Melanoma

Symptoms Of Melanoma

Melanoma can develop anywhere on the body but is most common in sun-exposed areas like the face, arms, legs, and back. In darker skin tones, it may appear in less exposed areas such as the palms, soles, or nail beds, known as hidden melanomas. Some of the earliest symptoms of melanoma can be:

• A change or development in a pre-existing mole

• A new mole, pigmented skin, or growth starts developing on your skin

However, it is important to note that melanoma doesn’t always start from a mole. There are some easy ways to differentiate between a normal mole and a mole that can become cancerous.

To remember this, all you need to think of are the letters ABCDE:

• ‘A’ stands for asymmetry: A potentially cancerous mole is often asymmetrical, with uneven halves and an irregular shape.

• ‘B’ stands for border: In a cancerous mole, the border will be irregular. It will not be circular or oval, like normal moles. Instead, it might have a notched or scalloped border.

• ‘C’ stands for color:  Carcinogenic (cancerous) moles may show uneven or changing colors, so watch for unusual growths with irregular color patterns.

• ‘D’ stands for diameter: Usually, moles are about ¼ inch or 6 millimetres. Anything larger than that can be carcinogenic. 

• ‘E’ stands for evolving: The most significant indicator of a cancerous mole is that it changes over time. Try to see if the mole grows in size or changes its colors. It might even change its shape or become itchy. In some cases, one might even note bleeding.

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Types Of Melanoma

Melanoma can be classified into the following types:

1. Cutaneous (skin) melanoma

There are four major types of cutaneous melanoma:

• Superficial spreading melanoma: This is the most common form of the disease, responsible for about 70% of cases. This type usually develops in a pre-existing mole.
  
  

• Nodular melanoma: This is the second most common, responsible for 15 to 30% of cases. These are more aggressive and usually develop more rapidly than superficial melanomas.
  
  

• Lentigo maligna: This type of melanoma appears as large, flat lesions most commonly found on the faces of light-skinned women over the age of 50. This form of melanoma, responsible for about 4% to 10% of cases, has a lower risk of metastasis than other types.
  
  

• Acral lentiginous melanoma: This occurs on the palms, soles of the feet or beneath the nail beds. They account for only 2% to 8% of melanomas in fair-skinned patients, but up to 60% of melanomas in darker-skinned patients. This type of melanoma is extremely aggressive and large, with an average diameter of three centimeters. 

2. Mucosal melanoma

• Mucosal melanomas are rare, making up only about 1% of all diagnosed melanoma cases. 
• This disease occurs in mucosal tissue, which lines body cavities and hollow organs like the nasal cavity, mouth and esophagus, rectum, urinary tract and vagina.

3. Ocular melanoma

Because the eyes contain melanocytes, or pigment-producing cells, they can be susceptible to melanoma. Two types of ocular melanoma include:

• Uveal melanoma:  It is an eye cancer that affects the iris (the colored part of the eye), the ciliary body (helps focus and produces eye fluid), or the choroid (provides oxygen and nutrients to the eye).

• Conjunctival melanoma: This is the melanoma of the conjunctiva that presents as a raised, pigmented or non-pigmented lesion that appears in adult life. 

Causes Of Melanoma

Melanoma happens when melanocytes, the cells that produce skin color, become damaged. It usually starts in moles, but most moles aren't cancerous.

Normally, old skin cells are shed, but DNA damage can cause cells to multiply abnormally, forming cancerous clusters.
The cancerous moles can be a result of DNA mutations. DNA mutations can cause different types of cancers. 

The gene mutations resulting in melanoma can be of two types:

1. Acquired gene mutations

• Melanoma is typically caused by gene mutations acquired during life, not inherited.

• These mutations can happen randomly or be triggered by external factors like UV exposure.

• UV rays from the sun or tanning beds damage skin cells and can lead to melanoma over time.

• Melanoma is more common in adults due to long-term UV exposure, but can also occur in areas not exposed to the sun, often due to genetic changes.

