Symptoms and treatment of Melanoma

Description

Melanoma is a type of skin cancer that begins in the melanocytes. Melanocytes are cells that produce the pigment that gives the skin its color. The pigment called melanin.

Melanoma usually starts in the skin that is often exposed to the sun. This includes the skin of the arms, the back, the face and the legs. Melanoma can also form in the eyes. Rarely, it can occur inside the body, such as the nose or the throat.

The exact cause of all melanomas isn't clear. The majority of melanomas are caused by exposure to ultraviolet light. Ultraviolet light, also called UV light, comes the light from the sun or tanning lamps and beds. Limit the exposure to UV light can help reduce the risk of melanoma.

The risk of melanoma appears to be increasing in people under 40, especially women. Knowing the symptoms of skin cancer can help ensure that cancerous changes are detected and treated before the cancer has spread. Melanoma can be successfully treated if found early.

Symptoms

The first melanoma signs and symptoms often are:

A change in an existing mole.
The development of a new pigmented or unusual-looking growth on your skin.

Melanoma does not always begin as a mole. It can also occur in otherwise healthy skin.

Melanoma symptoms can occur in any part of the body. Melanomas are most often develop in areas that have had exposure to the sun. This includes the arms, back, face, and legs.

Melanomas can also occur in areas that are not as exposed to the sun. This includes the soles of the feet, palms of the hands and under the nails. Melanoma can also occur within the body. These hidden melanomas are more common in people with brown or Black skin.

Typical polka dot

Typical moles are generally of a uniform color. You can have a look pink, tan, brown or black. In people with brown and Black skin, typical of moles are more likely to be dark brown or black. Typical of moles have a clear boundary that separates the top of the surrounding skin. They are round or oval and usually less than 1/4 inch (about 6 millimeters) in diameter.

Most moles will begin to appear in childhood and new moles can form up to around 40 years of age. By the time they are adults, most people have between 10 and 40 moles. The moles may change in appearance over time, and some may even disappear with age.

The signs that may indicate melanoma

Some moles are not typical. They may have certain characteristics that indicate the melanomas or other skin cancers. Features may include:

Asymmetrical shape. Look for moles with unusual shapes, such as two very different-looking halves.
Changes in the color. Look for growths that have many colors or unusual color patterns.
Changes in size. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters).
The changes in symptoms. Look for changes in symptoms, such as new itching or bleeding.
Unusual border. Look for moles with unusual, serrated or scalloped borders.

Moles that become cancers look very different. Some may show all the changes mentioned above, while others may have only one or two unusual features.

Hidden melanomas

Melanomas can also develop in areas of the body that have little or no exposure to the sun. These areas may include spaces between the toes of the feet and the palms of the hands, soles of the feet, scalp, or on the genitals. These are sometimes referred to as hidden melanomas because they occur in places that most people wouldn't think to check. When melanoma occurs in people with brown or Black skin, it is more likely to occur in a hidden area.

Hidden melanomas that includes:

Melanoma in the interior of the body. Mucosal melanoma develops in the mucous membrane. This tissue lines the nose, the mouth, esophagus, anus, urinary tract, and vagina. Mucosal melanomas are especially difficult to detect, because they can easily be confused with other more common conditions.
The Melanoma in the eye. Eye melanoma is also called ocular melanoma. Most often occurs in the layer of tissue beneath the white part of the eye. This layer is called the uvea. A melanoma of the eye can cause vision changes, and can be diagnosed during an eye exam.
Melanoma under a nail. Acral-acral melanoma is a rare form of melanoma that can occur in a nail or toe nails. You can also find it in the palms of the hands or the soles of the feet. Acral-acral melanoma tends to be very dark, flat, and have a very unusual borders. It is more common in people of Asian descent and people with brown or Black skin.

When to see a doctor

Make an appointment with your doctor or other health care professional if you notice any skin changes that worry you.

Causes

Melanoma occurs when there is healthy changes of melanocytes, the cells of cancer. Melanocytes are the skin cells that produce the pigment that gives the skin its color. The pigment called melanin.

