Malignant Melanoma

Malignant melanoma is the least common of the three main skin cancers, but the most aggressive. While melanoma only accounts for about 4% of all skin cancers, it is responsible for more than 73% of skin cancer deaths. Melanoma is a form of skin cancer that arises from melanocytes – the cells that produce pigment which gives the skin its color and protects it from sun damage. People with darker skin produce more melanin and are therefore more protected. Melanocytes often cluster together and form moles (nevi). Most moles are benign, but some may go on to become malignant melanomas.

Melanomas are divided into 4 main types, depending on their location, shape and whether they grow outward or downward into the dermis:

Superficial Spreading Melanoma: This often begins as a flat dark stain on the skin or appears as a change to a pre-existing mole. It accounts for 2/3 of all melanomas.

Nodular Melanoma: This is usually unrelated to a pre-existing mole. A smooth nodule appears, and it is often blue-black in color – it may grow rapidly and spread to the lymph glands quickly.

Acral Lentiginous Melanomas: This occurs on the palms of the hand, on the soles of the feet or under nail beds, and can grow and spread quickly. In dark-skinned people it accounts for most of melanomas.

Lentigo Maligna Melanoma: This is quite common on chronically sun-exposed skin and usually appears on the face of elderly people. If you notice any changes to an existing mole, or new skin growths, have a dermatologist examine them. The chance of beating melanoma is greatest when the tumor is new, and can be removed in its entirety.

Common symptoms of malignant melanomas include: Sudden appearance of small, irregularly shaped, pigmented growths on or under the surface of the skin Moles that suddenly or continuously get larger Mole that change color or become swollen Moles that become scaly, erode or ooze. Crusting, ulceration or bleeding are signs of more advanced disease Itching may be a symptom – there may also be feelings of tenderness or pain. Skin cancers however are usually painless and symptomless Early detection of skin cancer is critical as it reduces the risk for spread to other areas of the body. Have your moles checked regularly by a dermatologist or your family doctor. Err on the side of caution and always have a mole checked if you are unsure.

Sunlight is the main environmental agent that causes malignant melanomas. However, the exact wavelengths of sunlight that cause melanoma are unknown. Research has shown that people with certain risk factors are more likely than others to develop melanomas.Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes) than in people with dark skin. Melanoma sometimes runs in families. Having two or more close relatives who have had this disease is a risk factor. About 10 percent of all patients with melanoma have a family member with the disease.People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. Because of this, doctors advise that parents protect children’s skin from the sun to reduce the risk of melanoma later in life. Sunburns in adulthood are also a risk factor for melanoma.People whose immune system is weakened by certain cancers, by drugs given following organ transplantation, or by HIV are at increased risk of developing melanoma.

 

Take proper and gentle skin care measures with skin damaged by UV light. Use gentle cleansers that are fragrance and allergen free to avoid irritating damaged areas of the skin. Look for moisturizers that contain UV filters, which can offer additional safeguards against UV radiation. Make sure to apply these frequently and generously, to adequately hydrate and protect the skin.

Since malignant melanomas are caused by exposure to UV rays, it’s important to take preventive measures when going outdoors.

Limit sun exposure: Reducing your time in the sun is perhaps the easiest way to avoid damage to your skin caused by UV rays. When outdoors, set a time limit and seek shade when necessary. Also keep in mind that UV radiation is the strongest between the hours of 10 a.m. to 4 p.m.

Use Sunscreen:Sunscreens are an essential part of protection against the sun. Look for sunscreens that are labeled “Broad Spectrum”. They are often the most effective and offer protection against both UVA and UVB rays. Make sure to apply generously and frequently.

Cover and protect: Wrap-around sunglasses, wide-brimmed hats and clothing that covers your arms and legs, can offer extra protection against the sun’s harmful UV rays.

Look for any changes in your skin: If any changes in existing moles, or new skin growths are noticed, consult with a dermatologist immediately to determine if the symptoms may be precancerous.

 

OTC
The daily use of sunscreen can greatly reduce your chances of developing malignant melanoma. Look for sunscreens that contain the following ingredients: Benzophenone, Oxybenzone, Avobenzone, Titanium Dioxide and Zinc Oxide. These are all active ingredients that help to prevent sun damage. Make sure your sunscreen offers protection against both UVA and UVB rays. These will be simply labeled “broad spectrum”. A recent study from Australia indicated that sun protection from sunscreens can reduce the appearance of melanoma. A reduction in sun exposure is also likely to be important.

Procedures
Surgery is the primary standard treatment for localized melanoma. Additional therapy may be given after surgery for high risk melanomas to destroy any cancer cells that may have escaped from the primary site. Chemotherapy and radiation therapy are both supplementary therapies for melanoma. Chemotherapy reaches cells all over the body (systemic therapy) and destroys cancer cells that may have travelled from the primary melanoma site. Chemotherapy is usually given in advanced melanoma Radiation therapy destroys cancer cells that may still be in the area after a melanoma is removed. It may be used for select cases of melanoma Biological Therapy (immunotherapy) may be offered as therapy for melanomas with higher risk of recurrence or regional lymph node metastasis. A newly approved drug affecting the BRAF mechanism is showing great promise in slowing the advance of melanoma.Non-specific immunotherapy is used to stimulate the immune system as a whole. Specific immunotherapy targets the tumor selectively. The primary agent used in biological therapy is high dose interferon alpha. There are new very promising drugs coming available that are the start of a new generation of helpful drug therapy.