What you Need to Know About Melanoma

Melanoma

Melanoma is the most deadly form of skin cancer because of its potential to spread quickly to other parts of the body. Typically resulting from overexposure to the sun (as well as tanning beds and sunlamps), and affecting those with fairer skin at a higher rate, it is one of the most common forms of cancer among young adults.

The two other major forms of skin cancer, basal-cell and squamous-cell carcinoma, are also strongly linked to sun exposure. Although people with higher levels of pigment in their skin are naturally more protected from the sun’s radiation, they are not immune to its potentially harmful effects. Melanoma is less commonly diagnosed than basal-cell and squamous-cell skin cancer, but can affect any part of the skin, including areas not typically exposed to the sun (like the palms of the hands or the soles of the feet).

Doctors strongly recommend wearing sunscreen with an SPF of at least 15 and both UVA and UVB protection. In addition to sunscreen’s ability to help block out the sun’s ultraviolet rays, it helps to slow the skin’s aging process, including the prevention of wrinkle formation.

It may present itself as a new mole or within an existing mole itself. Although those with a greater number of pre-existing moles are at a higher risk of developing the disease, melanomas can appear anywhere on the body, even in those without any moles at all.

Moles showing symptoms of melanoma are variegated in color, shape, and size, and are often characterized by an irregular border and an overall asymmetrical shape.

It may appear in other kinds of skin abnormalities, such as discolorations or bruise-like irregularities. For instance, a dark streak under a fingernail or toenail may indicate early stage melanoma. Although extremely rare, ocular melanoma can also occur, with initial symptoms including blurriness and increased pressure behind one eye.

Areas not typically overexposed to the sun can also be affected, including the bottoms of the feet, nasal cavity, rectum, and genitals.

People over the age of 50 are also at a higher risk as sunscreen technology was not as advanced during their younger years. The risks associated with excessive tanning were not widely known among the general public prior to the 1970s. As a result, it may occur in older individuals from the latent effects of a genetic mutation in their melanocytes (the skin’s pigment-producing melanin).

While all forms of skin cancer are potentially life-threatening, melanoma represents the majority of skin cancer deaths. The Skin Cancer Foundation estimates that about 9,730 people in the U.S. will die of melanoma in 2017. Although basal-cell and squamous-cell carcinomas are more widely diagnosed, they have much higher rates of survival.

The chances of surviving melanoma are greatly increased the earlier it is detected. If it is detected prior to spreading to the lymph nodes (stage III melanoma), the five-year survival rate is estimated at 98%. As skin cancer exams are now being recommended on a yearly basis, melanoma is more frequently being caught while it’s still in the very treatable stage 0.

Although overexposure to ultraviolet radiation is strongly correlated with skin cancer, other factors are at play. For instance, someone with a close relative having been diagnosed with the disease has an increased 10-15% chance of also being diagnosed.

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Stages of Melanoma

Stages of Melanoma

Melanoma—a particularly deadly form of skin cancer due to its potential for spreading to other parts of the body—progresses in five stages. Depending on the state of a patient’s melanoma, and the extent to which it has spread from the initial site, melanoma may fall between stages 0 to IV. Catching melanoma in its earlier stages greatly increases the chances of treatment working effectively. So how can you tell the different stages of melanoma?

Classifying the stage of a melanoma involves examining the thickness of the skin abnormality, the presence or absence of ulceration, and determining whether the lymph nodes or other parts of the body have been affected. Other considerations include the patient’s medical history and family history, blood tests, biopsies, and pre-existing immunodeficiencies.

Stage 0

Stage 0 melanoma can be effectively treated as it is confined only to the melanocytes in the outer layers of the epidermis. Signs include small areas of the skin becoming abnormally colored, or the darkening of a pre-existing mole or freckle. Ulceration and bleeding are not likely at this phase. Once a biopsy confirms the presence of cancerous cells, a relatively simple excision of the site is performed, removing 1-2 cm of normal skin surrounding the affected area.

