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Cancer (Oncology)

Melanoma

Melanoma is a cancer that develops from melanocytes, the pigment-making cells of the skin. It usually, but not always, appears as a brown or black spot. Melanoma is not terribly common, accounting for fewer than five percent of skin cancer cases. However, it is far more lethal than other varieties, causing the vast majority of deaths from skin cancer, and it is steadily increasing in incidence.

Risk Factors and Prevention

Sun exposure (or ultraviolet light radiation) is the biggest risk factor for developing melanoma, as it can damage DNA. Fair-skinned people, especially those with freckles, light hair and blue or green eyes, are far more likely than those with darker skin and eyes to develop melanoma. Men have a slightly higher risk of developing melanoma than women. Melanoma risk increases with age, although melanoma is one of the most prevalent cancers in people under 30.

Having many moles, particularly large, abnormally shaped ones, is a risk factor. It is important to note that most moles do not develop into melanoma. A family or personal history of melanoma and a suppressed immune system also increases the risk.

Many, though not all, melanomas can be prevented. Limiting exposure to the sun, steering clear of tanning beds, wearing protective clothing, wearing a wide-brimmed hat, using sunscreen and wearing sunglasses that block UVA and UVB light decreases risk. It is very important to protect children, as frequent sunburns in childhood may increase the risk for future melanomas. Thorough routine skin exams, ideally by a dermatologist, are important for early detection.

Symptoms and Diagnosis

Warning signs are often visible in the form of a change in the skin's appearance. Any new growths or changes in existing skin lesions are cause for concern. Moles or growths that are larger than 1/4 inch, are asymmetrical, have irregular edges, or look spotted and varied in color are worth having checked out. Other red flags include sores that don't heal; redness or swelling beyond the border of a skin spot; itchy, tender or painful skin; scaly patches; and unexplained oozing or bleeding.

Melanomas are most common on the chest and back (in men) and on the legs (in women). They also appear on the face and neck and can develop on more sun-starved areas of the body, including: palms of the hands, soles of the feet, under the nails, or even in the mouth and the vagina.

Treatment

Surgery is the main treatment option for most cases of melanoma, usually curing early-stage melanomas. If lymph nodes are involved, they will be examined by a sentinel node biopsy and may be dissected (removed), if they show that the cancer has spread. When the melanoma has spread to distant organs – such as the lungs or brain – it is very unlikely that surgery can cure the cancer. However, surgery can aid in extending lives and improving the patient's quality of life, in these instances.

For advanced melanomas, other treatment options are used – sometimes in combination. Those options include amputation (fingers and toes only); chemotherapy to relieve symptoms or extend survival; immunotherapy, to stimulate the immune system to destroy cancer cells; and radiation therapy. Radiation is rarely used to treat the original melanoma, but rather as palliative therapy to relieve symptoms caused by metastases to the brain or bone. Newer treatments have been successful in prolonging the lives of patients with advanced and metastatic melanomas, and clinical trials using these medications are available at our institution.

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