Melanoma skin cancer

What is melanoma skin cancer?

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can then spread to other areas of the body.

Melanoma is a cancer that usually starts in a certain type of skin cell called melanocytes. Other names for this cancer include malignant melanoma and cutaneous melanoma. Most melanoma cells still make melanin, so melanoma tumors are usually brown or black. But some melanomas do not make melanin and can appear pink, tan, or even white.

Melanomas can develop anywhere on the skin, but they are more likely to start on the trunk (chest and back) in men and on the legs in women. The neck and face are other common sites.

Having darkly pigmented skin lowers your risk of melanoma at these more common sites, but anyone can get melanoma on the palms of the hands, soles of the feet, and under the nails. Melanomas in these areas make up a much larger portion of melanomas in African Americans than in whites.

Melanomas can also form in other parts of your body such as the eyes, mouth, genitals, and anal area, but these are much less common than melanoma of the skin.

Melanoma is much less common than basal cell and squamous cell skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught early.

What are the risk factors for melanoma skin cancer?

Having a risk factor, or even many risk factors, does not mean that you will get melanoma. Many people with risk factors never get melanoma, while others with this disease may have few or no known risk factors.

Still, it’s important to know about the risk factors for melanoma because there may be things you can do to lower the risk of getting it. If you are at higher risk because of certain factors, there are also things you can do that might help find it early, when it’s likely to be easier to treat.

Several risk factors can make a person more likely to develop melanoma.

Ultraviolet (UV) light exposure

Exposure to ultraviolet (UV) rays is a major risk factor for most melanomas. Sunlight is the main source of UV rays. Tanning beds and sun lamps are also sources of UV rays.

While UV rays make up only a very small portion of the sun’s rays, they are the main cause of the damaging effects of the sun on the skin. UV rays damage the DNA of skin cells. Skin cancers begin when this damage affects the DNA of genes that control skin cell growth.

The nature of the UV exposure may play a role in melanoma development. For example, melanoma on the trunk (chest and back) and legs has been linked to frequent sunburns (especially in childhood). This might also have something to do with the fact that these areas are not constantly exposed to UV light. Some experts think that melanomas that start in these areas are different from those on the face, neck, and arms, where the sun exposure is more constant. And different from either of these are melanomas on the palms of the hands, soles of the feet, under the nails, or on internal surfaces such as the mouth and vagina, where there has been little or no sun exposure.

Moles

A mole (also known as a nevus) is a benign (non-cancerous) pigmented tumor. Babies are not usually born with moles; they often begin to appear in children and young adults. Most moles will never cause any problems, but someone who has many moles is more likely to develop melanoma.

Atypical moles (dysplastic nevi): These moles look a little like normal moles but also have some features of melanoma. They are often larger than other moles and have an abnormal shape or color. They can appear on skin that is exposed to the sun as well as skin that is usually covered, such as on the buttocks or scalp.

Dysplastic nevi often run in families. A small percentage of dysplastic nevi may develop into melanomas. But most dysplastic nevi never become cancer, and many melanomas seem to arise without a pre-existing dysplastic nevus.

Dysplastic nevus syndrome (also known as familial atypical multiple mole melanoma syndrome, or FAMMM): People with this inherited condition have many dysplastic nevi and at least one close relative who has had melanoma.

People with this condition have a very high lifetime risk of melanoma, so they need to have very thorough, regular skin exams by a dermatologist. Sometimes full body photos are taken to help the doctor recognize if moles are changing and growing. Many doctors recommend that these patients be taught to do monthly skin self-exams as well.

Congenital melanocytic nevi: Moles present at birth are called congenital melanocytic nevi. The lifetime risk of melanoma developing in congenital melanocytic nevi is estimated to be between 0 and 10%, depending on the size of the nevus. People with very large congenital nevi have a higher risk, while the risk is lower for those with small nevi. For example, the risk for melanoma in congenital nevi smaller than the palm of your hand is very low, while those that cover large portions of back and buttocks (“bathing trunk nevi”) have significantly higher risks.

Congenital nevi are sometimes removed by surgery so that they don’t have a chance to become cancer. Whether doctors advise removing a congenital nevus depends on several factors including its size, location, and color. Many doctors recommend that congenital nevi that are not removed should be examined regularly by a dermatologist and that the patient should be taught how to do monthly skin self-exams.

Again, the chance of any single mole turning into cancer is very low. However, anyone with lots of irregular or large moles has an increased risk for melanoma.

Fair skin, freckling and light hair

Whites with red or blond hair, blue or green eyes, or fair skin that freckles or burns easily are at increased risk. Family history of melanoma

Your risk of melanoma is higher if one or more of your first-degree relatives (parents, brothers, sisters, or children) has had melanoma. Around 10% of all people with melanoma have a family history of the disease.

The increased risk might be because of a shared family lifestyle of frequent sun exposure, a family tendency to have fair skin, certain gene changes (mutations) that run in a family, or a combination of factors.