2. Inherited gene mutations

• People can also inherit the gene changes that are responsible for melanoma from their parents. However, this is a rare scenario.
• These people have specific DNAs that are more likely to develop melanomas, especially in regions exposed to the sun.

Risk Factors For Melanoma

There are several risk factors for melanoma. Some of these include:

1. Dysplastic moles

• A dysplastic nevus is a type of mole that looks different from a common mole (nevi). 

• The risk of melanoma is greatest for people who have a large number of dysplastic nevi.

2. Fair skin

• 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. 

3. Ethnicity

• Caucasians tend to get melanoma far more often than black people, probably because light skin is more easily damaged by the sun.

4. Personal or family history of melanoma or other skin cancers

• People who have been treated for melanoma have a high risk of a second melanoma. Melanoma sometimes runs in families. 

• Having two or more close relatives who have had this disease is a risk factor. 

5. Atypical mole syndrome (formerly termed B-K mole syndrome, dysplastic nevus syndrome)

• This inherited condition causes the growth of many unusual moles. 

• If a close relative has had melanoma, it is known as familial atypical multiple mole and melanoma syndrome (FAMMM).

6. Age

• Melanoma is more common in older people, with a median age of diagnosis around 50, but it can also affect younger individuals, especially those with a family history.

7. Environmental factors

•  Ultraviolet (UV) radiation

• Indoor tanning

• Severe, blistering sunburns

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8. Weakened immune system

• 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.

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9. Other inherited conditions

• Xeroderma Pigmentosum

• Retinoblastoma

• Li-Fraumeni Syndrome

• Werner Syndrome

• Hereditary Breast and Ovarian Cancer Syndromes

Diagnosis Of Melanoma

Several tests and procedures can be conducted to diagnose melanoma. Some of the standard tests include:

1. Physical exam

The doctor will first ask you various questions about your medical and health history. After that, they will inspect your skin to find any symptoms or signs that might indicate melanoma.

2. Biopsy

• Shave (tangential) biopsy: A shave biopsy is useful in diagnosing many types of skin diseases and in sampling moles when the risk of melanoma is very low.
  
  
• Punch biopsy: The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin. The sample is removed and the edges of the biopsy site are often stitched together.
  
  
• Excisional biopsy: This is done to examine a tumor that might have grown into deeper layers of the skin.
  
  
• Incisional biopsy: An incisional biopsy removes only a portion of the tumor.

3. Biopsies of melanoma that may have metastasized (spread)

• Fine needle aspiration cytology (FNAC): It may be used to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread to them.

• Surgical (excisional) lymph node biopsy: This procedure can be used to remove an enlarged lymph node through a small incision (cut) in the skin.

• Sentinel lymph node biopsy: If melanoma has been diagnosed and has any concerning features (such as being at least a certain thickness), a sentinel lymph node biopsy (SLNB) is often done to see if the cancer has spread to nearby lymph nodes.

4. Imaging tests

• Chest x-ray: This test might be done to help determine if melanoma has spread to the lungs.

• Ultrasound: It uses sound waves to create images of the inside of your body on a computer screen. 

• Ultrasound-guided needle biopsy:  It helps assess melanoma by creating detailed images of nearby lymph nodes or tissues to check for cancer spread. 

• Computed tomography (CT) scan: It helps detect melanoma spread to internal organs or lymph nodes with detailed cross-sectional images.

• CT-guided needle biopsy: CT scans can also be used to help guide a biopsy needle into a suspicious area within the body.

• Magnetic resonance imaging (MRI) scan: MRI scans use radio waves and strong magnets instead and can be very helpful in looking at any tumor in the brain and spinal cord.

• Positron emission tomography (PET) scan: A PET scan can help show if the cancer has spread to lymph nodes or other parts of the body. It is most useful in people with more advanced stages of melanoma.

• PET/CT scan: This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.

