Cancer / OncologyDermatologyMelanoma / Skin Cancer

What to know about melanoma

Melanoma is more like a type of skin cancer. It is not the most common, but it is the most dangerous, because it spreads frequently. It can be difficult to handle when this happens and the outlook could be low. Risk factors for melanoma include, among others, over-exposure to the sun, fair skin and a family history of melanoma.

Receiving an early diagnosis and prompt care can improve the outlook for melanoma sufferers.

Receiving an early diagnosis and prompt care can improve the outlook for melanoma sufferers.

For this purpose, humans should keep track of any moles that alter or grow. Using adequate sun exposure protection can help a person prevent melanoma altogether.

This article covers melanoma signs, how it can be treated by a doctor and ways to treat it. We’ll also clarify how to better prevent melanoma.

What is melanoma?

Melanoma in the foot
A person may be more at risk of melanoma if they have a family history of the condition.

Melanoma is a form of skin cancer that develops when cell-producing pigments called melanocytes mutate and begin to uncontrollably divide.

Most cells in the skin produce pigment. Melanomas can grow anywhere on the skin but some areas are at greater risk than others. It is most likely to impact both the chest and back in men. The legs are the most popular site between women. Certain common melanoma sites include facials.

Melanoma, however, can also occur in the eyes and other areas of the body, including the intestines – on very rare occasions.

For people with darker skin melanoma is relatively rare.

The American Cancer Society (ACS) predicts about 96,480 new melanoma diagnoses will occur in 2019. We also predict about 7,230 people will die in 2019 as a result of melanoma.

Stages

Diagnosis stage of a cancer would show how far it has already spread and what form of treatment will be necessary.

One method of assigning melanoma to one stage identifies the cancer in five stages, from 0 to 4:

  • Stage 0: The cancer is only present in the outermost layer of skin. Doctors refer to this stage as “melanoma in situ.”
  • Stage 1: The cancer is up to 2 millimeters (mm) thick. It has not yet spread to lymph nodes or other sites, and it may or may not be ulcerated.
  • Stage 2: The cancer is at least 1 mm thick but may be thicker than 4 mm. It may or may not be ulcerated, and it has not yet spread to lymph nodes or other sites.
  • Stage 3: The cancer has spread to one or more lymph nodes or nearby lymphatic channels but not distant sites. The original cancer may no longer be visible. If it is visible, it may be thicker than 4 mm and also ulcerated.
  • Stage 4: The cancer has spread to distant lymph nodes or organs, such as the brain, lungs, or liver.

The more advanced a cancer is, the more difficult it is to treat and the worse the outlook is.

Types

There are four types of melanoma. Learn more about each type in the sections below.

Superficial spreading melanoma

This type of melanoma is the most common, and it mostly occurs on the trunk or limbs. At first, the cells begin to expand gradually, until they disperse across the skin surface.

Nodular melanoma

This is the second most common type of melanoma that occurs on the trunk, head, or neck. It appears to grow faster than other types, and can look like a reddish or blue-black colour.

Lentigo maligna melanoma

It is less common and tends to occur in older adults, particularly in areas of the body that have had over many years of prolonged sun exposure, such as the face.

It starts off as the freckle of a Hutchinson, or lentigo maligna, that looks like a skin stain. This typically grows slowly, and is less harmful than melanoma of other forms.

Acral lentiginous melanoma

That’s the rarest form of melanoma. It occurs on the hands’ palms, feet soles, or under the nails.

Since people with darker skin do not usually get certain forms of melanoma, those with darker skin forms tend to be the most common form of melanoma among those.

Risk factors

Research is under way on the exact causes of melanoma.

Scientists do note however that people with other types of skin are more likely to develop melanoma.

Factors that can also lead to an increased risk of skin cancer include:

  • a high density of freckles or a tendency to develop freckles following exposure to the sun
  • a high number of moles
  • five or more atypical moles
  • the presence of actinic lentigines, also known as liver spots or age spots
  • giant congenital melanocytic nevi, a type of brown birthmark
  • pale skin that does not tan easily and tends to burn
  • light eyes
  • red or light hair
  • high sun exposure, particularly if it produces blistering sunburn, and if sun exposure is intermittent rather than regular
  • older age
  • a family or personal history of melanoma
  • a previous organ transplant

Only sun exposure and sunburn could be avoided of those risk factors. Eviting overexposure to the sun and avoiding sunburn will dramatically reduce skin cancer risk. Tanning beds are also a source of damaging ultraviolet (UV) rays.

Pictures

  • Acral lentiginous melanoma. Image credit Will Blake, 2006.
  • Nodular melanoma. Image credit: Dermnet New Zealand.
  • Superficial spreading melanoma. Image credit: National Cancer Institute.
  • Lentigo maligna melanoma.

An early diagnosis can be helped by being able to tell the difference between normal moles or freckles and those that suggest skin cancer

  • Superficial spreading melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral lentiginous melanoma
  • Skin changes due to cancer
  • Normal mole

Symptoms

Melanoma can be difficult to spot in its early stages. The skin should be tested for any signs of transition.

Changes in skin appearance are essential indicators of melanoma. Doctors use these in the course of diagnosis.

The Foundation for Melanoma Research provides pictures of melanomas and regular moles to help a person know how to tell the difference.

