side effects of each treatment fully, the patient should ask the doctor and other members of the melanoma treatment team any questions he/she has. Seeking a second opinion, especially from a doctor who specializes in treating melanoma, should be considered as well. After weighing the options that the patient has, in some cases he/she may choose not to treat the melanoma itself but rather to try to relieve any symptoms the cancer may cause.

 

HOW TO TREAT EARLY-STAGE MELANOMAS:

Surgical removal (simple excision) is the best treatment for early-stage melanomas. During the biopsy, very thin melanomas may be entirely removed and require no further treatment. The surgeon will otherwise excise the cancer as well as a small border of normal skin and a layer of tissue beneath the skin, which eliminates the cancer in almost every case.
In the past, cutting out the cancer along with a large border of normal skin (wide local excision) was involved in a surgery for more invasive early-stage tumors, which meant having a skin graft, a procedure in which skin from another part of the body is used to replace the skin that's removed. However, in some cases of invasive melanomas, taking smaller amounts of normal skin may be just as effective in treating cancer and may eliminate the need for skin grafts.

 

HOW TO TREAT MELANOMAS THAT HAVE SPREAD BEYOND THE SKIN:

Treatment options may include the following if melanoma has spread beyond the skin.

Surgical removal:

Surgically removing a melanoma that has spread (metastatic melanoma) can often provide relief of symptoms, sometimes for years, as it's very difficult to cure melanomas that have spread beyond the skin. Where the cancer is located and how severe it is, as well as the patient's own preferences and overall health are some of the factors that this procedure will depend on.

Chemotherapy:

To destroy cancer cells, this form of treatment uses drugs. Usually for four to six months, two or more drugs are often given in combination and may be administered intravenously, in pill form or both. New chemotherapy regimens are being studied and developed as melanoma has long been thought to be resistant to most forms of chemotherapy. To relieve symptoms in people with advanced metastatic melanoma, chemotherapy is sometimes used.

Radiation therapy:

To kill cancer cells, high-energy X-rays are used in this treatment. The symptoms of melanoma that has spread to another organ could also be treated with radiation therapy. A common side effect of radiation therapy is fatigue, however, once the treatment is completed, the energy of the patient usually returns.

Biological therapy (immunotherapy):

To help the body fight cancer, biological therapy boosts the patient’s immune system. These treatments are made of substances produced by the body or similar substances produced in a laboratory. Interferon and interleukin-2 are included in the biological therapies used to treat melanoma. Including muscle aches, fatigue, chills, headache and fever, side effects of these treatments are similar to those of the flu.
 

Prognosis:

Not available

Expert's opinion

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