Melanoma starts when the melanocytes develop changes in their DNA. A cell's DNA contains the instructions that tell a cell what to do. In healthy cells, the DNA contains the instructions to grow and multiply at a set rate. The instructions that tell cells to die at a set time. In cancer cells, changes in DNA to give different instructions. The changes, to tell the cancer cells to make many more cells quickly. Cancer cells can continue living when healthy cells would die. This makes too many cells.

The cancer cells may form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. At the time, cancer cells can break off and spread to other parts of the body. When cancer spreads, it is called metastatic cancer.

It is not clear what changes in the DNA of the cells of the skin and how it leads to melanoma. It is likely that a combination of factors, including genetic and environmental factors. Even so, health professionals believe that exposure to ultraviolet light is the main cause of melanoma. Ultraviolet light, also called UV light, from the sun and tanning lamps and beds.

The UV light is not the cause of all melanomas, especially those that occur in places of your body that do not receive exposure to sunlight. This means that other factors may contribute to the risk of melanoma.

Risk factors

Factors that may increase the risk of melanoma include:

A family history of melanoma. If a close relative has had melanoma, you have a greater chance of developing a melanoma, also. Close relatives may include a parent, child or sibling.
A history of sunburn. One or more severe, blistering sunburns can increase your risk of melanoma.
Exposure toUVlight. Ultraviolet light, also called UV light, which comes from the sun and tanning lamps and beds increases your risk of skin cancer, including melanoma.
Having many moles, or moles that are not typical. With more than 50 typical of moles on your body indicates an increased risk of melanoma. In addition, we have a type of mole that is not typical increases the risk of melanoma. Medically known as dysplastic nevi, these moles tend to be larger than the typical moles. They may have unusual borders and a mixture of colours.
Live close to the equator or at a higher elevation. People who live closer to the earth the equator of the most direct experience of the sun's rays. Therefore, they experience a greater amount of UV light of the sun that the people who live more to the north or the south. In addition, people who live in a higher elevation are more exposed to the UV light.
Skin burns easily. Anyone can get melanoma, but it is more common in people with white skin. If you have blond or red hair, light-colored eyes, and freckle or sunburn easily, you're more likely to develop melanoma.
Weakened immune system. If the body's germ-fighting immune system is weakened by medications or disease, there may be an increased risk of melanoma and other skin cancers. People with a weakened immune system include those who take medications to control the immune system, such as after an organ transplant. Certain medical conditions, such as infection with HIV can weaken the immune system.

Prevention

You can reduce your risk of melanoma and other types of skin cancer if you:

Avoid tanning lamps and beds. Tanning lamps and beds emit ultraviolet light, also called UV light. The exposure to this type of light can increase your risk of skin cancer.
Avoid the sun during the middle of the day. For many people in North America, the sun's rays are strongest between 10 am and 4 pm Schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy.
Become familiar with your skin so that you'll notice changes.Check your skin often for new growths of the skin. Look for changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp. Look at your chest and trunk, and upper and lower part of the arms and hands. Check the front and back of the legs and feet, including the soles of the feet and the spaces between the toes. Also make sure that your genital area and between your buttocks.
Wear protective clothing.When you go out on the street during the day, wear clothes that help protect your skin from the sun's rays. Cover your skin with dark, tightly woven clothing that covers the arms and legs. Wear a wide-brimmed hat, which provides more protection than a baseball cap or visor. Some companies also sell protective clothing. A dermatologist can recommend a brand. Don't forget the sunglasses. Look for those that block both types ofUVlight that come from the sun, calledUVAandUVB.
Use sunscreen all year round. The use of a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously. Re-apply every two hours, or more often if you're swimming or perspiring.

Become familiar with your skin so that you'll notice changes. Check your skin often for new growths of the skin. Look for changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp.

Look at your chest and trunk, and upper and lower part of the arms and hands. Check the front and back of the legs and feet, including the soles of the feet and the spaces between the toes. Also make sure that your genital area and between your buttocks.

Wear protective clothing. When you go out on the street during the day, wear clothes that help protect your skin from the sun's rays. Cover your skin with dark, tightly woven clothing that covers the arms and legs. Wear a wide-brimmed hat, which provides more protection than a baseball cap or visor. Some companies also sell protective clothing. A dermatologist can recommend a brand.

Don't forget the sunglasses. Look for those that block both types of UV light that comes from the sun, called UVA and UVB rays .