Stage I

Stage 1 melanoma shows greater abnormal growth features in the melanocytes of the tumor, with a biopsy revealing the thickness of the lesion is less than 2mm. At this stage, just a few cells have mitotic figures as they are still dividing slowly. The most common form of treatment at this stage is the excision of the tumor along with 1-2 cm of normal skin around it. Lymphatic mapping and sentinel lymph node biopsy (SLNB) may also be recommended.

Stage II

At this stage, the melanoma is starting to invade deeper into the skin. As it progresses into the dermis (the layer below the epidermis), stage II presents a higher risk of spreading to the lymph nodes and other tissues. Stage II melanomas are typically larger than 2 cm in diameter on the skin, often showing variegated colors and irregular borders. Other signs include itchiness, ulceration, and sporadic bleeding. The most common treatment is local excision, including up to 2 cm of normal skin surrounding the affected area. If an SLNB proves positive, a selective lymph node dissection may be recommended.

Stage III

Stage III melanoma represents spreading external to the initial lesion, affecting surrounding areas and nearby lymph nodes. With a five-year survival rate of 40-78%, melanomas at this stage are larger in size, with the possibility of ulceration. Lesions often present themselves in even more varied colors and irregular shapes. Bleeding, itchiness, and pain to the touch, are common symptoms.

In addition to biopsies, blood work and lymph node mapping are often conducted to examine the extent to which the melanoma has spread. Surgery is the most common treatment of stage II melanoma, entailing the wide excision of the primary melanoma, as well as the possible removal of secondary lesions and lymph node dissection. Immunotherapy is often recommended for patients assessed as having a high risk for recurrence. Other treatment options include chemotherapy, radiation therapy, and clinical trial drugs.

Stage IV

At its most advanced stage, melanoma has invaded the lymphatic system and spread to other parts of the body, possibly including vital organs. Stage IV lesions are much larger and present themselves in a variegated colors and shapes. Signs include itchiness and bleeding, respiratory problems, and abdominal pains. With a survival rate of 15-20%, surgery is not a viable option at the stage. Patients are normally treated with a combination of immunotherapy, chemotherapy, radiation therapy, as well as experimental drugs.

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The Risks Associated with Skin Cancer

Risks Associated with Skin Cancer

One of the most frequently diagnosed forms of cancer in the U.S., skin cancer affects all sectors of the population regardless of age, race, or gender. Skin cancer occurs in three major forms:  basal-cell carcinoma, squamous-cell carcinoma, and melanoma. Squamous-cell and basal-cell represent a decreased risk of spreading to other parts of the body. Melanoma, on the other hand, is particularly deadly for its high risk of spreading if not caught early enough. So what are the risks associated with skin cancer?

Overexposure to the sun, as well as the overuse of tanning booths and sunlamps, are major contributors to the development of skin cancer. Excessive ultraviolet radiation causes DNA damage in skin cells, which can eventually lead to tumors. The face, neck, arms, and upper back are therefore at greater risk of skin cancer as they are most often exposed to the sun. Preventative measures include wearing sunscreen with SPF 15 or higher (with both UVA and UVB protection), applying sunscreen at least 20 minutes before going outside, avoiding direct sunlight for extended periods of time, and wearing long sleeves and hats while outdoors. Even when it is not particularly sunny, such as on cloudy days, wearing sunscreen is recommended as the sun’s UV rays can be redirected towards the ground by clouds. Although these actions may decrease the chances of developing skin cancer, the disease can affect any area of the skin, with other contributing factors.

For example, a family history of skin cancer greatly increases the chances of being diagnosed with the disease. Further, those with fair skin are at a higher risk. Tobacco and alcohol use, as well as HPV infections, are strongly correlated with squamous-cell carcinoma in particular. Environmental toxins, such as petroleum by-products, and work environments involving high radiation exposure, have also been shown to increase the likelihood of diagnosis. Pre-existing immune deficiencies also make the body less able to fight infection.

