Malignant melanoma is a skin disorder, which produces tumors of melanocytes or tumors of cells produced by melanocytes . The disease was uncommon in the past; however, in the recent years, the number of cases of malignant melanoma increased significantly, especially, the number of deaths due to malignant melanoma. The disease develops in radical and vertical phases. In the radical phase, the malignant cells develop in a radical manner within the epidermis, while in the vertical phase; the malignant cells intrude into the dermis cells. The lesions developed by malignant melanoma are thin, moderate or thick depending upon the depth of the lesion. The five kinds of malignant melanoma are nodular melanoma, acral lentiginous melanoma, uperficial spreading melanoma, mucosal lentiginous melanoma and lentigo maligna melanoma . In addition to the skin, malignant melanoma also develops in the eyes, esophagus, genital organs and mucosal surfaces.
The rate of occurrence of malignant melanoma is common in whites when compared to Asians and Blacks. In whites, it is more common in individuals with white skin than black skin. A typical patient suffering from malignant melanoma is prone to sunburn frequently. The disease occurs more commonly in men than in women. The lesions are thinner in women when compared to men . Also, the mortality rate is less in the early stages of malignant melanoma because the disease has lesser chances to spread rapidly . Malignant melanoma occurs irrespective of the age. It is more common in the age group between 25 and 29. However, in children below the age of ten years and adults above the age of 75 years, malignant melanoma is rare. In the United States, the incidence of malignant melanoma increases at a rate of 5-7% per year. Globally, Australia records the highest cases of malignant melanoma, followed by Israel.
When considering the signs and symptoms of malignant melanoma, one needs to learn the family history of the patient regarding melanoma, skin cancer, irregular moles, astrocytoma and multiple nevus syndrome . Previous exposure of the patient to melanoma or sun, and change in the color, size or symmetry of the moles also causes melanoma. Malignant melanoma occurs in several stages. However, acute staging is crucial to evaluate the method of treatment, follow-up and risk of recurrence. Malignant melanoma develops into a tumor and thickens for up to 4 mm. The tumors may occur with or without ulceration and mitosis. Malignant melanoma also develops in the nodes. The different steps in the nodal stage are micro metastasis and macro metastasis. In the metastasis stage, malignant melanoma occurs subcutaneously. Other steps include visceral metastases with elevated serum. The final stage is the TNM stage, which is tumor, node, and metastasis stage . It involves four substages depending on the occurrence of malignant melanoma at various locations and in various forms of the skin.
The diagnosis of malignant melanoma involves several steps. The initial diagnosis involves the examination of the body, followed by epiluminescence microscopy, and skin examination to distinguish between the different types of lesions . Excisional biopsy also assists in the diagnosis of malignant melanoma. Sentinel biopsy at the lymph node provides prognostic information. A dermatoscope helps to identify the lesions closer and determine the accuracy of the disease. Complete blood count and chemistry panel are the laboratory studies that indicate the physical health of the patient. The imaging techniques include chest radiography, MRI scan of the brain, CT scan of the chest, pelvis and abdomen, ultrasonography to diagnose the involvement of the lymph node . Histologic findings such as Cytologic atypia and upward growth pattern melanocytes.
Early stage melanoma cures instantly with the help of surgical treatment. In some cases, lymph node biopsy and dissection are the main treatment techniques in primary melanoma. Surgery relieves the major symptoms and controls the disease locally. Adjuvant therapy is a mandate for patients suffering from advanced melanoma to facilitate long-term survival of the patients . Also, there are high chances of recurrence of the disease, due to which doctors approve interferon alfa after the excision. Biological therapies along with chemotherapy regimens also treat the advanced stage of malignant melanoma. Palliative therapy for malignant melanoma includes the administration of dacarbazine, , lomustine, taxanes and cytokines, or a combination of the above drugs . In the aggressive stage, cisplatin and vindesine respond partially, however, the survival chances are unclear. The recent drugs ipilimumab and vemurafenib show excellent results, but they are still in the testing phase .
Patients suffering from malignant melanoma should undergo regular follow-ups to check the progress of the treatment in curing the disease. While patients suffering from static disease do not require frequent follow ups, those suffering from invasive melanomas have a risk of relapse of the disease depending on their age. On the other hand, stage I-A melanoma patients require 2-4 follow ups a month for up to one year and stage IB-IIIA melanoma patients require a single follow up per 3 months for up to 3-5 years . Patients with advanced melanoma require follow ups depending on their need and progress of the disease. The chances of survival of patients suffering from malignant melanoma varies from patient to patient as it purely depends on the depth at which the melanoma cells are present. In the case of thinner lesions, the response of the treatment is high when compared to thicker lesions.
The following are the preventive measures to reduce the occurrence of malignant melanoma. Reduced exposure to sun significantly lessens the chances of the disease as exposure to sun causes damage to the skin in individuals with vitamin D deficiency. Awareness programs also help to prevent the incidence of the disease; however, the past programs did not give expected results. The use of sunscreens while going out in the sun helps to reduce the occurrence of malignant melanoma; however, there are no scientific recommendations on the use of sunscreens . Avoiding the use of sun bed not only reduces the risk of occurrence of malignant melanoma, but also non-melanoma cancers. Furthermore, wearing protective clothing and sunglasses, avoiding UV radiation and sun exposure in the peak hours reduces the incidence of the disease . Regular skin checkups to evaluate the health of the skin help to take preventive measures against malignant melanoma.
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