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Melanoma

Melanoma is a skin cancer.

Risk Factors

Sunlight (UV Radiation)

Too much exposure to UV radiation is thought to be the major risk factor for most melanomas. The main source of such radiation is sunlight. Tanning lamps and booths are another source. The amount of UV exposure depends on the strength of the radiation, how long the skin was exposed, and whether the skin was covered with clothing and sunscreen.

Moles

A mole (nevus) is a benign (not cancerous) skin tumor. Certain types of moles increase a person’s chance of getting melanoma. The chance of any single mole turning into cancer is very low. But anyone with lots of irregular or large moles has an increased risk for melanoma. These people should have frequent, thorough skin exams by a skin doctor (dermatologist). They should also examine their own skin every month and practice good sun protection.

Fair Skin

People with fair skin, freckles, or red or blond hair have a higher risk of melanoma. Red-haired people have the highest risk.

Family History

Around 10% of people with melanoma have a close relative (mother, father, brother, sister, child) with the disease. This could be because the family tends to spend more time in the sun, or because the family members have fair skin, or both. Less often, it is because of a gene change (mutation) along with sun exposure. People with a strong family history of melanoma should do the following:

Weakened Immune Systems

People who have been treated with medicines that suppress the immune system, such as transplant patients, have an increased risk of developing melanoma.

Age

Melanoma is a cancer of old people. But it is one of the few cancers that are also found in younger people.

Gender

Men have a higher rate of this cancer than women.

Xeroderma Pigmentosum (XP)

This is a rare, inherited condition. People with XP are less able to repair damage caused by sunlight and are at greater risk of melanoma.

Past History of Melanoma

A person who has already had melanoma has a higher risk of getting another melanoma.

Prevention:

Limit UV Exposure

The best way to lower the risk of melanoma is to avoid too much exposure to the sun and other sources of UV light. Avoid being outdoors in sunlight too long, especially in the middle of the day when UV light is most intense. These things can help you prevent skin cancer:

Protect Your Skin with Clothing

This is probably the best way to protect against too much UV if you are out in the sun. Protect your skin with clothing, including a shirt with long sleeves and a hat with a broad brim. Baseball hats can protect the head, but they do not protect the ears, neck, or lower part of the face.

Seek Shade

Look for shade, especially in the middle of the day, between the hours of 10 am and 4 pm, when the sun’s rays are strongest. Keep in mind that sunlight (and UV rays) can come through clouds, can reflect off water, sand, concrete, and snow, and can reach below the water's surface.

Use Sunscreen

Use sunscreen and lip balm with an SPF of 15 or higher. Be sure to use enough (a palmful for your whole body) and put it on again every 2 hours and after swimming or sweating. Use sunscreen even on hazy or overcast days. For it to work best, sunscreen should be put on before you go outside. Don’t make the mistake of thinking that because you’re using sunscreen, you can stay out in the sun longer. Staying out longer because you’re using sunscreen just means you’ll end up getting the same amount of UV light as you would otherwise. You won’t reduce your risk that way.

Wear Sunglasses

Wrap-around sunglasses with at least 99% UV absorption give the best protection to your eyes and the skin around your eyes.

Protect Children

Be especially careful about sun protection for children. Children tend to spend more time outdoors and they burn more easily. Teach them to protect themselves from the sun as they get older.

Avoid Other Sources of UV Light

Tanning beds and sun lamps are dangerous because they can damage your skin. Most skin doctors say not to use tanning beds and sun lamps. There is growing evidence that they may increase your risk of getting melanoma. This is an area of active research.

Check for Abnormal Moles and Have Them Removed

Check suspicious moles with your doctor and have them removed if needed. If you have many moles, a careful exam by your doctor (or a skin doctor), along with monthly skin self-exams may be recommended.

Early Detection:

Self Exams

It's important to check your own skin about once a month. You should know the pattern of moles, freckles, and other marks on your skin so that you'll notice any changes. Self-exam is best done in front of a full-length mirror. A hand-held mirror can be used for areas that are hard to see. A family member can check areas such as your lower back or the back of your thighs.

Spots on the skin that change in size, shape, or color should be seen by a doctor right away. Any unusual sore, lump, blemish, marking, or change in the way an area of the skin looks or feels may be a sign of skin cancer.

