Introduction

Melanoma, clinically known as malignant melanoma, is the most serious type of skin cancer. If not treated, melanoma may metastasize, or rather, quickly spread to other parts of the body, which could be fatal. Fortunately if diagnosed early, melanoma is highly manageable and treatable. Melanoma affects both genders as well as people of all color; nonetheless, those with light skin are more at risk for melanoma. Associated risk factors that increase one’s risk for contracting melanoma are those who frequently sun bathe, use tanning beds, and/or sun lamps. Ultraviolet (UV) light is emitted by the aforementioned examples, which may cause mutations in DNA. Such mutations in DNA may consequently cause skin cancer. Other factors concerning UV light that put one at higher risk for contracting melanoma are those who: use tanning beds before the age of 35; have had five or more blistering sunburns between the ages of 15-20 years old; live in sunny states such as Arizona and Florida; and 65 years old and older due to the longer exposure to UV light. While exposure to UV light greatly increases one’s risk for developing melanoma, other characteristics also play a role. The risk of getting melanoma increases if someone has one or more of the following: having many or large atypical moles; taking certain medications; having previously developed other forms of cancer; having previously developed an immunocompromised-disease such as AIDS; and also having a family history of melanoma.

Causes

As mentioned above, melanoma is generally caused by DNA damage to skin cells (called melanocytes), from exposure to ultraviolet (UV) light. It is also known that, similar to other cancers, genetic predisposition plays a role in causing melanoma. This means that certain genes passed down from generations have been found to cause melanoma. It is documented that UV light from the sun and tanning beds can do two things: cause melanoma on normal skin through DNA mutations and increase the risk of a mole turning into a melanoma.

Symptoms 

Early signs of melanoma can be categorized by the shape or color of existing moles. For nodular melanoma (the most dangerous form of melanoma), appearance of a new lump anywhere on the skin is a telltale sign of hyperplasiac cell growth (i.e. cancer). For later stage cases of melanoma, the mole may itch, ulcerate, or even bleed.  There exists a handy mnemonic (worth memorizing) that summarizes the early signs of melanoma. Knowing this “ABCDE” mnemonic may assist in remaining vigilant to the characteristics of melanoma in the hopes of catching and treating melanoma before it advances. The “ABCDE” mnemonic goes as follows:

• Asymmetry (one half does not resemble the other)
• Borders (irregular and poorly defined border)
• Color (has shades of tan, brown, or black; may at times be white, red or blue)
• Diameter (greater than 0.24 inches; roughly the size of a pencil eraser)
• Evolving over time (where skin lesions or moles looks different in their shape, size, and color)

Nodular melanoma does not follow the above characteristics for it has its own classifications:

• Elevated above the skin surface
• Firm to the touch
• Growing

Metastasis of early melanoma is possible, yet relatively rare. Metastatic melanoma may cause nonspecific paraneoplastic symptoms, including loss of appetite, nausea, vomiting, and fatigue. If melanoma does metastasize, common places of it spreading are to the abdomen, liver, distant limp nodules, and bones. Also, brain metastases are particularly common in patients with metastatic melanoma.

Diagnosis

After we have collected your history of symptoms and overall health, we will then examine your skin as well as palpate your lymph nodes. If present, we may meticulously examine moles and other suspicious spots, especially in more sun-exposed areas. To get a better look, we may use a device called a dermoscope, which helps to view pigments and structures by magnifying the skin via light. If a suspicious mole or other structure is spotted, we may perform a skin biopsy where the whole or portion of the mole is removed and sent to the laboratory for analysis. It is worth mentioning that melanoma cannot be diagnosed without a biopsy. If the biopsy confirms the presence of melanoma, the stage of the melanoma will be categorized. Staging allows us to determine the severity and aggressiveness of the cancer. Staging can be categorized into five stages where Stage 0 is described as melanoma that is confined to the epidermis (top layer of skin) and the most severe stage, stage IV, describes melanoma that has spread. If it has been confirmed the melanoma is present, we may order another type of biopsy, known as a sentinel lymph node biopsy (SLNB), which more precisely stages melanoma. Other tests that a patient may need include x-rays, blood work, and a CT scan.

Treatment

The type of treatment someone receives will depend on how deep the melanoma has grown into the skin, whether it has metastasized, and overall health. The first line of treatment may be to aggressively remove the moles and/or cancerous structures through surgery. Two common types of surgery are excision and Mohs surgery. Excision is recommended for cases where the melanoma has not spread and is often a noninvasive procedure. Mohs surgery begins by removing the visible part of the melanoma. When caught early, removing the melanoma by excision or Mohs surgery may be all the treatment a patient needs. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). We may refer to this as melanoma in situ or stage 0. In this stage, the cure rate with surgical removal is nearly 100%. For cases of melanoma where it has grown deeper into the skin, more complex treatments may be advised. More advanced treatments include: targeted pharmaceutical therapy, chemotherapy, radiation therapy, adoptive T-Cell therapy, immunotherapy, and a lymphadenectomy (surgical removal of affected lymph nodes).