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Melanoma

Melanomas look like moles, in most cases. They can be aggressive and common sites for melanomas are the neck and face, which are usually exposed to sunlight.

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Overview

Melanoma is a type of skin cancer that develops from melanocytes, which are the cells responsible for skin pigmentation. This cancer is aggressive. Common sites for melanomas are the neck and face, which are usually exposed to sunlight. In men, melanomas are more common in the regions of the chest and back; whereas in women, they commonly occur on the legs.

In many cases, melanomas could look like moles. Melanomas are most commonly black or brown in colour; however, they can also be pink, red, purple, blue or white. The actual cause of melanomas remains unclear, but exposure to ultraviolet (UV) rays from the sun and tanning lights is considered to be a risk factor.

Melanoma risk appears to be rising in those under the age of 40, particularly among women.

Symptoms

Melanomas are most common in places with a lot of sun exposure, such as the face, neck, arms, back and lastly, legs. Moles, lumps or lesions on the skin that appear suddenly should not be overlooked as they could be an indication of melanoma or other types of skin cancer.

Learning the signs and symptoms of melanoma is important as it may help in identifying the skin changes and catching the disease in its early stages when it can be treated successfully.

Below are the common symptoms that are associated with melanoma:

  • A mole that already exists starts changing
  • Pigmentation in the skin
  • Skin growth that appears to be unusual
  • Pigments that spread from a spot’s edge into the skin around it
  • Redness in the skin
  • Itching sensation

Melanoma can also occur on otherwise normal-appearing skin. Unusual moles often indicate melanoma. Learning the ABCDEs of melanoma will help in the early diagnosis of the disease, which is important for successful treatment of the disease:

A – Asymmetry: When a line is drawn through the centre of an asymmetrical mole and the two parts don’t match, it could indicate melanoma. Unlike melanoma, benign moles are symmetrical.

B – Border: An early melanoma’s boundaries are frequently uneven, unlike a benign mole whose edges are smooth. Scalloped or notched edges are possible.

C – Colour: The majority of benign moles are the same colour, which is usually brown. Melanoma, on the other hand, is characterised by a wide range of colours. It’s possible that a variety of brown, tan or black hues will occur. Melanomas can also be white, red or blue in colour.

D – Diameter: The diameter of benign moles is usually smaller than that of malignant moles.

E – Evolving: Over time, all benign moles look the same. When a mole begins to change in any way, it must be brought to a physician’s attention. Any change in size, shape, colour, elevation or any other attribute, as well as any new symptom like bleeding, itching, or crusting, can indicate melanoma formation.

Melanomas can also form in places of the body that receive little or no sunlight, such as within the eyes, between the toes and on the palms, under the nails, soles, scalp, and genitals. These are known as “hidden melanomas” because they appear in places where most people would not think to look.

Causes

The actual cause of melanoma is not clearly understood. A combination of factors which includes environmental and genetic factors is most likely to contribute to the formation of melanoma. Following are some of the melanoma risk factors that have been identified:

  • Fair Skin Complexion: Having fair skin or low melanin levels in the skin indicate poor protection against UV damage and therefore increased risk of melanoma formation.
  • Sunburns: Scorching sunburns are also linked to an increased risk of melanoma.
  • Prolonged UV Exposure: UV radiation from the sun for long hours, as well as tanning lights and beds, raises the risk of melanoma and other skin cancers.
  • Residing Nearer the Equator or at a Higher Altitude: Sun rays are more direct near the equator, and those living closer to the equator are naturally exposed to more UV radiation than those not living near the equator. Similarly, living at higher altitudes also result in higher exposure to UV radiation and thereby lead to increased melanoma risk.
  • Unusual Moles or Too Many Moles: Melanoma is more likely to occur in those who have more than 50 typical moles on their bodies. Melanoma risk is also increased if there is an odd type of mole formed.

In addition to these factors, a family history of melanoma and a compromised immune system can also increase one’s melanoma risk.