Exam by a Health Professional

Part of a routine cancer check-up should include a skin exam by a doctor or qualified health professional.

Possible Signs and Symptoms of Melanoma

The ABCD rule can help you tell a normal mole from an abnormal mole. Moles that have any of these traits should be checked by your doctor. ABCD stands for the following:

Other important signs of melanoma include changes in size, shape, or color of a mole. Some melanomas do not fit the "rules" above, and it may be hard to tell if the mole is normal or not, so

If Cancer Is Suspected

If there is any reason to suspect that you have a melanoma, your doctor will order further exams and tests to find out if it is really a melanoma or something else.

Exam

The doctor probably will ask about your symptoms and risk factors, including your age, when the mark on the skin first appeared, and whether it has changed in size or the way it looks. You may also be asked about whether anyone in your family has had skin cancer and about past exposure to known causes of skin cancer.

During the exam, the doctor will note the size, shape, color, and texture of the area in question, and whether there is bleeding or scaling. The rest of the body will be checked for other spots and moles. The doctor may also examine lymph nodes in the groin, underarm, or neck areas near the area in question. Enlarged lymph nodes might suggest the spread of a melanoma. You might be referred to a skin doctor (dermatologist).

The doctor might use a special magnifying lens and light source held near the skin. Sometimes a thin layer of oil is used with this instrument. A picture of the spot may be taken. These tests, when used by a doctor who has experience with them, can improve the chances in finding melanomas early. It can also often show that a lesion is not cancer without the need for a biopsy.

Skin Biopsy

If the doctor thinks you might have a melanoma, he or she will take a sample of the skin to look at under a microscope. This is called a biopsy. Different methods can be used for a skin biopsy. The choice depends on the size of the area in question and where it is found on the body. All methods are likely to leave a scar. Since different methods leave different types of scars, you should ask the doctor about this before the biopsy is done.

The skin around the area of the biopsy will be numbed before the biopsy. You will feel a small needle stick and a little burning with some pressure for less than a minute, but no pain.

Incisional and excisional biopsies: If the doctor has to look at a tumor in the deeper layers of the skin, an incisional or excisional biopsy will be done. The skin will be numbed before the biopsy. A surgical knife is used to cut through the full thickness of skin. A wedge of skin is removed, and the edges of the wound are sewn together. An incisional biopsy removes only a portion of the tumor. If the entire tumor is removed, it is called an excisional biopsy. Excisional biopsy is the method most often used.

Shave biopsy: After numbing the area, the doctor "shaves" off the top layers of the skin. A shave biopsy is useful for many types of skin diseases and in treating benign moles. But it is not often used if a melanoma is suspected because the sample may not be thick enough to find out how deeply the cancer goes into the tissues.

Punch biopsy: In a punch biopsy a deeper sample of skin is removed. The doctor uses a tool that looks like a tiny round cookie cutter. Once the skin is numbed, the doctor rotates the tool on the surface of the skin until it cuts through all the layers of the skin and takes out a sample of tissue.

After a biopsy, the skin sample is sent to a lab to be looked at under a microscope. The sample may also be sent to a doctor with special training in diagnosing from skin samples (a dermatopathologist).

Biopsies of Melanoma That Has Spread

Rarely, some melanomas spread so quickly that a person could have a lot of cancer in the lymph nodes, lungs, brain, or other places while the original skin melanoma is still small. Melanoma that has spread to other parts of the body may not be found until long after the first melanoma was removed from the skin.

When this happens, melanoma in those organs might be confused with a cancer starting in that organ. For example, melanoma that has spread to the lung might be confused with a cancer that starts in the lung. There are special tests that can be done on biopsy samples to tell whether it is a melanoma or some other kind of cancer. This is important because different treatments are used for different cancers.

Finding Metastases

Fine needle aspiration biopsy (FNA): This approach can sometimes be used if the doctor suspects the melanoma has spread to organs such as the lung or liver. A thin needle is used to remove very small tissue samples from a tumor. The test rarely causes much discomfort and does not leave a scar. The FNA is not used to diagnose a suspicious mole, but it may be used to biopsy large lymph nodes near a melanoma to find out if it has spread.

