Melanoma Monday

 

1. What is Melanoma?
2. The Four Types of Melanoma
3. Causes and at Risk of Melanoma
4. Melanoma Detection and Prevention
5. Treatments for Melanoma
6. After Treatment

What is Melanoma?

Melanoma is a type of skin cancer made of melanocytes that grow out of control. Melanocytes are responsible for giving your skin its tan or brown color, however, if they start to grow out of control they result in skin cancer. While melanoma is one of the less common types of skin cancer, it is still very dangerous because it will likely spread to other parts of the body if it isn’t diagnosed and treated early on.

While melanoma accounts for about 1% of skin cancers, it has the large majority of skin cancer deaths. However, if detected early, the survival rate for people with melanoma is 5 years. Even though it is a deadly cancer, it is also one of the few cancers you can identify for yourself through different methods in order to avoid serious consequences.

The Four Types of Melanoma

There are four types of melanoma; superficial spreading, nodular, lentigo maligna, and acral lentiginous. Here are some of the facts and differences between the four:

• Superficial Spreading: This is the most common type of skin cancer, it makes up about 70% of the cases. It tends to grow and spread across the surface of the skin. It usually has uneven borders, it’s thin, and can be in different colors. Sometimes it can start from a mole on the skin and spread to other parts of your body like the chest or legs.
• Nodular: This is the second most common type of skin cancer. It grows down into the skin, making it spread faster than the other types of melanoma cancer. This can be identified usually by a raised growth from the skin and it can be black, red, pink, or your skin color. This type tends to develop on the face, chest, and back, but also in places that are not exposed to the sun.
• Lentigo maligna: This type of skin cancer tends to develop in people who are older. It can look like a flat tan or brown patch with an uneven border. It tends to grow and can change pigmentation or have multiple pigmentations at once. It also grows on the surface of the skin before it starts growing down into your body. It is connected to sun exposure and it is common on the face, ears, and arms.
• Acral Lentiginous: This one is most common in people of color, usually coming from African and Hispanic descent. It makes up less than 5% of all melanoma skin cancers and it is not related to sun exposure. It looks like a small, flat spot of discolored skin and it grows on the surface of the skin before it starts spreading down into the body. While this affects a small percentage of people, it is the hardest to diagnose because it grows mainly on the soles of your feet, the palms of your hands, and even under your nails, which makes it hard to spot.

There are also 3 more types of melanoma but they are rare. There is one that affects your eyes, one that develops on the inner layer of skin, and the last starts on the thin and moist lining of organs in your body. While these might be rare, it’s always good to get yearly checkups regardless.

Causes and at Risk of Melanoma

Most of the cases are caused by UV rays from the sun, but there are also moles and spots on your skin that can also be melanoma. Even though many cases are caused by sun rays and tanning beds, there are multiple factors that go into this skin cancer, some of which aren’t affected by the sun at all. While melanoma can affect anyone, those with fair-colored skin are at a higher risk as well.

Starting with UV exposure, there has been a clear correlation between radiation and skin cancer. Whether it’s from the sun or from tanning beds, they are very harsh on the skin and the primary factor for developing this cancer. Severe and multiple sunburns also increase your risk of developing melanoma.

A weak immune system is another factor that can affect skin cancer. Some people have weak immune systems due to medications and treatments, which put them at risk of developing melanoma. Those who have lymphoma and HIV are also at a higher risk.

Having many moles can also put you at an increased risk for melanoma. While some moles are harmless, about 20% to 30% of melanomas can come from existing moles already. There are also atypical moles, which means they can have irregular borders and multiple colors. While these moles aren’t usually cancerous, people with these moles are at a higher risk of developing melanoma. There are also tips that we will discuss later on to help you identify moles that could be harmful.

Having a history of skin cancer in the family also puts you at a higher risk of developing melanoma. One in about every ten patients diagnosed with this skin cancer has had a family member with melanoma. You are at an even higher risk if it’s a close relative, such as parents, siblings, or even your own kids. Plus, if you have already had melanoma, you have a higher risk of reoccurrence and are at risk for developing new melanomas, too.

