All You Need to Know: Melanoma Skin Cancer
Written By: Margaret Huai
Skin conditions and cancers are often heard of. However, these two “worlds” may collide, for conditions ranging from kaposi sarcoma to lymphoma of the skin. Melanoma skin cancer is just one of such examples, and although it might not be the first deadly disease that comes to your mind, it is more serious than you may think.
Now, how exactly is melanoma brought about? Melanoma is brought on by genetics-a family history increases chances of obtaining this by leaps and bounds (Cancer.net). Looking at DNA sequences, genetic mutations in the CDKN2A and CDK4 genes seem to be responsible for some cases, with regulating cell division, the method by which cancer most quickly and devastatingly replicates itself . MC1R, a gene that regulates body pigment and whose most common variations are freckles or red hair, is a more prevalent cause of melanoma . On the more rare side, xeroderma pigmentosum (XP), a disorder caused by a need to repair DNA damage as a result of ultraviolet rays, and BRCA2, a heritable gene for breast cancer, both increase chances for melanoma . It is certainly difficult to put up a strong front against irreversible code embedded in DNA strands of your cell nuclei, but rest assured that you’re far from the only one who will have melanoma.
Let’s put the scale of melanoma into perspective with some good old statistics. Melanoma is only responsible for 1% of cancer cases, but is a leading cause of deaths resulting from skin cancer (Aim at Melanoma Foundation). It is projected that in 2020 alone, the United States will increase by 100,350 cases and 6,850 deaths from melanoma, with 60,190 males and 40,160 females contracting invasive forms of melanoma, and the ethnicity in America most susceptible to melanoma are Caucasians, with a whopping 28/100000 case rate . Yes, these numbers can seem disheartening, but fear not: skilled dermatologists have no shortage of methods of detecting and treating melanoma should you develop it.
The medicinal methods prevalent to determine melanoma are abundantly clear. A rule called the ABCDE rule is your go-to-guide for such detection — A meaning asymmetry (half of a birthmark or mole doesn’t match the other half); B standing for border (abnormal or rough edges of a mark on your skin); C for color (different color hues within one birthmark or mole); D meaning diameter (a spot larger than 6 millimeters or 0.25 inches, though it should be noted that it is possible for melanomas to be smaller); and E for evolving (a mole changing color, size or shape) (Cancer.org) . However, not all melanomas are created equal and there are other warning signs indicative of this skin cancer, including non-healing sores, the pigment of a sore spreading into nearby skin starting from the edges, red swelling on the mole’s border, sudden changes in sensation (itching, tenderness, pain), and a surface change in a mole evidenced by bleeding, oozing, a scaly feel or lumps/bumps .
So, what’s next after comprehension and recognition of these warning signs? It’s time to delve into the characteristics of the disease itself. Melanoma consists of four major types (Memorial Sloan Kettering Cancer Center) . The major types are superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma, and the two minor ones are eye and mucosal melanoma . Superficial spreading melanoma is the most common type that grows on the skin surface, but slowly goes deeper into the skin . Nodular melanoma is often aggressive in rapid growth and is characterized by a firm bump on the skin surface . Lentigo maligna melanoma develops on your face, scalp or neck and usually occurs in elderly people whose skin has severe skin damage . Acral lentiginous melanoma is relatively rare but is commonly found in African and Asian people, growing on hands, feet, and underneath nails . Understanding of these melanoma types can be taken a step further by examining what they all have in common.