Surgical (excisional) lymph node biopsy: This method involves removing an abnormally large lymph node through a small incision. It is often done if a lymph node’s size suggests spread of melanoma but FNA did not find any cancer cells.

Sentinel lymph node biopsy: This has become a common method for finding out if the cancer has spread to lymph nodes. A surgeon injects a radioactive substance into the area of the melanoma. Within an hour, lymph nodes are checked for radioactivity to find which ones are the first to drain fluid from the skin near the melanoma. Then the lesion is injected with a blue dye that will travel to the nodes that the cancer would first drain into. These are the sentinal lymph nodes, called that because they "stand watch," so to speak, over the tumor. When these lymph nodes have been found, they are removed and looked at under a microscope. If cancer cells are found, the rest of the lymph nodes in this area are removed, too. If the sentinel nodes do not contain cancer cells, further lymph node surgery might not be needed.

Imaging Tests

Imaging tests are done to produce pictures of the inside of the body. They are used to look for the spread of melanoma. They are not needed for people with very early melanoma which is not likely to have spread.

Chest X-rays: This test may be done to see if the cancer has spread to the lungs.

CT (computed tomography) scans: If there is any reason to suspect that the melanoma has spread to the liver or other organs, the doctor might order CT scans. These scans use many x-ray images that are combined by a computer to give a detailed, cross-sectional view of the body. CT scans take longer than regular x-rays and you usually need to lie still on a table while they are being done. You might feel a bit confined by the ring you have to lie in when the pictures are being taken.

MRI (magnetic resonance imaging): Like a CT scan except that it uses radio waves and strong magnets to produce an image. MRI scans are very helpful in looking at the brain and spinal cord. MRI scans take longer than CT scans--often up to an hour. You may have to lie inside a narrow tube, which is confining and can upset some people. Newer, "open" MRI machines can help with this if needed. The MRI machine makes loud buzzing and thumping noises that may bother some people. Some places provide headphones to block this out.

PET (positron emission tomography) scans: In this test, a special kind of radioactive sugar is injected into the patient’s vein. The sugar collects in areas that have cancer and a scanner can spot these areas. This test is useful when the doctor thinks the cancer has spread but doesn’t know where. Doctors find it most useful in people with advanced stages (see below) of melanoma. It is not very helpful in people with early stage melanoma.

Nuclear bone scans: A bone scan is used to look for cancer that has spread to the bones and is rarely used for melanoma. In this test a radioactive chemical is injected into a vein. The substance collects in the bones where the cancer has spread. These areas may be biopsied to see if they contain melanoma.

Treatment:

There are different methods of treatment. The best choice depends largely on the thickness of the tumor and the stage of the disease.

Types of Surgery for Melanoma

Simple Excision

Thin melanomas can be completely cured by a fairly minor operation called simple excision. After the skin is numbed, the tumor is cut out, along with an amount of normal skin at the edges (called the margin). The wound is carefully stitched back together. This surgery will leave a scar.

Re-excision

If melanoma was confirmed by biopsy, the area will need to be excised (removed) again. More skin will be cut away from the area around the melanoma and the tissue will be looked at under a microscope to make sure that no cancer cells remain in the skin. If the cancer is on the face, a smaller amount of tissue may be removed. A technique called Mohs surgery may be used. In this approach, the cancer is removed layer by layer until the tissue shows no signs of cancer. Not all doctors agree on the use of Mohs surgery for melanoma.

Amputation

If the melanoma is on a finger or toe, the treatment may mean amputation. At one time, some melanomas of the arms and legs were also treated by amputation, but that is no longer done.

Lymph Node Dissection

Once a diagnosis of melanoma has been made, the doctor will check the lymph nodes nearest the cancer. If the nodes are not enlarged, then a sentinel node biopsy may be done. If the sentinel node does not show cancer, then the disease has most likely not spread to other nodes. So, there would be no need to remove lymph nodes.

If the sentinel lymph node does show cancer, then the remaining nodes might be removed. But right now doctors do not know whether finding and taking out lymph nodes that may have cancer cells really helps save lives. Still, many surgeons are doing a sentinel node biopsy, as it does help to determine a patient's outlook. If the nodes feel very hard or large, and the FNA biopsy shows that the cancer has spread, then the nodes are usually removed.