They also list other symptoms that may cause a doctor to visit, including:

  • any skin changes, such as a new spot or mole or a change in the color, shape, or size of an existing spot or mole
  • a skin sore that fails to heal
  • a spot or sore that becomes painful, itchy, or tender
  • a spot or sore that starts to bleed
  • a spot or lump that looks shiny, waxy, smooth, or pale
  • a firm, red lump that bleeds or looks ulcerated or crusty
  • a flat, red spot that is rough, dry, or scaly

ABCDE examination

ABCDE moles test is an effective tool for the discovery of potentially cancerous lesions. It identifies five basic features to look for in a mole that can either help a person confirm or rule out melanoma:

  • Asymmetric: Noncancerous moles tend to be round and symmetrical, whereas one side of a cancerous mole is likely to look different to the other side.
  • Border: This is likely to be irregular rather than smooth and may appear ragged, notched, or blurred.
  • Color: Melanomas tend to contain uneven shades and colors, including black, brown, and tan. They may even contain white or blue pigmentation.
  • Diameter: Melanoma can cause a change in the size of a mole. For example, if a mole becomes larger than one-quarter of an inch in diameter, it might be cancerous.
  • Evolving: A change in a mole’s appearance over weeks or months can be a sign of skin cancer.

Treatment

Skin cancer therapy is similar to that used by other cancers. Unlike other cancers within the body, however, it is easier to reach and extract the cancerous tissue altogether. Operation is the preferred treatment choice for melanoma, for that reason.

Surgery includes extracting the lesion and any of the underlying noncancerous tissue. When the surgeon removes the lesion, they send it to pathology to assess the severity of the cancer presence, and to ensure they have removed it all.

If melanoma covers a wide area of the skin, it can involve a skin graft.

If there is a risk of the cancer spreading to the lymph nodes a doctor may order a biopsy of the lymph node.

Also, they can recommend radiation therapy for melanoma treatment, particularly in later stages.

Melanoma may be metastasised in other tissues. If so, a doctor will ask for therapies depending on where the melanoma has spread, including:

  • chemotherapy, in which a doctor uses medications that target the cancer cells
  • immunotherapy, in which a doctor administers drugs that work with the immune system to help fight the cancer
  • targeted therapy, which uses medications that identify and target particular genes or proteins specific to melanoma

Prevention

Avoiding excessive UV radiation exposure can reduce skin cancer risk. Users will have this achieved by:

  • avoiding sunburn
  • wearing clothes that protect the body from the sun
  • using broad spectrum sunscreen with a minimum sun protection factor (SPF) of 30, preferably a physical blocker such as zinc oxide or titanium dioxide
  • liberally applying sunscreen about half an hour before going outside in the sun
  • reapplying sunscreen every 2 hours and after swimming or sweating to maintain adequate protection
  • avoiding the highest sun intensity by finding shade between the hours of 10 a.m. and 4 p.m.
  • keeping children in the shade as much as possible, having them wear protective clothing, and applying SPF 50+ sunscreen
  • ]keeping infants out of direct sunlight

Wearing sunscreen isn’t a excuse to remain in the sun for longer. People will also be taking action to restrict exposure to the sun where possible.

Those working outdoors, too, will take care to minimize exposure.

Doctors warn to stop tanning booths, lights, and sunbeds.

What about vitamin D?

Currently, the American Academy of Dermatology (AAD) does not recommend sun exposure (or tanning) for vitamin D intake.

Instead, they recommend “seeking vitamin D from a [healthy] diet that includes foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and/or vitamin D supplements”

Diagnosis

Most melanoma cases concern the skin. They produce normally changes in existing moles.

By periodically inspecting existing moles and other colored blemishes and freckles, a person can detect the early signs of melanoma themselves. People should get their backs inspected frequently, as moles in this area can be harder to see.

A spouse, family member, friend, or doctor may help examine the back and other places that are difficult to see without help.

Any changes in appearance of the skin need further examination by a physician.

Some apps claim to help identify a individual and monitor the changing moles. Many aren’t accurate though.

Clinical tests

Doctors may use microscopic or photographic tools to take a more detailed look at a lesion.

They will have a dermatologist biopsy of the lesion if they suspect skin cancer to determine whether it is cancerous or not. A biopsy is a procedure in which a health care provider takes a sample of a lesion and sends it to the laboratory for analysis.

Outlook

Melanoma is an aggressive form of cancer that can be dangerous if spreading. People who recognise an early lesion, however, will get a very positive outlook.

The 5 year relative survival rates for melanoma were estimated by the ACS. These compare the chance of a person with melanoma living for 5 years with that of a person without cancer.

If a doctor detects melanoma and treats it until it spreads, the average survival rate for 5 years is 98%. Nevertheless, if it extends to deeper tissues or neighboring lymph nodes, the rate would fall to 64%.

If it enters distant organs or tissues, it reduces the chance of survival to 23 percent for 5 years.

It is therefore important to monitor any changing moles and seek medical attention for anyone that is changing, becoming irregular or growing. It is also important to take protective steps when spending long periods of time in the sun.

Question :

Should I have regular checkups for skin cancer?

Answer:

The AAD recommend performing regular skin self-exams. If a person is concerned by anything on their skin, they should see a board certified dermatologist.

Some individuals, such as those with a family history of melanoma or a personal history of skin cancer, should have their skin checked regularly — even in the absence of any skin concerns.

A dermatologist can provide guidance regarding the recommended frequency of a person’s skin exams. Owen Kramer, MD

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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