Skin cancer – melanoma

The most dangerous form of skin cancer, these cancerous growths develop when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors. These tumors originate in the pigment-producing melanocytes in the basal layer of the epidermis. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. Melanoma kills an estimated 10,130 people in the US annually.

If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. In 2016, an estimated 76,380 of these will be invasive melanomas, with about 46,870 in males and 29,510 in women.

Skin Cancer, Melanoma – Symptoms

The patient may not have any symptoms in the early stages of melanoma. Or a melanoma may be sore, or it may itch or bleed.

Most melanomas start as a new skin growth on unmarked skin. The growth may change color, shape, or size. These types of changes are an early sign that the growth is melanoma. But melanoma can also develop in an existing mole or other mark on the skin. Or it may look like a bruise that isn’t healing or show up as a brown or black streak under a fingernail or toenail.

Melanoma can grow anywhere on the body. It most often occurs on the upper back in men and women and on the legs in women. Less often, it can grow in other places, such as on the soles, palms, nail beds, or mucous membranes that line body cavities such as the mouth, the rectum, and the vagina.

On older people, the face is the most common place for melanoma to grow. And in older men, the most common sites are the neck, scalp, and ears.

The ABCDE rule is another guide to the usual signs of melanoma:

• A is for Asymmetry: One half of a mole or birthmark does not match the other;
• B is for Border: The edges are irregular, ragged, notched, or blurred;
• C is for Color: The color is not the same all over and may include different shades of brown or black, or sometimes with patches of pink, red, white, or blue;
• D is for Diameter: The spot is larger than 6 millimeters across (about ¼ inch – the size of a pencil eraser), although melanomas can sometimes be smaller than this;
• E is for Evolving: The mole is changing in size, shape, or color.

Some melanomas don’t fit these rules..

Other warning signs are:

• A sore that doesn’t heal;
• Spread of pigment from the border of a spot into surrounding skin;
• Redness or a new swelling beyond the border of the mole;
• Change in sensation, such as itchiness, tenderness, or pain;
• Change in the surface of a mole – scaliness, oozing, bleeding, or the appearance of a lump or bump.

Skin Cancer, Melanoma – Treatment

Once melanoma has been diagnosed and staged, the cancer care team will discuss the treatment options with the patient. Based on the stage of the cancer and other factors, the treatment options might include:

• Surgery;
• Immunotherapy;
• Targeted therapy;
• Chemotherapy;
• Radiation therapy.

Early-stage melanomas can often be treated with surgery alone, but more advanced cancers often require other treatments. Sometimes more than one type of treatment is used.

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