All melanoma skin cancers share the four stages of progression. Stage 0, or melanoma in situ, is when the cancer is only present in the epidermis (outermost surface) of the skin and it has not yet spread to surrounding lymph nodes or farther body parts . The next stage, stage I, is when the tumor, which may or may not have an ulcer, has a thickness no more than 2/25 inches or 2 millimeters and the cancer still has not yet spread to surrounding lymph nodes or farther body parts . In Stage II, the tumor, which may or may not have an ulcer, is anywhere between 1 and 4 millimeters in thickness and the cancer still has not yet spread to surrounding lymph nodes or farther body parts . Stage III is divided into parts A through D, during which the tumor starts spreading to nearby lymph nodes, skin areas, or skin lymphatic channels without reaching nearby lymph nodes . Last but not least, Stage IV is when there is no limit on tumor thickness, the tumor may or may not have an ulcer, the cancer may or may not have spread to nearby lymph nodes, and has spread to farther lymph nodes or vital organs including the brain, lungs, and liver . Although this does sound rather frightening, there is still a plethora of treatment options for melanoma skin cancer patients.
Different medical treatments are utilized to cure melanoma skin cancer depending on the stage of progression. In Stage 0, surgical removal of the melanoma and surrounding skin areas is carried out, and this is sent to a lab to determine if there are cancer cells at sample edges . If so, a second surgical removal will be necessary . Zyclara (imiquimod cream) or radiation therapy can be used instead of surgery, but not all doctors agree with such methods . If the melanoma is growing on high-sensitivity regions of the face, then Mohs surgery or Zyclara, in the case of potential scarring, will be utilized, although these methods are also disputed amongst the medical community . Surgical removal is still an option in Stage 1, though a seminal lymph node biopsy can be used to look for cancer spread in lymph nodes for more aggressive cancers and a lymph node dissection may be necessary if cancer is found . Therapy drugs or replication cycle checkpoint inhibitors can also be utilized to decrease the chance of melanoma making a return, and clinical trials can also be a feasible option for this purpose . Once the cancer has progressed into Stage 2, the same choices as those of Stage 1 are still available, though the surgical removal will probably have a wider scope than Stage 1 . During Stage 3, surgical excision of the primary tumor, lymph node dissection, radiation therapy targeting areas where lymph nodes were removed, injections of vaccines (T-VEC, Bacille Calmette-Guerin, or interleukin-2) into the melanomas, isolated limb perfusion or infusion using chemotherapy infusions for melanomas on the arm or leg, targeted therapy for mutations in the BRAF or C-KIT genes, immunotherapy, or general chemotherapy are additional treatment options besides those in Stages 1 through 2 . For the final stage, metastases in internal organs are surgically excised, and symptom-causing metastases unable to be surgically removed can be eliminated using radiation, immunotherapy, targeted therapy, or chemotherapy .
Even though melanoma is a rather deadly disease, it is evident that sufficient medical processes already exist and can be used to slow the onset of this skin cancer before it turns lethal. However, before melanoma progresses to the more severe stages, it is in your best interest to take care of your skin and limit skin exposure under the sun. Pay attention to your body and if any indicators of melanoma, then be sure to not panic and report them to a dermatologist. Being educated about melanoma in general may prove beneficial in the long run. Before things escalate to that point, be sure to do your due diligence in taking care of yourself for the sake of your own health!
Sources
“Familial Malignant Melanoma.” Cancer.Net, ASCO, 30 Apr. 2020, www.cancer.net/cancer-types/familial-malignant-melanoma#:~:text=To%20date%2C%202%20genes%20have,small%20percentage%20of%20familial%20melanoma.
“Melanoma Stats, Facts, and Figures.” AIM at Melanoma Foundation, www.aimatmelanoma.org/about-melanoma/melanoma-stats-facts-and-figures/#:~:text=Figures%20From%20Around%20the%20World,to%20the%20World%20Health%20Organization.
“Signs of Melanoma Skin Cancer: Symptoms of Melanoma.” American Cancer Society, www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/signs-and-symptoms.html.
“Stages of Melanoma Skin Cancer.” American Cancer Society, www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/melanoma-skin-cancer-stages.html.
“Treatment of Melanoma by Stage.” American Cancer Society, www.cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.html.
“Types of Melanoma.” Memorial Sloan Kettering Cancer Center, Sloan Kettering Institute, www.mskcc.org/cancer-care/types/melanoma/types-melanoma.