Diagnosis

Tests and procedures used to diagnose melanoma include:

Physical examination

Your health care professional will ask you questions about your health history. This person will also examine your skin to look for signs that could mean the melanoma.

The removal of a sample of tissue for testing

A biopsy is a procedure to remove a sample of tissue for testing in a lab. What type of biopsy procedure you use depends on your situation. Most often, health care professionals recommend the removal of all the growth when possible.

A common technique is called the punch biopsy. A punch biopsy is done with a circular blade that is pressed into the skin around the suspicious mole.

Another technique which is called an excisional biopsy. An excisional biopsy uses a scalpel to cut out the entire mole and a part of the healthy tissue around it.

The determination of the extent of the melanoma

If you receive a diagnosis of melanoma, the next step is to determine the extent of the cancer, called the stage. To assign a stage of your melanoma, your care team will be:

Determine the thickness.In general, the thicker the melanoma, the most serious of the disease. The thickness of a melanoma is determined by looking at the melanoma under a microscope and measure with a special tool. The thickness of a melanoma helps your care team to decide on a treatment plan. Thinner melanomas may only require surgery to remove the cancer and some healthy tissue around it. If the melanoma is thicker, your health care team may recommend other tests to see if the cancer has spread before you decide on your treatment options.
To see if the melanoma has spread to the lymph nodes.If there is a risk that the cancer has spread to nearby lymph nodes, you may need a biopsy of the sentinel lymph node. During a sentinel lymph node biopsy, a dye is injected into the area where the melanoma was removed. The dye flows into the nearby lymph nodes. The first of the lymph nodes to take up the dye are removed and tested for cancer cells. The first of these lymph nodes are called the sentinel lymph nodes. If you are free of cancer, there is a good chance that the melanoma has spread.
Look for signs of cancer beyond the skin. If there is a concern that the melanoma has spread, imaging tests, can be used to look for signs of cancer in other areas of the body. The tests may include X-rays, magnetic resonance imaging , computed tomography and positron emission tomography, also called a PET scan. These imaging tests are not usually used for the smaller melanomas with a lower risk of spread beyond the skin.

Determine the thickness. In general, the thicker the melanoma, the most serious of the disease. The thickness of a melanoma is determined by looking at the melanoma under a microscope and measure with a special tool. The thickness of a melanoma helps your care team to decide on a treatment plan.

Thinner melanomas may only require surgery to remove the cancer and some healthy tissue around it. If the melanoma is thicker, your health care team may recommend other tests to see if the cancer has spread before you decide on your treatment options.

To see if the melanoma has spread to the lymph nodes. If there is a risk that the cancer has spread to nearby lymph nodes, you may need a biopsy of the sentinel lymph node.

During a sentinel lymph node biopsy, a dye is injected into the area where the melanoma was removed. The dye flows into the nearby lymph nodes. The first of the lymph nodes to take up the dye are removed and tested for cancer cells. The first of these lymph nodes are called the sentinel lymph nodes. If you are free of cancer, there is a good chance that the melanoma has spread.

Other factors that will determine the risk that the cancer may spread. A factor to consider is if the skin over the area has formed an open sore, called ulceration. Another is how many division of cancer cells are found when looking at a sample of the cancer under a microscope. Doctors call this the cancer of the mitotic index.

Your health care team uses the results of these tests to find out your melanoma of the stage. Melanoma stages use the numbers from 0 to 4. In phase 0 and phase 1, a melanoma is thin and small. It is likely that the treatment will be successful. As the melanoma grows deeper into the skin, the stages get more. The treatment becomes more difficult. In stage 4, the cancer has spread beyond the skin to other organs, like the lungs or the liver.

Treatment

The treatment for Melanoma often starts with the surgery to remove the cancer. Other treatments may include radiation therapy and treatment with medications. The treatment for melanoma depends on several factors. These factors include the stage of your cancer, your overall health and your own preferences.

Surgery

Melanoma treatment usually includes surgery to remove the melanoma. A very thin melanoma can be removed during the biopsy and require no further treatment. Otherwise, the surgeon will remove the cancer, as well as some of the surrounding healthy tissue.

