Melanoma is the cancer of the cells that make the skin pigment. It usually starts as a small mole and then changes its size, color and has itchiness. It is a fairly common type of cancer and is found equally in women and men. Being one of the most common types of cancer, it is also considered one of the most deadly. It took more than 55 thousand lives in 2012 alone. Scientists think that the rising cause of melanoma is the increase in use of UV rays. This paper will look into what melanoma is and what are the major causes and risks of melanoma. This paper explains the simple rules that doctors have shown to diagnose melanoma. It will also summarize what treatment options are available and how much research is being done to eliminate this cancer. Different therapies like surgery, chemotherapy and proleukin are done to treat melanoma according to the intensity of the disease.
Melanoma is commonly referred to as malignant melanoma. Developed from cells that contain pigment (called melanocytes), it is a common kind of cancer. It is usually attributed to being the disease of the skin but can also occur in one’s intestines, eyes, mouth and legs. Women patients often develop the disease on their legs while men can experience the disease on their backs. It is common for melanoma to start from a mole on the skin which eventually changes. The size may increase, the edges become irregular, skin breaks down, there are itching and color changes. (WHO, 2009)
Melanoma is called the most deadly kind of skin cancer. In 2012 alone it killed fifty-five thousand people and affected over two hundred thousand. Countries that have a high rate of melanoma include Australia and New Zealand with continents like North America, and Europe high on the list too. It is found in Asia, South America, and Africa too but is not that common. After the 1960s, it has become quite common in Caucasians. (WHO, 2009)
The disease is becoming more and more coming to people below the age of forty with a startling increase in female patients. The cause of the disease is still unclear, but an overexposure to Ultraviolet rays seems to be a common reason. Tanning beds or lamps is common too.
If one is aware of the causes of the disease, it may be easy to prevent it. If not that, then it may get easier to detect the changes in early stages and treat cancer at the earliest possible time. The treatment of Melanoma can be quite successful if it is detected in its earlier stages.
Doctors have commonly referred an easy method, the ABCDE, to detect the symptoms of melanoma.
A is for asymmetrical skin lesion.
B is for Border is irregular (of the lesion).
C is for multiple colors.
D is for the diameter of the lesion. If it is more than six mm, it is a cause for alarm.
E is for enlarging of the moles or their evolution.
Doctors have discovered problems with this method, nevertheless. Many melanoma moles, when they first appear are smaller than 6 mm and all of them are very small dots. When diagnosing the lesion, doctors will usually check out all moles, regardless of their size. Sometimes, seborrheic keratosis, an old age skin condition relatively harmless, can raise a false alarm. With examination through dermatoscopy, physicians are able to distinguish between seborrheic keratosis and melanoma.
A few doctors are of the opinion that moles which evolve are more dangerous than those that simply grow bigger. Others opine that elevation of said moles is far more dangerous. However, if the mole does not elevate or enlarge or both, it can still be melanoma. Many cases in America are detected before elevation because, by the time that happens, cancer becomes far worse.
A different kind of melanoma, called Nodular Melanoma, is detected through the EFG method.
E is for the elevation of the mole (as compared to the skin).
F is for firm – the mole is solid to the touch.
G is for growth – the mole grows bigger.
After a visual examination and dermatoscopy, a biopsy is common. The biopsy may also occur after applying vivo diagnostic methods. It is performed under anesthesia to determine the existence and severity of the disease.
Melanoma damages the DNA when the skin is exposed to ultraviolet radiation from the sun. It can also be genetic. UV rays received from tanning beds raise the risk of melanoma. Researchers have often titled tanning beds to be carcinogenic to human beings. The International Agency for Cancer Research says that people who use tanning beds before turning thirty are seventy-five percent more likely to get melanoma. UVB that has wavelengths between 315 to 280 nm is immersed in the skin cells and DNA and can damage the skin through cyclobutane pyrimidine dimers (CPDs). These are created by the combining of two pyrimidine bases right next to each other on a DNA strand. UVA light has wavelengths of 400 to 315 nm. These also come from the sun or tanning beds. The rays from UVA are more quickly absorbed by DNA in the skin. (Azoury, 2014)
Melanoma is also genetic, and a few rare mutations run through families. This can raise the risk of melanoma – especially some specific genes that carry a relatively high risk of the disease. A gene called MC1R (it causes red hair) has a lower risk but still increases susceptibility. Many physicians use genetic testing for mutations.
The gene CDKN2A affects a specific class of mutations. A substitute reading frame alteration in this gene can cause the destabilization of p53. It is found in nearly half of human cancer types. Xerodermapigmentosum can also increase the chances of melanoma. This mutation can decrease the ability of the cell to repair damaged DNA, as it spreads through the genome. (Azoury,2014)
There are a number of other mutations that increase the genetic chances of skin cancer or melanoma.
Some kinds of biopsies, like the excisional biopsy, may remove the tumor, but it is necessary to conduct additional surgeries for the complete cure and to make sure cancer does not come back. A standard procedure includes a thorough excision surgery (but with margins and surgical assessments to allow for future detections of the metastatic disease) and follow ups after a few months and a couple of years. A wide local excision with is 2 to three centimeters margins is common. With smaller stages of melanoma, like melanoma in situ and lentigo malign as, the margins are about 0.3 to 0.5 cms long, with most surgeons preferring the 0.5 cm margin. However, the 0.2 margin is acceptable as well. (National Cancer Institute, 2015)
Melanoma diseases in later stages need additional enhancive treatment. However, physicians in different countries have different opinions to this. In America, for example, patients in good health will still continue with interferon treatment for at least twelve months. Now, this may cause severe side effects but it does improve the prognosis of the patient. However, in Britain, dermatologists from all over the country do not recommend interferon in melanoma – in fact, they discourage it as an enhancive treatment for cancer. (Swanson, 2002)
Chemotherapy is another option for patients. Many agents, like immunotherapy, interferon, dacarbazine (also known as DTIC), interleukin 2 (or IL 2) and local perfusion are commonly used by different chemotherapists. However, the success of this procedure is very little.
Proleukin was a therapy introduced in 1990 for the first time in almost two decades. Studies show that it may offer a long-term and everlasting possibility of curing the disease although this has been seen in a very limited number of patients. (Swanson, 2002)
Azoury, SC; Lange, JR (October 2014). "Epidemiology, risk factors, prevention, and early detection of melanoma,". The Surgical clinics of North America 94 (5): 945–62, vii. PMID 25245960
National Cancer Institute (June 26, 2015) "Melanoma Treatment–for health professionals (PDQ®)".Retrieved 25 July 2015.
Swanson N, Lee K, Gorman A, Lee H (2002). "Biopsy techniques.Diagnosis of melanoma". Intensive 2011: The Third International Conference on Resource Intensive Applications and Services 20 (4): 677–80.
WHO International Agency for Research on Cancer Monograph Working Group (August 2009). "A Review of Human Carcinogens—Part D:Radiation." The Lancet Oncology 10 (8): 751–2.