Melanoma

Melanoma is a serious type of skin cancer originating from melanocytes, the cells responsible for skin pigmentation. While it generally appears on the skin, it can also develop in the eye, genitals, or inside the mouth. Though less common than other skin cancers, melanoma is more dangerous due to its potential to spread to other parts of the body if not treated swiftly. In the last decade, the incidence of invasive melanoma has increased by 42% annually, with around 100,000 new cases expected in the U.S. this year, leading to over 8,000 deaths. While melanoma can occur in anyone, light-skinned and older individuals, as well as young people under 30, are more susceptible. In individuals with skin of color, melanoma is often detected at a more advanced stage, complicating treatment. Early detection is crucial, as melanoma is highly treatable in its initial stages. Awareness of melanoma and recognition of early signs can facilitate early diagnosis, making treatment simpler.

Causes

Melanoma development is linked to several primary causes:

• Ultraviolet (UV) Light Exposure: The main contributor to melanoma is UV light-induced damage to skin cells, whether from the sun or artificial sources like tanning beds. UV rays can damage the DNA in skin cells, leading to uncontrolled cell growth.

• Genetic Mutations: The BRAF oncogene mutation is a typical genetic change in about half of melanomas. Some people inherit genetic mutations that impair DNA damage repair, heightening melanoma risk.

• Skin Characteristics and History: Individuals with fair skin, history of sunburns, or a family history of melanoma are more at risk. Those with numerous or atypical moles also face higher risks.

• Melanomas in Less Sun-Exposed Areas: While UV exposure is significant, some melanomas appear in areas not heavily exposed to the sun, suggesting other factors like genetic predispositions.

Preventing melanoma involves protective measures such as regular sunscreen use, wearing protective clothing, and avoiding peak sun hours.

Symptoms

Melanoma manifests through noticeable changes in the skin. Be aware of:

• New, dark, or unusual spots differing from existing moles.

• Moles changing in size, shape, or color.

• Moles that differ significantly from others, known as the “ugly duckling sign.”

• Colors ranging from brown or black to blue, pink, or skin-colored, appearing flat, bumpy, or elevated.

• Itching or pain associated with spots.

Remember the ABCDEs for early detection:

• Asymmetry: Uneven halves of a mole.

• Border: Irregular or notched edges.

• Color: Multiple colors within a single spot.

• Diameter: Larger than a pencil eraser.

• Evolving: Changes in existing moles or lesions.

Regular skin monitoring and consulting a healthcare provider for concerning changes are essential for early detection, greatly enhancing treatment effectiveness.

Diagnosis

Diagnosis begins with a thorough skin examination by a healthcare professional, typically a dermatologist, searching for unusual spots. Upon finding a suspicious area, a skin biopsy is conducted to check for cancer cells. This minor procedure involves removing a small skin section, often under local anesthesia. Depending on the biopsy type—excisional or punch—you might need stitches. Upon melanoma confirmation, staging, crucial for treatment planning, follows. This involves measuring melanoma's thickness, checking for ulceration, and assessing cancer spread through tests like sentinel lymph node biopsies and imaging scans (CT or PET). These detailed protocols ensure an informed approach to melanoma management and treatment.

Treatments

Initial melanoma treatment typically involves surgery to remove cancerous tissue, adequate for early-stage cases. The aim is complete melanoma removal with healthy skin margins, often performed in a doctor's office or surgical center, potentially alongside a sentinel lymph node biopsy. Post-surgery, a pathologist verifies clear margins, ensuring the cancer's removal.

Advanced or metastasized melanoma requires additional treatments. Radiation therapy eliminates cancer cells using high-energy waves, often when melanoma reoccurs or affects lymph nodes. Medication treatments include immunotherapy to boost the immune system against cancer cells and targeted therapy to disable specific melanoma cell vulnerabilities. Chemotherapy is considered when other treatments aren't effective. Treatment choice depends on cancer stage, location, and patient health. Continuous follow-ups help manage side effects and detect recurrence.

Medications

Several medications treat advanced melanoma:

• Immunotherapy Medications: Drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) improve the immune system's capacity to fight cancer cells.

• Targeted Therapy Medications: These treatments, including vemurafenib (Zelboraf) and dabrafenib (Tafinlar), attack proteins from the BRAF mutation. Combining with MEK inhibitors, like trametinib, enhances their effectiveness.

• Chemotherapy Medications: Directly kill cancer cells, but are not the primary choice due to better options.

These therapies show promising results but can cause side effects such as skin issues, fever, or joint pain, necessitating regular medical monitoring.

Prevention

• Protect skin from UV rays to lower melanoma risk.

• Avoid sun exposure during peak UV hours (10 a.m. to 4 p.m.).

• Use a broad-spectrum sunscreen (minimum SPF 30) on exposed skin, reapplying regularly post-swimming or sweating.

• Wear protective clothing, wide-brimmed hats, and UV-blocking sunglasses.

• Avoid tanning beds, known to increase melanoma risk.

• Educate children on sun safety to protect their skin.

• Regularly check skin for new or changing moles, consulting healthcare professionals for unusual changes.

Incorporating these measures into daily life, coupled with a healthy lifestyle, can help protect against melanoma.