Diagnosis

Melanomas are detected by merely looking or inspecting the skin, but a biopsy is the most appropriate way to get a confirmed diagnosis of melanoma. All or portion of the abnormal mole or growth is excised and examined during the biopsy. Following are the biopsy procedures used in the diagnosis of melanoma:

  • Punch Biopsy: A punch biopsy is performed with a circular blade tool. A circular piece of skin is excised by pressing the blade into the skin around a suspected mole.
  • Excisional Biopsy: This procedure removes the entire mole or tumour, as well as a narrow border of normal-looking skin.
  • Incisional Biopsy: During an incisional biopsy, the most irregular section of a mole or growth alone is excised for laboratory investigation.

Imaging tests such as PET/CT and MRI scans may be recommended for the staging of the disease. These tests can help in finding if the disease has spread to critical internal organs.

Once the doctor receives a confirmed diagnosis of melanoma, a personalised treatment plan is created which may involve one or more treatment modalities.

Treatment

Before a treatment plan is created, doctors consider multiple factors namely the stage of the disease, the location, the size, the patient’s age and his/her overall condition. Melanomas can be treated with the following treatment options:

a. Surgery: The mole/growth, as well as some surrounding healthy tissue, is removed during surgery. If the disease has migrated to neighbouring lymph nodes, they will be removed as well. Additional treatments, namely chemotherapy or radiation therapy may be administered in conjunction with surgery to treat melanoma with positive clinical outcomes.

b. Radiation therapy: To kill the melanoma cells, high-powered radiation beams, such as X-rays, are used during radiation therapy. The doctor may recommend radiation therapy if the lymph nodes are also removed during the surgery. Radiation therapy is also given to ease symptoms, such as pain, caused by advanced-stage melanomas.

c. Chemotherapy: Chemotherapy involves the use of chemicals to kill cancer cells. Chemotherapy can be given intravenously, or in pill form, or both, to kill cancer cells all over the body. Depending on the location, chemotherapy can also be administered directly into a vein in the arm or leg, a process known as isolated limb perfusion. During this operation, blood in the arm or leg is blocked from reaching other regions of the body for a brief period of time so that the chemo drugs can directly reach the melanoma.

d. Immunotherapy: Immunotherapy is administered for melanoma cases to strengthen the patient’s immune system so that it can recognise and kill melanoma cells. Immunotherapy may be recommended after the removal of lymph nodes after the surgery or if the surgery could not remove the melanoma completely.

e. Targeted therapy: Medication developed to target specific vulnerabilities in cancer cells is used in targeted therapy. These vulnerabilities could be particular protein particles, biomarkers, specific genes, etc. Targeted therapy stops cancer cells from growing and spreading, as well as limiting damage to the surrounding tissues.

Frequently Asked Questions

1. Is melanoma treatable?

When melanoma is found early on, it is usually treatable. Some melanomas progress slowly, while others advance more readily. Therefore, it is critical to evaluate your skin every three to four months in order to detect any changes as soon as possible.

2. Can melanomas become metastatic?

When melanoma is found early on, it is usually treatable. Some melanomas progress slowly, while others advance more readily. Therefore, it is critical to evaluate your skin every three to four months in order to detect any changes as soon as possible.

3. I have many moles. Am I at a higher risk of developing melanoma?

Yes, having many moles is considered a risk factor for melanoma but not all moles are melanomas.

That said, you must keep an eye on any new or changing skin growths, particularly those that look different from other moles – this helps in catching melanoma in its early stages when it can be treated successfully.

4. Does melanoma come back?

In some cases, melanoma can come back.

After melanoma treatment, doctors recommend a stringent follow-up regimen, which should be diligently followed by the patients. Follow-ups play a critical role in reducing the risk of relapses or catching them before they advance.

Hence, it is important for melanoma survivors to not miss their follow-up appointments and follow the recommended medical advice.

5. Can I reduce my risk of getting melanoma?

As melanoma formation is controlled by a few lifestyle factors, you can reduce its risk by following a few measures:

  • Avoid prolonged sun exposure, especially between 10 am and 4 pm.
  • Always slather some sunscreen on your skin before leaving your home – a good sunscreen with SPF 30 reduces not just reduces your melanoma risk but also other skin cancer types.
  • Avoid artificial tanning as it increases your melanoma risk.
  • Always keep an eye on any mole that is forming or any mole whose appearance is changing.

These measures can help you reduce your melanoma risk remarkably.

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