Abnormalities developing on the skin, such as unusual moles or lesions, should be brought to the attention of your doctor immediately as the sooner skin cancer is diagnosed, the more effective its treatment. Although skin irregularities can be benign, moles changing in size, shape, and color, along with sporadic bleeding, are of particular concern. Those living or working in environments that present higher risks of developing skin cancer, as well as those with a family history of the disease, should make their doctor aware so that they may better examine your potential for developing skin cancer.

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Skin Cancer Symptoms

Skin Cancer Symptoms

The most common type of cancer diagnosed in the U.S. is skin cancer, affecting persons of any age, gender, or race, indiscriminately. The three most common forms of skin cancer are melanoma, basal cell carcinoma, and squamous cell carcinoma. While basal cell and squamous cell are diagnosed most frequently, melanoma is particularly deadly for its potential to spread to other parts of the body. There are skin cancer symptoms for each of the three types, as well.

Overexposure to the sun is commonly attributed to most forms of skin cancer. Other causes include exposure to environmental toxins, pre-existing autoimmune deficiencies, and genetic predisposition.

The two most apparent signs of skin cancer are the body’s inability to quickly heal cuts and wounds, as well as unusual mole growths and skin discolorations.

Often appearing in the face or neck area, basal cell carcinoma is characterized by waxy, pearly bumps that bleed sporadically and are slow to heal. While skin cancer is most often attributed to overexposure to the sun, the chances of diagnosis increase with a family medical history of the disease.

The face, neck, arms, and upper back are the most frequent parts of the epidermis in which squamous cell carcinoma is found, mainly because these areas tend to be exposed to the sun the most. A major symptom is the appearance of red bumps in a small cluster. As these bumps increase in size, their centers tend to form a crater that bleeds sporadically. Resembling a wart, these bumps are often patchy or scaly. Tobacco and alcohol use are associated with squamous-cell carcinoma. Squamous cell presents a higher risk of affecting the rest of the body than basal-cell carcinoma, though the risk of spreading to other parts of the body is not as high as melanoma.

Most commonly appearing on the backs of the legs and back, melanoma may occur anywhere on the body. Symptoms include moles that change in shape and size (with sporadic bleeding) and discolorations of the skin characterized by jagged borders. Medical professionals use the mnemonic device ‘ABCDE’ to initially assess the possibility of whether a skin abnormality is melanoma,.

A – Asymmetry

If a skin irregularity, such as a legion, is asymmetrical in appearance, the chances of it being melanoma increase. Symmetrical moles tend to be benign.

B – Border

Benign skin abnormalities, such as moles, tend to have well-defined borders, making them easily distinguishable from the rest of the skin. Melanomas, on the other hand, may have blotchy, faded, or jagged borders, often making it difficult to tell exactly where an abnormality ends and normal skin begins.

C – Color

Whereas as benign moles are typically singular in color, melanomas may have a combination of colors, such as brown, tan and black, or red, white, and blue.

D – Diameter

The size of the skin abnormality itself is often an indicator, with melanomas typically exceeding ¼ inch (6mm) in diameter. Benign moles are usually smaller in size.

E – Evolving

Benign moles are usually consistent in shape, size, and coloration, over time. Melanomas, however, often mutate, grow larger, and start to bleed on an irregular basis.  

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The Different Types of Skin Cancer

Types of Skin Cancer

The three primary types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma—each presenting its own set of diagnostic techniques and treatment strategies.

1 – Basal-cell Carcinoma

The most frequently occurring forms of skin cancer (making up nearly 80% of all cases), basal-cell carcinoma often occurs in areas frequently exposed to the sun’s radiation. Certain vaccinations, infections, inflammatory skin problems, and radiation exposure, are also linked as causes.

Symptoms vary and are sometimes hard to detect. Usually beginning as a small nodule, the carcinoma eventually grows with the center becoming lethal, and the nodule itself developing into an ulcer. Sores produced by basal-cell carcinoma can be asymptomatic. Typically the ulcer or red skin plaque grows slowly, with sporadic bleeding. It may appear as a shiny raised area of skin with small visible veins running through it.

The growth may lie below the surface of the skin.

