Melanoma

Overview:

Melanoma is the most severe form of skin cancer, known for its potential to spread to other organs. While it can be fatal, early detection through surgery offers a chance of cure. The incidence of melanoma in the United States has been on the rise. It occurs as a result of changes in melanocytes, the cells responsible for producing skin pigment, and can develop independently or within existing moles. Melanoma can affect any part of the skin, including areas not typically exposed to the sun, and may even develop within the eye.

The risk of developing melanoma increases with age, but it is the most common cancer among women aged 25 to 29, although it is rare before puberty. There are several types of melanoma, including superficial spreading, nodular, lentigo maligna, and acral lentiginous. Superficial spreading melanoma comprises up to 70% of cases and is commonly found on the backs of men and the legs of women. It appears as a flat or slightly raised spot with irregular shape and color, typically growing slowly over years. Nodular melanomas, representing 15% to 30% of cases, grow rapidly over months, affecting deeper skin layers, and can appear as brown, black, blue, or non-pigmented raised lesions. Lentigo maligna melanoma, accounting for 4% to 10% of cases, occurs on sun-exposed areas of older individuals, particularly the face, characterized by irregularly shaped and colored flat spots. The least common type is acral lentiginous melanoma, making up 2% to 8% of cases, typically seen in black individuals on the palms, soles, or under fingernails or toenails, exhibiting a dark streak within the nail.

Diagnosis:

Melanomas are diagnosed through skin biopsies and are staged based on tumor size, lymph node involvement, and metastasis. Lesion thickness and the presence of ulceration are also important factors in determining the severity and prognosis of melanoma. During skin exams, professionals use the ABCD criteria: asymmetry, irregular borders, color variation, and diameter. Suspicious lesions should be biopsied, and a definitive diagnosis is made after microscopic evaluation by a pathologist.

Treatment:

Surgery is the primary treatment for melanoma, involving the complete excision of the lesion along with a margin of healthy tissue. The width of the margin depends on the depth of the melanoma. Thicker melanomas may require a sentinel lymph node biopsy to check for lymphatic system involvement.

Management:

Following a melanoma diagnosis, individuals should undergo complete skin exams every 3 months for the initial 1-3 years, and then every 6 months. These examinations should cover the entire skin surface as melanomas can occur in non-sun-exposed areas. The goal is to detect any recurrence, metastasis, or precursor lesions. Annual complete skin examinations are also recommended for immediate family members.

Coping:

Organizations like the American Melanoma Foundation (www.melanomafoundation.org) provide support for individuals diagnosed with melanoma. Regular self-checks for new or changing lesions, along with compliance with professional skin checks, are essential.

Prevention:

Strict sun protection measures, such as daily use of sunscreen and wearing sun-protective clothing, can help prevent melanoma and other skin cancers. Regular skin checks conducted by trained professionals aid in identifying skin cancers and potential precursor lesions.