Removing lymph nodes can cause some upsetting long-term side effects. The most troublesome is called lymphedema. Lymph nodes help drain fluid from the arms and legs. If the lymph nodes are removed, fluid can build up, leading to limb swelling. This side effect, along with the discomfort of the surgery itself, is the reason lymph nodes are not removed unless the doctor thinks it's necessary.

Surgery for Melanoma That Has Spread

Once it looks like the melanoma has spread from the skin to distant organs (such as the lungs or brain), doctors generally assume it can no longer be cured by surgery. Even so, surgery is sometimes done because removing even a few areas of spread could help some people to live longer or to have a better quality of life.

Chemotherapy

The chemo drugs kill cancer cells, but they also damage some normal cells and this can lead to side effects. These side effects will depend on the type of drugs used, the amount taken, and the length of treatment. Temporary side effects might include:

Most side effects go away once treatment is over. There are ways to lessen many of the side effects, so be sure to tell your doctor or nurse if you are having any of these problems.

Several types of chemo can be used for stage IV melanoma. Although chemo does not usually work as well for melanoma as it does for some other types of cancer, it may relieve symptoms or extend the life of some patients with stage IV melanoma. Recent studies have found that combining several drugs with one or more immunotherapy drugs works much better than using a single drug.

Isolated limb perfusion is a type of chemotherapy sometimes used for treating melanomas on the arms or legs. The method temporarily separates the blood flow of the limb with cancer from the rest of the body. High doses of chemo are injected into the artery feeding the limb. This allows high doses to be given to the area of the tumor without exposing the whole body to these doses, which would cause severe side effects.

Immunotherapy

Immunotherapy helps a person's immune system to better attack the cancer. There are several types of immunotherapy used for people with advanced melanoma.

These are proteins that "turn on" the immune system. They can help shrink stage III and IV melanomas in about 10% to 20% of patients. Side effects, though, may include fever, chills, aches and severe tiredness. One kind of approach can cause fluid to build up in the body so that the person swells up and can feel quite sick.

Patients with deeper melanomas often have cancer cells that travel to other parts of the body. Even after it looks as if all the cancer has been removed, some of these cells may remain. Interferon-alpha can be used as an added (adjuvant) therapy after surgery to help prevent these cells from spreading and growing. This treatment might delay the recurrence of melanoma. Some studies have found that interferon improves survival in certain cases, but others found no effect on survival.

In order to work, though, high doses of interferon must be used. Many patients can’t take the side effects of these high doses. These side effects could include fever, chills, aches, severe tiredness, and effects on the heart and liver. Patients having this treatment should be followed by a cancer doctor (oncologist) who has experience with this treatment.

Vaccine Therapy

Weakened melanoma cells (or certain substances found in these cells) can be injected into a patient in an attempt to stimulate the body’s immune system to destroy cancer cells. This is something like the way we use vaccines to destroy viruses that cause polio, measles, and mumps. But making a vaccine against a tumor like melanoma is harder than making a vaccine to fight a virus. Clinical trials are going on to test the value of treating people with stage III or stage IV melanoma with vaccines, sometimes combined with cytokine therapy as well. This approach is still being studied, and so far the results have been mixed.

BCG (Bacille Calmette-Guerin) Vaccine

BCG is a bacterium that is related to the germ that causes tuberculosis. Unlike its bacterial "cousin," BCG does not cause serious disease in humans, but it does "turn on" the immune system. It is sometimes used to help treat stage III melanomas. It is given as an injection directly into tumors.

Radiation Therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. External beam radiation focuses radiation from outside the body on the skin tumor. This method may be used for treating some patients with melanoma.

Radiation therapy is not often used to treat the original tumor that started on the skin. But it may be used to treat cancer that has come back, either in the skin or lymph nodes, if it cannot all be removed by surgery. It may also be used to treat distant spread or to relieve symptoms of cancer that has spread to the brain or the bone. Radiation therapy used this way is not meant to cure the cancer.

Treatment Centers in Georgia:

Melanoma

National Organizations and Web Sites


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