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Melanoma - Types, Risks, Diagnosis and Treatment
What is Melanoma
Melanoma is a very serious form of skin cancer. It begins in melanocytes cells that make the skin pigment called melanin. Although melanoma accounts for only about 4% of all skin cancer cases, it causes most skin cancer related deaths. The good news is that melanoma is often curable if detected and treated in the early stages.
Four Basic Types
Melanomas fall into four basic categories.
1. Lentigo maligna - This remains close to the skin surface for quite a while and usually appears as a flat or mildly elevated mottled tan, brown, or dark brown discoloration. This type of melanoma is usually found among the elderly. It develops on chronically sun-exposed, damaged skin on the face, ears, arms, and the upper trunk. Lentigo maligna is the most common form of melanoma in the Hawaii region.
2. Lentigo maligna melanoma is the invasive form.
3. Acral lentiginous melanoma also spreads superficially before penetrating more deeply. It usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is sometimes found among dark-skinned people.
4. Nodular melanoma is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. The color is most often black but can be blue, gray, white, brown, tan, red, or skin tone.
How Does Melanoma Develop and who is at Risk
When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in the eye (ocular melanoma or intraocular melanoma) and, rarely, in other areas where melanocytes are found such as the digestive tract, meninges, or lymph nodes. When melanoma spreads (metastasis), cancerous cells are also found in the lymph nodes and possibly other parts of the body such as liver, lungs, or brain. In this case, the cancer cells are still melanoma cells and the disease is called metastatic melanoma.
Anyone can contract melanoma but some people are more likely to get it. You are also at risk if you have someone in the family who had cancerous moles or a melanoma. If you have moles larger than a pencil eraser or more than 50 moles of any size, you should get a thorough check up. If you ever received a sun burn that caused blisters, you should see a doctor. If your skin usually burns, it may mean there is a problem. Melanomas can be anywhere on your body.
It is important to detect Melanoma as early as possible. The American Cancer Society recommends that people aged 20-40 years have a skin check up every 3 years. People 40 years or older should get one every year. Self-examination of the skin is also important to detect new growths or other changes. If you notice an odd-looking mole or marking, contact your doctor as soon as possible. Your doctor will take a complete medical history and give you a physical examination. If your doctor also thinks the mole or marking looks unusual, a procedure known as a biopsy will be performed. To perform a biopsy, a local anesthetic will be injected under the skin to numb the area. The entire mole or a small sample will be removed and examined in a laboratory to determine if it is cancerous.
Treatment of Melanoma
There are various treatments for melanoma. A dermatologist is the best source to guide a patient regarding the treatment of melanoma. The dermatologist will consider the size, type and stage of the disease. The most important factor is the extent of penetration of the cancer cells.
Surgery:
This is the main form of treatment for all melanomas. The extent of surgery depends on a number of factors including the depth of tumor invasion and the location on the body surface.
Immunotherapy or Biological Agents:
These drugs are used to help the body's immune system fight the cancer. Alpha interferon can be used to prevent the spread of cancer cells in patients who are at high risk of disease recurrence following surgery. Biological agents are generally considered for patients with advanced melanoma.
Chemotherapy:
In case of metastatic melanoma, chemotherapy may be recommended. A single drug or a combination may be used to try and halt the growth of cancer cells once they have spread.
Radiation Therapy:
The tumor is targeted with high energy X-rays. This is occasionally useful for local disease control in certain cases.
Melanoma is one of the few cancers that have shown regression without treatment. Spontaneous partial regression can be common but complete and permanent regression is rare. It has been suggested that spontaneous regressions occur because the patient’s immune system rejects the cancer. This observation has caused physicians to try treatments with interferons, interleukins, vaccines and other treatments that stimulate the immune system.
Diagnosis:
For disease confined to the site of origin: the greater the thickness or depth of local invasion of the melanoma, the higher the chance of lymph node metastases. This may make the prognosis worse. Following surgery, the highest risk of recurrence is within the first two years but late relapses are not uncommon.
Questions to ask your doctor, if you are diagnosed with Melanoma
1. What stage is the melanoma at?
2. How does that affect my treatment?
3. How deep was the melanoma when it was removed?
4. Can you explain what this means for me?
5. Was a margin of healthy tissue removed around the melanoma?
6. What are the chances that my cancer will come back?
7. Is there any other treatment you recommend for me after surgery?
8. Why do I need this treatment?
9. Can I choose what treatment to have?
10. Will this treatment reduce the risk of my cancer coming back?
11. How long does the treatment take?
12. What are the side effects of this treatment?
13. Are there any long term side effects of this treatment?
14. Are there any experimental treatments I could try?
15. Are there any trials running at this hospital (or another hospital) that you would recommend for me?
16. Can you tell me about the melanoma vaccine?
17. How often will you want to see me after my treatment has been completed?
18. What will happen on these follow up appointments?
19. What should I do if I am worried between appointments?
20. Should I have my other moles checked regularly and if so, how and where? |
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