5. Blood tests

• Lactate dehydrogenase (LDH)

• Complete blood count (CBC)

• Liver function tests (LFT)

• Kidney function tests (KFT)

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Prevention Of Melanoma

There are several different ways to reduce the risk of getting melanoma and all other types of skin cancer. 

1. Protect yourself from the sun

• Stay away from sun exposure between 10 am and 4 pm when UV rays are the strongest

• Avoid getting suntans or sunburns 

• Apply sunscreen with SPF 30+ daily, even on cloudy days, and reapply every two hours.
  
  

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2. Cover yourself

Wear full-sleeved clothing, broad-brimmed hats, and UV-blocking sunglasses for extra protection.

3. Do not use tanning beds or lamps

• Avoid artificial tanning devices as they emit harmful UV radiation.
  
  

4. Examine your skin regularly

• Check your skin for new or unusual changes and visit a dermatologist annually.

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Specialist To Visit 

If you notice new or concerning skin changes, consult a doctor to evaluate and plan the best course of treatment if needed. Specialists that can help include:

• Dermatologist

• Surgical oncologist

• Radiation oncologist

• Medical oncologist 

A dermatologist can detect, diagnose, and provide treatment options for melanoma at an early stage, improving outcomes.

A surgical oncologist is a surgeon who has special training in performing biopsies and other surgical procedures in cancer patients.

A radiation oncologist is a doctor who has special training in using radiation to treat cancer. A medical oncologist treats cancer using chemotherapy and other medications like targeted therapy or immunotherapy. 

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Treatment Of Melanoma

In its early stages, the easiest way to treat melanoma is through surgery. However, when melanoma spreads beyond the skin, several different methods might get used for treatment in its later stages. 

1. Removal of lymph nodes

It is a surgical method used if the melanoma has spread beyond the skin to the lymph nodes. The doctor will remove the affected lymph nodes and a small part of the surrounding area to stop the spread. 

2. Immunotherapy 

It is a drug treatment that is commonly recommended after surgery. There are two major types of drugs that are used in immunotherapy.

Immune checkpoint inhibitors: These drugs enable the proteins in the immune system, which are disabled by the cancerous cells. Therefore, the immune system again starts attacking the cancer cells. Some common drugs include:

• Nivolumab

• Pembrolizumab

• Ipilimumab

Cytokines: The body produces proteins called cytokines which help in boosting the immune system. In some cases, doctors recommend artificial cytokines for melanoma. These drugs make it difficult for cancer cells to divide and multiply.
Some common drugs include:

• Interferon Alpha 2A

• Interferon Alpha 2B

• Pegylated Interferon Alpha 2B

• Pegylated Interferon Alpha 2A

3. Targeted therapy

In targeted therapies, drugs are aimed at a distinct point in the cancer cells responsible for multiplying and dividing abnormally. This therapy is unique to every patient, depending on how their cancer cells react to the drug.

4. Chemotherapy

These are drugs that kill cancer cells. Some common chemotherapy drugs include:

• Carboplatin

• Abraxane

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5. Radiation therapy

In this procedure, X-rays or other high-energy beams are given to the patient to kill the cancer cells. It is suggested if the melanoma has spread to the lymph nodes and beyond, and can’t be treated by surgery. 

Home-Care For Melanoma

Diet might not be closely linked to melanoma, but it can help in building immunity and helping you fight against the side effects that can occur due to the drug treatments. Here are some things you can do to take care of melanoma at home:

1. Eat right

• Protein-rich food like lean meats, eggs, low-fat dairy products, nuts, etc can be beneficial.

• Include whole grains in your diet like whole-wheat bread, oatmeal, brown rice, etc. 

• Also try to eat fat from healthy sources like olive oil, nuts, seeds, etc. Avoid eating a lot of sweets or added sugars.

• In addition, you should eat foods rich in antioxidants and even take antioxidant supplements, if necessary. 