2 – Squamous Cell Carcinoma

The second most common form of skin cancer, squamous cell carcinoma, can occur anywhere on the epidermis, but most often affects areas exposed to the sun (i.e. face, arms, neck). One known cause of this form of carcinoma is the human papillomavirus (HPV). If not detected and treated early enough, it can spread quickly to other parts of the body, including the circulatory and lymphatic systems, as well as nerve pathways.

Similar to basal-cell, squamous cell carcinoma initiates as a tiny nodule and as it grows the center ends up being lethal, with the nodule becoming an ulcer. Additionally, the sore can be asymptomatic. The ulcer, or red skin plaque, grows slowly, with intermittent bleeding.  

The growth may also lie below the surface of the skin.

3 – Melanoma

Melanomaconsidered to be the most life-threatening form of skin canceroriginates in the pigment-producing cells of the skin. Common indicators of melanoma include unusual moles, blemishes, and discolorations, of the epidermis. Often affecting areas exposed to the sun at a greater rate, melanoma can appear in all area of the skin, including the soles of the feet, the palms of the hand, and the mucous membranes of the nasal cavity and rectum.

UVA and UVB sun rays are contributing factors. Unusual moles are often considered warning signs of melanoma. Further, someone with an unusually high number of moles is more at risk of being diagnosed with this form of skin cancer. Individuals with fair skin are also at greater risk.

Having melanoma previously increases the chances of getting melanoma again. Pre-existing conditions such as HIV or AIDS, or lymphoma, also raise the risk of melanoma.

Family medical history has been shown to be a factor in developing this form of cancer.  

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Symptoms of Melanoma

Symptoms of Melanoma

Forming in the pigment-producing cells of the epidermis, melanoma is often considered the most dangerous form of skin cancer due to its potential to spread out to other areas of the body. Often caused by overexposure to ultraviolet rays produced by the sun or tanning beds, melanoma can normally be effectively treated if diagnosed in its early stages. So what are the symptoms of melanoma?

Early indicators of melanoma include atypical skin changes, such as discolored patches, spots, and moles, which may change in size and shape over time.

Although melanoma may appear anywhere on the epidermis, areas typically subject to more sun exposure are affected at a higher rate. These may include the face, arms, leg, and upper back. Melanoma may also appear on mucous membranes in the nasal cavity and rectum, underneath fingernails, the soles of the feet, and the palms of the hand.

Noticing an unusual skin blemish or protrusion, however, is not an automatic diagnosis of melanoma. Medical professionals recommend the ‘ABCDE’ mnemonic device to help assess whether a mole, discoloration, or blotch, is potentially cancerous.  

A—Asymmetry

Relatively symmetrical moles are most often not cancerous. That doesn’t mean that all asymmetrical moles are melanoma, but there does exist a high correlation.

B—Border

Moles with borders that are not well-defined can be an indicator of melanoma. Melanomas may have an irregular edge around them, or the skin of the mole may blend into the surrounding skin making it difficult to determine its boundary.

C—Color

Although there is no one particular color specifically correlated with melanoma, multiple colors appearing in the same mole is an indication that the mole is potentially cancerous. Common combinations of color include brown and black, or white and pink.

D—Diameter

Melanomas are typically larger in size (6mm in diameter or larger).

E—Evolving

A mole that changes in size, shape, and color, over time may also be cancerous.

If a mole or blemish falls under one or more of these categories then it is likely wise to seek medical assessment.

Other signs that a mole is cancerous include persistent itchiness, sensitivity to the touch, and sporadic bleeding.

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Treating Melanoma

Treating Melanoma

Melanoma is a dangerous type of cancer occurring in the pigment-producing cells of the skin. Often developing as a result of overexposure to the sun or tanning booths, the potentially fatal nature of the disease can be effectively offset through early detection and surgical removal of the affected area. So what does treating melanoma involve?

Melanoma treatment largely depends on the stage at which the cancer has progressed. Fighting the disease may come in the form of surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, or any combination of these methods.

