Melanoma, the rare malignant melanocyte tumor commonly causes mortality to the affected individual. 77% of Skin cancer deaths are due to melanoma hence it is considered as “the most lethal form of skin cancer”(” Melanoma: How It Returns, Where It Spreads”).
The National Cancer Institute of the US National Institute of Health in their website stated that “each year in the United States, more than 53,600 people learn they have melanoma”. A person of any age group can get melanoma but its prevalence is higher as a person gets older. In US, this disease is one of the most common cancers affecting young adults(“What Is Melanoma?”).The incidence of the occurrence of melanoma increases every year especially in Western countries (Niederhuber).
Among the tumors the rate of incidence is faster in this disease condition. The primary risk factors are: family history, over exposure to ultraviolet rays, phenotype of the patient, atypical moles, fair skin and history of previous melanoma(de Braud et al.).The skin, specifically the epidermis has a part the melanocytes.
These melanocytes are the producers of the skin pigment melanin. The function of melanin is to protect the deeper layers of the skin from the harmful ultraviolet rays (UV) of the sun. When over exposure to the UV light happen these melanocytes undergo morphological and physiological changes resulting to the abnormal growth and these leads to the cancerous disease condition called melanoma(“What Is Melanoma?”).Melanoma can occur in any parts of the human body but there are locations in which these tumors usually thrive.
In males, the body parts that are often predisposed to this condition are upper body, between the hips and the shoulders; neck; and the head, while in women the lower legs are where melanoma is frequently found. Melanoma also occurs in dark skinned people and it emerge on the soles of the feet, fingernails or toenails, and on the palms of the hands.(“What Is Melanoma?”).Like any other disease, the malignancy of melanoma worsens with time but if treated at an earlier stage the percentage of cure is of greater number.
If diagnosed and treated in late stages of progression the cancer has increased probability of having undergone metastasis. The need for a routine examination for tumors of the body therefore arises and has to be done regularly. Examination can be done be health personnel or the individual himself. Guidelines are available for this self examination like those in breast cancer(“What Is Melanoma?”).
Change in size, color, and shape of a mole are considered the first signs of melanoma though it can also appear as a new mole. A black or blue black area is commonly found in this tumor. To help with the earlier diagnosis of this cancer, the ABCD of it is established and followed. The ABCD’s are the following: A stands for the asymmetry in the shape of the whole mole is divided into two and they are of different looks; B is for border where the edges can be notched, blurred, ragged, or irregular in outline and the surrounding skin may be extended with pigment; C means color where it is uneven, black, brown, and tan shades my be seen with areas of white, grey, red, blur or pink.
Appearance of this malignant tumor is varied but they can be one or two of the ABCD features(Niederhuber).Today, with the advancement of technology diagnostic tools available for the detection melanoma also increases in number and are more sensitive and specific. A biopsy which obtains tissue samples from the suspected tumor can be used. Melanoma can be diagnosed by this method based on the characteristics of the cells obtained.
If melanoma is the diagnosis, the extent of the spread and thickness of the tumor are information’s to be obtained next. Staging is the term for this process and this is important because the approach of treatment varies according to the stages of melanoma. This staging is done by excision of the tumor along with some of the surrounding skin and then the Sentinel Lymph Node (SLN) biopsy can also be done to find out if the melanoma has spread. CT (computed tomography), blood tests, chest x-rays, PET scan (positron emission tomography scan), and MRI (magnetic resonance imaging) can also be done to aide in the determination of the extent of the spread of the tumor.
The CT scan searches for melanoma in the chest specifically the lungs and the lymph nodes and abdomen, bowel and liver. Areas that are metabolically active which might be melanoma are previewed in PET Scan. Brain involvement is investigated in MRI scans while the Sentinel Node Biopsy searches for lymph node metastasis(Lomax).There are five stages used in the classification of melanoma.
These are; Stage 0, melanoma have not invaded the deeper tissues and are only located on the outer cell layer of the skin; Stage I (thin), tumor is lesser than 1 mm thick and the epidermis may appear ulcerated or between 1 to 2mm thick but without ulceration, lymph nodes are devoid of melanoma; Stage II, 1 mm thick at least, with or without ulceration, and still not spread in the lymph nodes; Stage III, melanoma has spread in the Lymph nodes in close proximity or found in tissues close to the original tumor but has not spread to the lymph nodes; and Stage IV, the melanoma has metastasize already in organs, lymph nodes and skin .Recurrent melanoma is when the cancerous cells return after treatment(Niederhuber).Melanoma treatment includes chemotherapy, surgery, and biological or radiation therapy. Treatment modalities today can be a combination of the available treatment to totally eliminate the cancer cells.
Symptomatic and supportive therapies are given to patients with this condition to help the patient’s body handle the course of the treatment(Niederhuber).Surgeries for melanoma includes: Amputation, when melanoma occurs on a toe or finger; Excisional surgery or “re-excision” or “wide surgical excision” to remove the remaining tumor; Lymph node dissection or lymphadenectomy wherein the lymph nodes that are dissected are near the tumor to prevent the spread of the melanoma; Adjuvant therapy used to kill undetected cancer cells to prevent spread and recurrence, but this is not effective when used alone or when used as a means of controlling the spread of melanoma to other body parts; and Chemotherapy which the use of medications to stop the growth of cancer cells thru killing infected cells or preventing them from dividing. Chemotherapy has side effects like nausea and hair loss which generally disappears after the treatment is stopped. These are given either orally or by injections.
The effectiveness of chemotherapy is increased if medications are combined rather than used singly but it is also prone to side effects. In order to reduce these side effects, chemotherapy is combined with the use of immunotherapy(” Melanoma: How It Returns, Where It Spreads”).Another treatment modality for melanoma is radiation therapy where high-energy rays are directed to the areas with melanoma of the patient’s body to kill the malignant cells. Radiation therapy is used as an adjuvant therapy not as a primary treatment.
This can be used in combination with chemotherapy and can bring relief especially in cases with bone or brain involvement(” Melanoma: How It Returns, Where It Spreads”).Aggressive treatment decreases the risk of recurrence of the cancer cells but still there is no substitute though to the early detection of melanoma to be able to treat the malignancy effectively and with decreased risk of recurrence. With the increasing numbers of patients that are having this malignancy, every individual should acquire the information about how to examine one’s self about melanoma and do self examination regularly. Decrease in the number of patients is observed in avoidance of UV radiation and surveillance of high risk patients(* Markovic SN et al.). Nodular melanoma on a leg of an elderly woman
- Markovic SN, et al. “Malignant Melanoma in the 21st Century, Part 1: Epidemiology, Risk Factors, Screening, Prevention, and Diagnosis.” Mayo Clin Proc 82.3 (2007): 364-80.de Braud, F., et al. “Malignant Melanoma.
- ” Crit Rev Oncol Hematol 47.1 (2003): 35-63.Lomax, Randy. “Melanoma Information”. 2003.
- The Melanoma Research Foundation. April 21 2007. <http://www.melanoma.org/>.” Melanoma: How It Returns, Where It Spreads”. American Academy of Dermatology.April 21 2007. <http://www.skincarephysicians.com/skincancernet/melanoma_returns.html>.
- Niederhuber, John E. “What You Need to Know About Melanoma”. 2003. National Cancer Institute, US National Institute of Health April 21 2007. <http://www.cancer.gov/cancertopics/wyntk/melanoma>.
- “What Is Melanoma?” Kenilworth, 2001. Schering Corporation. April 21, 2007 2007. <http://www.melanoma.com/whatis.html>.