Most experts don’t recommend that people with a family history of melanoma have genetic testing to look for mutations, as it’s not yet clear how helpful this is. Rather, experts advise that they do the following:
• Have regular skin exams by a dermatologist
• Thoroughly examine their own skin once a month
• Be particularly careful about sun protection and avoiding artificial UV rays (such as those from tanning booths)

Personal history of melanoma or other skin cancers

A person who has already had melanoma has a higher risk of getting melanoma again. People who have had basal or squamous cell skin cancers are also at increased risk of getting melanoma.

Having a weakened immune system A person’s immune system helps fight cancers of the skin and other organs. People with weakened immune systems (from certain diseases or medical treatments) are more likely to develop many types of skin cancer, including melanoma.

For example, people who get organ transplants are usually given medicines that weaken their immune system to help prevent them from rejecting the new organ. This increases their risk of melanoma.

People infected with HIV, the virus that causes AIDS, often have weakened immune systems and are also at increased risk for melanoma.

Being older

Melanoma is more likely to occur in older people, but it is also found in younger people. In fact, melanoma is one of the most common cancers in people younger than 30 (especially younger women). Melanoma that runs in families may occur at a younger age.

Being male Men have a higher rate of melanoma than women, although this varies by age. Before age 50, the risk is higher for women; after age 50 the risk is higher in men.

Can melanoma skin cancer be prevented?

There is no sure way to prevent melanoma. Some risk factors such as your age, gender, race, and family history can’t be controlled. But there are things you can do that could lower your risk of getting melanoma and other skin cancers.

Limit your exposure to ultraviolet rays!

Seek shade!

„Slip! Slop! Slap!.......and Wrap!”

If you are going to be in the sun, this catchphrase can help you remember some of the key steps you can take to protect yourself from UV rays:
• Slip on a shirt.
• Slop on sunscreen.
• Slap on a hat.
• Wrap on sunglasses to protect the eyes and sensitive skin around them.

Avoid using tanning beds and sunlamps!

Protect children from the sun!

Whatch for abnormal moles!

Checking your skin regularly may help you spot any new or abnormal moles or other growths and show them to your doctor before they even have a chance to turn into skin cancer. Routine removal of many moles is not usually recommended as a way to prevent melanoma. Some melanomas develop from moles, but most do not. If you have many moles, getting careful, routine exams by a dermatologist, along with doing monthly skin self-exams are, might be recommended.

Certain types of moles are more likely to develop into melanoma. If you have moles, depending on how they look, your doctor may want to watch them closely with regular exams or may remove some of them if they have features that suggest they might change into a melanoma.

What are the possible signs and symptomes of melanoma?

The most important warning sign of melanoma is a new spot on the skin or a spot that is changing in size, shape, or color. Another important sign is a spot that looks different from all of the other spots on your skin (known as the ugly duckling sign). If you have one of these warning signs, have your skin checked by a doctor.

The ABCDE rule is another guide to the usual signs of melanoma. Be on the lookout and tell your doctor about spots that have any of the following features:
• A is for Asymmetry: One half of a mole or birthmark does not match the other.
• B is for Border: The edges are irregular, ragged, notched, or blurred.
• C is for Color: The color is not the same all over and may include different shades of brown, or black, or sometimes with patches of pink, red, white, or blue.
• D is for Diameter: The spot is larger than 6 millimeters across (about ¼ inch – the size of a pencil eraser), although melanomas can sometimes be smaller than this.
• E is for Evolving: The mole is changing in size, shape, or color.

Some melanomas don’t fit these rules. It’s important to tell your doctor about any changes or new spots on the skin, or growths that look different from the rest of your moles.

Other warning signs are:
• A sore that doesn’t heal
• Spread of pigment from the border of a spot into surrounding skin
• Redness or a new swelling beyond the border of the mole
• Change in sensation, such as itchiness, tenderness, or pain
• Change in the surface of a mole – scaliness, oozing, bleeding, or the appearance of a lump or bump

Be sure to show your doctor any areas that concern you and ask your doctor to look at areas that may be hard for you to see. It’s sometimes hard to tell the difference between melanoma and an ordinary mole, even for doctors, so it’s important to show your doctor any mole that you are unsure of.

How to treat melanoma skin cancer?

Based on the stage (extent) of the cancer and other factors, your treatment options might include:
• Surgery
• Immunotherapy
• Targeted therapy
• Chemotherapy
• Radiation therapy

Early-stage melanomas can often be treated with surgery alone, but more advanced cancers often require other treatments. Sometimes more than one type of treatment is used.

It’s important to discuss all of your treatment options as well as their possible side effects with your treatment team to help make the decision that best fits your needs. Some important things to consider include:
• Your age and overall health
• The stage of your cancer
• The likelihood that treatment will cure your cancer (or help in some other way)