Here are cursory descriptions of the five stages of melanoma and their treatment.

Stage 0

Removing cancerous tissue is relatively easy at stage 0 as the melanoma has not penetrated into the deeper levels of the epidermis. Surgeons usually remove one-fifth of an inch of extra skin around the cancerous area and test it for cancer. If tests prove positive, more surgery is required.

An alternative method is to treat stage 0 melanoma with radiation therapy.

Stage I

Surgical removal of stage 1 melanoma is not considered particularly difficult to perform since the cancer has likely not spread to other parts of the body. However, given that stage 1 involves a thicker amount of skin affected than in stage 0, more skin around the affected area must be removed (roughly four-fifths of an inch).

If stage 1 cancer spreads closer to the lymph nodes, a biopsy is performed. Positive results will likely mean the surgical removal of the lymph nodes to prevent the melanoma from spreading out.

Stage II

Melanoma between 1-4 mm thick is considered stage II. Surgery is still an option; however, an even greater amount of skin surrounding the area must be removed in order to minimize the risk of spreading

Stage II entails an increased chance of lymph node infection, which is determined by a lymph node biopsy.

In addition to surgery, an immunotherapy that uses interferon is sometimes deployed as a way of stimulating the immune system.

Stage III

Stage III melanoma involves the spread of cancer to the lymph nodes and potentially further, with additional tumors possibly developing around the initial area of melanoma. Cancer at this stage becomes increasingly difficult to treat, often requiring a combination of methods, including surgery and radiation therapy. Chemotherapy may also be required in the case of multiple melanomas developing.

Stage IV

At stage IV the cancer has spread past the lymph nodes into areas such as the lungs, brain, kidneys, and liver. The disease is especially hard to treat at this late stage, and treatment forms often focus on prolonging life rather than curing the disease. Radiation and chemotherapy are commonly attempted. Given the high rate of mortality at this stage, patients sometimes opt for experimental treatments.

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Melanoma: The Different Types

Melanoma

Melanoma is a particularly dangerous form of cancer compared with other forms of skin cancer because of its potential to spread to other parts of the body. It originates in the body’s pigment-producing cells (known as melanocytes), which give the skin its color.

Below are brief explanations of the different types of melanoma cancer.

Nodular Melanoma

Nodular melanoma occurs mostly in those middle-aged and older and is usually first found on the back or chest. It is characterized by its speed of development and invasive penetrability of the skin. Correlated with areas of the skin typically lacking sun exposure, this form of cancer may present itself in the form of a blackish bump (although other colors may include blue, grey, white, brown, red, or tan).

Superficial Spreading Melanoma

One of the most common forms, occurring in approximately 70% of cases, superficial spreading melanoma may first appear as a flat, or slightly raised patch of colored skin found anywhere on the body; though, oftentimes it is found on the back of the leg. The color may be black, blue, brown, tan, or whiteand raggedly-edged in shape. This form of cancer usually develops in the top layer of the skin before penetrating into deeper layers.

Lentigo Maligna Melanoma

Also called Hutchinson’s melanotic freckles, lentigo maligna melanoma occurs primarily among the elderly and comprises roughly a tenth of all cases. Appearing on skin that is frequently exposed to the sun, such as the face and arms, lentigo meligna first appears flat in the skin’s top layers and expands in size, and varies in shape, over time. After it invades into the deeper layers of the skin it is then referred to as lentigo maligna melanoma.

Mucosal Melanoma

A rarer form (occurring in about 1% of all cases), mucosal melanoma typically occurs in the mucosal tissue of the head and neck region—particularly the nose, mouth, and esophagus—as well as the vagina, rectum, and urinary tract.

This form is known for being difficult to detect.

Acral Lentiginous Melanoma

Another rare form, acral lentiginous melanoma presents itself as a black or brown discoloration that quickly invades deeper levels of the skin. Commonly found on the soles of the feet and palms of the hand, as well as under fingernails, this form of cancer is particularly prevalent among African-Americans and Asians, and quite rare among Caucasians.

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