For people with melanoma that are small and slender, surgery may be the only treatment needed. If the melanoma has grown deeper into the skin, there may be a risk that the cancer has spread. Therefore, other treatments are often used to ensure that all the cancer cells die.

If the melanoma has grown deeper into the skin or if it has spread to nearby lymph nodes, surgery could be used to remove the lymph nodes.

Radiation therapy

Radiation therapy treats cancer with powerful rays of energy. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

Radiation therapy can be directed to the lymph nodes if the melanoma has spread. The radiation therapy may also be used for the treatment of melanoma that cannot be removed completely with surgery. For the melanoma spreading to other areas of the body, the radiation therapy may help to relieve the symptoms.

Immunotherapy

Immunotherapy for cancer is a treatment with a medication that helps the body's immune system to kill cancer cells. The immune system fights diseases by attacking the germs and other cells that should not be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the cells of the immune system find and kill cancer cells.

For melanoma, immunotherapy may be used after surgery for cancer that has spread to the lymph nodes or to other areas of the body. When the melanoma cannot be removed completely with surgery, treatments of immunotherapy may be injected directly into the melanoma.

Targeted therapy

Targeted therapy for cancer is a treatment that uses drugs that attack specific chemicals in cancer cells. By blocking these chemicals, specific treatments can cause cancer cells to die.

For melanoma, targeted therapy may be recommended if the cancer has spread to the lymph nodes or to other areas of your body. Melanoma cells can be tested to see if targeted therapy is unlikely to be effective against the cancer.

Chemotherapy

Chemotherapy treats the cancer with strong medications. Many chemotherapy drugs exist. Most are administered through a vein. Some come in the form of a pill.

Chemotherapy may be an option to help control melanoma that has not responded to other treatments. Can be used when the immunotherapy or targeted therapy are not helping.

Sometimes chemotherapy may be given into a vein in your arm or leg in a procedure called perfusion of the isolated limb. During this procedure, the blood in your arm or leg is not allowed to travel to other areas of your body for a short time. This helps to keep the chemotherapy drugs near the melanoma and does not affect other parts of your body.

Coping and support

With time, you will find what helps you to deal with the uncertainty and distress of a cancer diagnosis. Until then, you can find help for:

Learn enough about the melanoma to make decisions about your care

Ask your health care team about your cancer, including your test results, treatment options, and, if you like, your prognosis. As you learn more about melanoma, you can be more confident in making treatment choices.

Keep friends and family close

Keep your close relationships strong will help you deal with the melanoma. Friends and family can provide the practical support you need, such as help to take care of your house if you're in the hospital. And that you can serve as emotional support when you feel overwhelmed by the fact of having cancer.

Find someone to talk to

Find someone who is willing to listen to you talk about your hopes and fears. This can be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group may also be useful.

Ask your health care team about support groups in your area. Other sources of information are the National Cancer Institute and the American Cancer Society.

Preparing for your appointment

Make an appointment with a doctor or other health care professional if you notice any skin changes that worry you.

If your healthcare provider thinks you might have melanoma, you may be referred to a doctor who specializes in diseases of the skin. This doctor is called a dermatologist. If a diagnosis of cancer, you may also be referred to a doctor who specializes in the treatment of cancer. This doctor is called an oncologist.

Because appointments can be brief, it is a good idea to be prepared. Here's some information to help you prepare.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that do not seem to be related to the reason for which you scheduled the appointment.
Write down key personal information, including major stresses or recent life changes.
Make a list of all medications, vitamins or supplements you are taking and the dose.
Have a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write questions to ask their health care team.

Your time with your health care team is limited, so preparing a list of questions to help you make the most of your time together. A list of questions from most important to least important in case time runs out. For melanoma, some basic questions to ask include:

Do I have melanoma?
How big is my melanoma?
How deep is my melanoma?
Has my melanoma spread beyond the area of skin where it was discovered for the first time?
What additional tests do I need?
What are my treatment options?
Can any treatment to cure my melanoma?
What are the possible side effects of each treatment option?
There is a treatment that you feel is best for me?
How much time can I take to decide on a treatment option?
You should see a specialist? What will that cost, and will my insurance cover it?
Are there brochures or other printed material that I can take with me? What sites do you recommend?
What is going to determine whether I should plan for a follow-up visit?

Do not hesitate to ask other questions.