Melanoma Detection and Prevention

Early detection of melanoma is key to staying healthy and safe. You should look for new, changing, or unusual skin and moles on the body, whether they are exposed to the sun or not. While melanomas can arise anywhere, they are more common on the legs for women and the chest and back for men. While some skin growths can be harmless, there are two techniques that will help you find out if they should be of concern: the ABCDEs and the Ugly Duckling signs.
The ABCDEs refer to the different warning signs of melanoma;

• Asymmetry: if you can draw a line down the middle and the two sides don’t match up, then it is asymmetrical, and most melanomas are asymmetrical.
• Border: If the borders seem to be uneven or have notched edges, then it has a higher chance of being melanoma because common moles are smooth and have even borders.
• Color: Having multiple colors is a sign of melanoma. Most normal moles are just one color shade, but if they have different shades of brown, black, tan, etc., and change as they grow, that is a warning sign.
• Diameter and Darkness: If the diameter of the mole is 6mm (the size of a pencil eraser) or larger, you should get it checked out. Also if it is darker in color than most moles, it could also be a warning sign.
• Evolving: Changes in size, shape, color, or elevation of moles or spots on your skin are all warning signs that you should not ignore.
• The second technique is the Ugly Duckling. This means that you are looking for a mole or spot that stands out. Most moles on your body should resemble each other, which is why we look for outliers. These lesions can be larger or smaller, lighter or darker, and could be isolated. If there is a lesion that doesn’t look like the rest of the spots or moles on your body, that is a warning sign and you should be checked by a doctor. Besides this, you should also check yourself for new moles, spots, or any lesions on your skin, especially if it starts evolving.

For prevention, the most obvious one is to protect yourself from UV rays. You should wear sunscreen every day, whether it is sunny or cloudy, the sun’s rays are very powerful regardless. Wearing clothing to protect your skin can also be very valuable. Avoiding tanning beds completely will have you at a lower risk by avoiding the radiation. The next step for prevention is to check yourself regularly. Check for new spots, moles, or anything new on your body every month. If they don’t have any warning signs then you are most likely safe as long as you are taking precautions. However, even though monthly checks are important, you should get checkups once a year just to get a medical professional’s diagnosis. Lastly, if you have had melanoma in the past, follow up regularly with your doctor as often as he recommends in order to stay healthy.

Treatment of Melanoma

In order to be diagnosed with melanoma, your dermatologists will take a biopsy of the tissue and send it to a lab where they can determine whether cancer cells are present or not. If you are diagnosed with melanoma, there are a few treatments. Depending on how early it is caught, the stage, where it is located, and your own health history, there are different treatments.

If you are in the early stages, then surgical removal is an option. Since it is only in the upper layers of skin and hasn’t spread, then the surgeon will remove the tumor and a margin of normal skin around it for safety.
There is also immunotherapy, which stimulates your immune system in order to destroy cancer cells. They use synthetic versions of natural immune system proteins and enable cell release to attack the tumor. This has proven to help patients by extending their life expectancy even in advanced stages. They also set up checkpoints to make sure your cells are only attacking the cancer cells and not healthy cells.

Then we have targeted therapy, which uses drugs and other agents to attack melanoma and control the growth and spread of the cancerous cells. This treatment halts or slows the progression of melanoma to help patients live longer while also causing minimal damage to healthy cells.

Chemotherapy is used as a last resort type of treatment. There has been a lot of success with immunotherapy and targeted therapy, so if those don’t work, you could turn to chemotherapy. However, it can be used in conjunction with other treatments as well. Chemotherapy tries to stop the growth of the tumor with medicines that kill the cancer cells or stop them from multiplying. Unfortunately, it has proven to extend the life of a patient by very little and can have serious side effects on top of that.

Lastly, we have radiation, which is mainly used for melanoma patients who have tumors that have spread to the brain and other organs. Radiation is supposed to shrink the tumor and lessen pain. It can also be used on a surgical site in order to ensure that all tumor cells are killed. This is basically high-energy X-ray beams that penetrate and destroy tumors or keep them from growing. They are mainly used on melanomas that have a high risk of reoccurrence, returning melanomas, and melanomas that have spread.

After Treatment

Once you finish treatment there are a few options depending on the outcome. Some people who have had treatment but melanoma is still in their body will have to learn to live with the cancer and that can be very stressful. There are groups and therapies that your doctor can recommend, and they can try new treatments in order to see if they can get you back on track. You will still have to do your part to stay healthy and get screenings in order to see if there are other kinds of cancers you could be susceptible to. Dealing with these feelings is the hardest part, but there are resources that can help, like the American Cancer Society.

The second option is finishing treatment and removing or destroying the cancer. While you may feel relieved about winning the battle, it is hard not to think about reoccurring cancer, which can be common for some patients. Follow your doctor’s advice about checkups, especially at first because your doctors will want to monitor you closely to make sure the cancer doesn’t come back. They may also ask you to take exams and lab tests to look for other signs of cancer. After treatment, you should also consult with your doctor about the long-term side effects, if any, of the treatment you received to make sure that it is normal and that you are dealing with them correctly. You should also set up early screening appointments to keep you healthy and finally maintain a healthy lifestyle with a good diet and exercise.