• Studies have shown that green tea (known for its healing abilities and abundance of antioxidants) can inhibit the growth of melanocytic cells.
  
  

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2. Stay hydrated

Fluids carry nutrients to cells, flush bacteria from the bladder and prevent constipation. Staying hydrated makes treatment side effects less severe and lowers your chances of missing or delaying cancer treatments.

3. Exercise

Exercising daily can also help you relieve stress and reduce tiredness.

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Complications of Melanoma

Some common complications of melanoma are:

• Recurrence: Cancer always has a chance of recurring in your lifetime, even after it has been completely removed. It is best to check yourself regularly, even when the treatment is complete.

• Metastasis: In this scenario, cancer can spread beyond the skin to the muscles, organs, and nerves of the body. 

• Secondary infection: This is seen due to disruption of the normal skin barrier.

• Scarring: Can result from the lesion itself or treatments.

• Lymphedema: It refers to tissue swelling caused by an accumulation of protein-rich fluid systems. It commonly occurs secondary to the removal of lymph nodes but can result from cancer alone.

• Depression and anxiety: A higher prevalence of anxiety and depression have been identified in patients with advanced melanoma compared to those with early disease.

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Alternative Treatment for Melanoma

Always consult your doctor before starting anything new. Remember, these approaches complement your treatment plan and are not a substitute for medical care.Some standard alternative therapies include:

1. Acupressure and acupuncture

• These are physical therapies that can help in lowering the pain experienced when you have cancer. 

• In acupressure, the energy is released by putting pressure on different body parts, while in acupuncture, needles are used to release the stored energy. 

2. Massage and physiotherapy

• These techniques can help you in dealing with chronic pain.

• Massages and physiotherapy can help manage pain, improve mobility, and enhance quality of life in advanced cancer stages.

3. Exercise and wellness therapy 

• Exercise is one of the best ways to become healthier and stronger. 

• It is highly recommended to patients dealing with melanoma. 

• They also help in maintaining a healthy body weight which is vital during the treatment process. There is no need to do strenuous activities, and you can just do light activities like walking regularly and yoga.

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4. Hyperthermia

• This is a type of treatment in which body tissue is heated to as high as 113 °F to help damage and kill cancer cells with little or no harm to normal tissue. 

• Hyperthermia to treat cancer is also called thermal therapy, thermal ablation, or thermotherapy. However, hyperthermia to treat cancer is not widely available. 

Living With Melanoma

Having cancer can be a life-altering event. It can be tremendously difficult for someone to cope with it both mentally and physically. It can change the course of your life, and when you first get the diagnosis, it can be pretty confusing as to what to do. Here are some tips that might help: 

1. Educate yourself

• After getting a diagnosis, make sure that you learn as much as you can about melanoma. 

• Ask your doctor all the questions you have. 

• Research treatment options, diet, and prognosis to make informed and confident decisions.
  
  

2. Maintain close relationships 

• Make sure that you are in close touch with your family and friends.

• This will help you have a strong support system and let you maintain a healthy mental state. 

• They can also provide care for you during the surgical procedures and just be there for you during a tough time. 
  
  

3. Prioritize emotional and mental well-being

• Address fears and anxiety by discussing advanced cancer openly.

• Share feelings with close family and friends.

• Gather all necessary information about treatment.

• Acknowledge physical limitations and adapt accordingly.

• Communicate openly with your partner about intimacy.

• Manage practical challenges like finances, childcare, and work.
  
  

4. Manage cancer treatment costs

• Cancer treatment can be financially overwhelming.

• Unexpected expenses may arise, making it hard to continue treatment.

• Seek financial aid through social workers, grants, and benefits.
  
  

Tips For Caregivers

• Offer emotional support and encouragement.

• Understand the treatment plan and help manage side effects.

• Ensure timely medications and medical appointments.

• Assist with personal care, hygiene, and household tasks.

• Communicate with empathy and maintain a positive approach.

• Help with insurance claims, billing, and financial matters.

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