Melanoma

Melanoma, the most lethal form of skin cancer, develops when pigment-producing cells (melanocytes) undergo malignant changes. Unlike other types of skin cancer, melanoma frequently metastasizes, spreading to the lungs, brain, liver, or other internal organs.

The incidence of melanoma has increased about 4 percent every year since 1973. In 1995, there were more than 34,500 new cases and over 7,000 deaths. Excessive sun exposure is by far the leading cause, especially among light-skinned people who sunburn easily. Heredity is also thought to play a part, and so is occupational exposure to coal tar, pitch, creosote, arsenic compounds, and radium.

A mole (nevus) or other darkly pigmented spot that changes in size or color is a common warning sign. Large moles are especially associated with an increased risk of melanoma; they should be examined periodically. Other warning signs include scaling, oozing, bleeding, or a change in the appearance of a bump or nodule, and pigmentation that spreads from the border of a mole or bump into the surrounding skin.

Although most melanoma originates on the skin, in rare cases it arises in the pigment cells of the eyes. Melanoma of the choroid -- the layer of tissue that lies between the retina and the eyes outer covering -- often metastasizes.

Diagnostic Studies and Procedures

New techniques have been developed to screen for early melanoma. One is epiluminescence microscopy, in which the outer layer of a lesion is coated with mineral oil to make it translucent. Then a magnifying instrument, called a dermatoscope, is used to examine skin for abnormalities. Computerized image analysis, in which a computer is used to study details that the human eye cannot see, is another experimental technique of screening for melanoma.

Any suspicious mole or skin lesion should be biopsied.

Medical Treatments

Surgery is almost always the most effective treatment. In addition to the tumor, a surgeon will remove a margin of tissue around and underneath it to excise any additional cancer cells. Skin grafts will be used to cover large incisions. Melanoma that has spread to internal organs may require additional surgery.

Chemotherapy may be used in addition to surgery. When melanoma is confined to an arm or a leg, a technique called isolation perfusion is sometimes tried. This treatment entails briefly isolating the blood supply of the limb from the rest of the circulation, and allowing a higher concentration of anticancer drugs in that area.

High-dose radiation therapy can control the spread of melanoma and also alleviate pain from metastases.
Experimental immunotherapy shows promise against some types of metastatic melanoma. The goal is to stimulate the body's white blood cells, or lymphocytes, to fight the cancer cells.

Alternative Therapies

Alternative therapies should be limited to controlling pain, coping with the stress of cancer therapy, or strengthening the body's immune system.

Imagery and Visualization. These techniques ate taught in many cancer centers to help patients cope with both cancer and its treatment. Some people believe that such methods can also boost the immune system to fight the cancer.

Nutrition Therapy. A diet high in antioxidant nutrients -- beta carotene, vitamins A, C, and E -- is believed to protect against cancer, including melanoma. Fish oil and other substances high in gamma linoleic acid may also be recommended.

Yoga and Meditation. These and other relaxation techniques such as deep-breathing exercises can help control pain and reduce stress.

Self-Treatment

The most effective preventive measure is to limit sun exposure. Using a sunscreen with an SPF of at least 15 may help reduce the risk of some skin cancers, but experts warn that it does not prevent melanoma. If possible, stay out of the sun between 10 a.m. and 3 p.m., or atleast wear protective clothing. Perform a monthly self-examination of your skin. Use mirrors to examine parts of your body that are difficult to see; for example, the back of your neck, scalp, and buttocks. Take careful note of the size and location of freckles, moles, bumps and other such features.

When inspecting moles, remember the ABCD description of the typical melanoma lesions: They are assymctrical; they have irregular borders and multiple colors (usually combinations of brown, red, gray, or black); and their diameters are larger than 5 to 10 millimeters (1/4 to 1/2 inch). During subsequent examinations, look for any changes in the number, size, shape, and color of moles or other blemishes. If you see any, consult your doctoral once.

Other Causes of Melanoma Symptoms

The warning signs of basal cell and squamous cell carcinomas, less aggressive forms of skin cancer, are sometimes similar to those of melanoma.