Melanoma

Melanoma is widely regarded as the most serious type of skin cancer, originating from melanocytes, which are the pigment-producing cells in the skin. Though primarily developing on the skin, it can also manifest in other locations such as the eyes, genital regions, or inside the mouth. Melanoma is less common compared to other skin cancers, yet it is more hazardous due to its propensity to spread to other body parts if untreated. Over the past decade, cases of invasive melanoma have risen by 42%, with approximately 100,000 new cases expected in the United States this year and more than 8,000 resulting in death. Although melanoma can develop in anyone, it is more frequently observed in older individuals with lighter skin. It can also affect younger adults and is prevalent among individuals under 30. In darker-skinned individuals, melanoma tends to present at more advanced stages, making it harder to treat. Early detection is critical, as melanoma is highly treatable in its early stages. Familiarity with melanoma basics and its warning signs is essential for early diagnosis and effective treatment.

Causes

Melanoma's development is influenced by several factors, with exposure to ultraviolet (UV) light being the most prevalent cause. Here are the primary factors contributing to melanoma:

• UV Light Exposure: UV rays from the sun and tanning beds can cause DNA damage in skin cells. While the body can initially repair some of this damage, excessive UV exposure can overwhelm the repair mechanisms, increasing melanoma risk.

• Genetic Mutations: Mutations in the BRAF oncogene are seen in approximately half of all melanoma cases. This mutation significantly impacts how skin cells grow and divide, playing a crucial role in melanoma development.

• Inherited Genetic Factors: Some individuals inherit gene mutations that compromise the body's ability to repair DNA damage, elevating melanoma risk.

Understanding these causes is vital for directing treatment approaches, specifically those targeting genetic mutations related to melanoma.

Symptoms

Recognizing melanoma's symptoms is key to early intervention. Here are significant signs to watch for:

• New dark or unusual skin spots.

• Moles that change in size, shape, or color.

• Moles differing from others on your body, known as the "ugly duckling sign."

• While often brown or black, melanoma can appear blue, pink, or match the skin tone and may vary in elevation.

The ABCDE rule can guide recognition:

• Asymmetry: Uneven halves of the mole.

• Border: Irregular or bumpy edges.

• Color: Multiple colors like tan, black, white, or pink.

• Diameter: Larger than a pencil eraser.

• Evolving: Changes in existing moles or lesions.

Melanoma typically appears in sun-exposed areas but can emerge unexpectedly on palms, soles, or under nails in individuals with darker skin. Awareness of symptoms facilitates early diagnosis and improved outcomes.

Diagnosis

Diagnosing melanoma begins with a comprehensive skin examination, often by a dermatologist, though a primary care provider may also conduct this assessment. If a suspicious area is identified, a skin biopsy will confirm melanoma presence. Conducted as an outpatient procedure, the biopsy involves numbing the area and excising a tissue sample for lab analysis. Subsequent steps involve staging the melanoma, crucial for prognosis and treatment planning. Staging considers the cancer's thickness, skin ulceration presence, and spread to lymph nodes or other regions. Early-stage melanoma, known as "melanoma in situ," is confined to the epidermis. Thicker melanomas indicate more severe conditions, especially with ulceration. Sentinel lymph node biopsy and imaging scans like CT or PET scans may assess spread beyond the skin.

Treatments

Melanoma treatment varies, accounting for the melanoma stage, genetic mutations, and patient's health and preferences. Early-stage melanoma may require surgery alone, conducted either in-office or at a surgical center. Surgery aims to remove the melanoma with sufficient surrounding normal tissue, verified by a pathologist for clear margins. In certain scenarios, radiation therapy using high-energy particles, like X-rays, may supplement treatment, particularly for lymph node involvement or recurrence sites.

Medications

Advanced melanoma may necessitate medications, including:

• Immunotherapy: Boosts the immune system's ability to recognize and eliminate cancer cells. Examples: pembrolizumab (Keytruda), nivolumab (Opdivo).

• Targeted Therapy: Focuses on specific components in melanoma cells, like proteins from the BRAF mutation. Examples: vemurafenib (Zelboraf), dabrafenib (Tafinlar).

• Chemotherapy: Directly attacks cancer cells but is less preferred due to more effective alternatives.