Malignant Melanoma

What is it?
Melanoma is a cancerous tumor that grows out of melanocyte cells. These cells make the pigment melanin which colors the skin, hair, and eyes. Melanoma most often develops in the skin (cutaneous), but it can also occur in the eye (ocular), and in other areas of the body where melanocytes are found. Melanoma is a serious cancer that can spread rapidly throughout the body.
Who gets it?
Melanoma affects people of all ages, and is one of the most common cancers in young adults. It is rare in black people and others with dark skin. The risk of developing melanoma increases with age. It also runs in families.

Among Western countries, the number of people who develop melanoma has been increasing over the years. In the United States, the number of new cases of this cancer has more than doubled in the past 20 years.

What are the symptoms?
The first sign of melanoma is often a change in the size, shape, color, or feel of a mole on the skin. These changes can be remembered as "ABCD":

Asymmetry - an odd shape, or one half is shaped differently from the other
Border - ragged, notched, blurred, or irregular outline
Color - different shades of black, brown, and tan in the same mole; there may also be patches of white, gray, red, pink, or blue in it
Diameter - the mole grows larger; melanomas are usually larger than ¼ inch across
Other mole changes to watch for are itching, oozing, or bleeding, or the mole becomes hard or lumpy. Melanoma usually does not cause pain.
How is it diagnosed?
A skin examination by a physician, nurse specialist, or nurse practitioner can uncover suspicious moles. A suspect mole is entirely or partially removed (biopsy) and the tissue examined under a microscope. This is the only way to make a definite diagnosis.

Four basic types

Superficial spreading melanoma - 70% of cases, most likely to occur on the trunk in men, the legs in women, and the upper back in both.
Lentigo maligna melanoma - found most often in the elderly, in chronically sun-exposed or -damaged skin on the face, ears, arms, and upper trunk.
Acral lentiginous melanoma - appears as a black or brown discoloration under the nails or on the soles of the feet or palms of hands; most common melanoma in African-Americans and Asians, least common among whites.
Nodular melanoma - 10-15% of cases, spreads quickly, looks like a black bump but may be other colors, found on the trunk, legs, and arms of elderly or scalp in men.
How is it treated?
The treatment plan takes into account the type of melanoma, its location, whether it has begun to spread, and the person's age and health. The standard treatments are:

Surgery - remove the melanoma and a ring of tissue around it (to make sure no cancer cells were missed)
Chemotherapy - to kill cancer cells that have spread throughout the body
Immunotherapy - interferon-alfa and interleukin-2 may be given to help the body's immune system prevent a recurrence of the melanoma
Radiation therapy - to kill cancer cells that may have spread beyond the tumor.
The good news
If melanoma is diagnosed early and removed before it begins to spread it is almost 100% curable. You can also reduce your risk by:

avoiding suntans, tanning booths, and sunburns - all damage the skin and increase melanoma risk
having your skin examined during your regular physical checkups
checking your own skin and reporting any changes to your doctor immediately

What is malignant melanoma?

Melanoma skin cancer starts in the melanocyte cells of the skin. The skin protects our body from heat, injury, infection, water loss and sunlight. Its outermost layer is called the epidermis, which consists of flat, scaly squamous cells. Squamous cells contain a protein (keratin) that makes the skin strong, but flexible. Basal cells and melanocytes (the cells that give the skin its colour) lie deeper in the epidermis. Beneath the epidermis is the dermis that contains nerves, blood vessels, lymphatic vessels, sweat glands, oil glands and hair follicles.

Melanocytes produce a pigment called melanin that gives the skin its colour and protects it from sun damage. When skin is exposed to the sun, it produces more pigment and tans. Melanocytes often cluster together and form moles (nevi). Most moles are benign, but some may go on to become malignant melanomas.



Melanomas are divided into 4 main types, depending on their location, shape and whether they grow outward or downward into the dermis:

superficial, spreading or flat: grows outwards at first to form an irregular pattern on the skin with an uneven colour
nodular: lumpy and often blue-black in colour may grow faster and spread downwards
acral melanomas: occur on the palms of the hand, soles of the feet or nailbeds
lentigo maligna: usually occur on the faces of elderly people
Melanoma can also start in the mucous membranes of the mouth, anus and vagina, in the eye or other places in the body where melanocytes are found.