Melanoma

Melanoma is a type of skin cancer that begins in melanocytes. Melanocytes are cells that produce melanin, the pigment that gives your skin its color. Imagine these melanocytes as tiny factories in your skin, producing the coloring. When these factories become cancerous, they can form melanoma. The image shows how melanoma cells can grow from the top layer of skin down into deeper layers.

Melanoma usually starts on areas of skin that are frequently exposed to the sun, like your arms, back, face, and legs. Sometimes, melanoma can develop in your eyes. In very rare cases, it can start inside the body, such as in the nose or throat.

Scientists aren't completely sure what causes melanoma, but exposure to ultraviolet (UV) light is a major factor. UV light comes from the sun and tanning beds. Protecting yourself from UV light is a good way to lower your chances of developing melanoma.

It's concerning that melanoma cases are on the rise in younger people, particularly women under 40. Knowing the signs of skin cancer is crucial. Early detection is key to successful treatment. If melanoma is found early, it's often treatable and curable. Being aware of potential warning signs, like changes in moles or new spots on your skin, can help you catch melanoma early.

Most moles are harmless. They can be different colors, shapes, and sizes, sometimes with hairs or a raised or wrinkled texture. If you notice any changes in a mole's color, size, or if it starts to itch, hurt, bleed, or become inflamed, see a doctor.

Skin cancer called melanoma often starts with a change in a mole. A melanoma might have uneven coloring or a blurry, irregular edge. These are warning signs.

Early signs of melanoma can include:

• A change in an existing mole: This could be a change in its size, shape, or color.
• A new growth: A new spot on your skin that looks different than your other moles.

Melanoma doesn't always start as a mole. It can sometimes appear on healthy-looking skin.

Melanoma can show up anywhere on the body, but it's more common in areas that get a lot of sun, like the arms, back, face, and legs. However, melanoma can also develop in places with less sun exposure, such as the soles of your feet, palms of your hands, and under fingernails. It can even form inside the body, particularly in people with brown or black skin.

Typical moles usually have a consistent color – they might be pink, tan, brown, or black. In people with darker skin tones, typical moles are often darker brown or black. They typically have a clear border separating the mole from the surrounding skin, and they're usually oval or round, and smaller than about a quarter of an inch (about 6 millimeters) across.

Most people develop moles during childhood, and new ones can appear until they're in their 40s. By adulthood, most people have between 10 and 40 moles. Over time, moles can change or even disappear.

Some moles aren't typical. These unusual moles might have certain characteristics that could signal melanoma or other skin cancers. These warning signs include:

• Asymmetrical shape: The mole might have two very different halves.
• Changes in color: The mole might have many different colors or unusual color patterns.
• Changes in size: The mole might get significantly larger than a quarter inch (6 mm).
• Changes in symptoms: The mole might start itching or bleeding.
• Unusual border: The mole's edge might be uneven, notched, or scalloped.

Cancerous moles can look very different. Some might show all of these changes, while others might only have one or two unusual characteristics.

Melanoma can also develop in areas with little sun exposure. These "hidden melanomas" can appear in places like between the toes, on the palms, soles, scalp, or genitals. These areas might not be checked as often. Hidden melanomas are more common in people with brown or black skin.

Hidden melanomas include:

• Melanoma inside the body (mucosal melanoma): This type develops in the lining of the nose, mouth, esophagus, anus, urinary tract, and vagina. It's hard to spot because it can easily be mistaken for other, more common conditions.
• Melanoma in the eye (ocular melanoma): This occurs in the tissue layer beneath the white part of your eye (the uvea). It can cause vision problems and might be discovered during a routine eye exam.
• Melanoma under a nail (acral-lentiginous melanoma): This rare type can form under fingernails or toenails, or on the palms or soles. It tends to be very dark, flat, and have an unusual border. It's more common in people of Asian descent and those with brown or black skin.

If you see any changes on your skin that concern you, schedule a visit with your doctor or another healthcare provider. It's important to get these checked out. Changes could include new spots, unusual moles, sores that won't heal, or any other skin problem that seems unusual or bothersome. Don't wait; early detection is key to good health.

Skin cancer is a disease that starts in the cells of the skin's outer layer, called the epidermis. There are different types.

One type, basal cell carcinoma, begins in the basal cells. These cells are like tiny workers that continually push older skin cells upward. As these cells rise, they change into squamous cells. Skin cancer that starts in these squamous cells is called squamous cell carcinoma.

Another type, melanoma, begins in melanocytes. These are special cells that create melanin, the pigment that gives your skin its color. Melanoma happens when these melanocytes become cancerous.

Imagine a cell's DNA as a set of instructions for how to function. In healthy cells, the instructions regulate how quickly they grow and divide, and when they should die. But in cancer cells, the instructions are changed. These altered instructions tell the cancer cells to grow and divide much faster than normal, and they don't die when they should. This uncontrolled growth creates a mass of cells called a tumor.

This tumor can grow and spread into nearby healthy tissue. Sometimes, cancer cells can break off and travel to other parts of the body, which is called metastasis. This spread makes the cancer more serious.

Scientists don't fully understand why skin cells' DNA changes to cause melanoma. It likely involves a combination of factors, including things you inherit from your family (genetics) and things from your environment. However, exposure to ultraviolet (UV) light, from sources like the sun, tanning beds, and tanning lamps, is believed to be a major factor.

While UV light is a key risk, it doesn't cause all melanomas. Some melanomas happen in areas of the body that don't get a lot of sun exposure. This means other factors, like a person's genes or family history, also play a role in the risk of developing melanoma.

Melanoma risk factors can be grouped into several categories. Here are some things that might make you more likely to get melanoma:

Family History: If a close relative (like a parent, child, or sibling) has had melanoma, you have a higher chance of developing it yourself. This suggests a possible genetic link.

Sunburns: Getting severe sunburns, especially multiple ones, can increase your risk of melanoma. Sunburns damage your skin's DNA, and repeated damage can lead to abnormal cell growth.

UV Light Exposure: Sunlight, tanning beds, and tanning lamps all emit ultraviolet (UV) light. Prolonged exposure to UV light can cause DNA damage in your skin cells and raise your risk of skin cancer, including melanoma.

Unusual Moles: Having many moles (more than 50) or moles that look different from typical moles can be a warning sign. These unusual moles, called dysplastic nevi, tend to be larger and have irregular edges or a mix of colors. If you notice any moles that look different, it's important to have them checked by a doctor.

Geography: Living closer to the equator or at higher altitudes means you're exposed to more direct sunlight and higher levels of UV radiation. This increased exposure increases your risk of skin damage and, potentially, melanoma.

Skin Type: Melanoma is more common in people with fair skin, light hair, light eyes, and a tendency to easily sunburn. These skin types are more vulnerable to UV damage. However, people of all skin tones can develop melanoma.

Weakened Immune System: A weakened immune system makes your body less capable of fighting off abnormal cells. Certain medications, like those taken after an organ transplant, can suppress the immune system. Illnesses like HIV can also weaken your immune system, making you more susceptible to skin cancer, including melanoma.

It's important to remember that these are just risk factors. Not everyone with these factors will get melanoma, and many people without these factors can still develop it. Regular skin checks and sun protection are crucial for everyone, regardless of their risk factors.

Protecting Your Skin from Skin Cancer

Skin cancer, including melanoma, is a serious concern. You can significantly reduce your risk by taking some simple precautions.

1. Limit Sun Exposure:

Avoid tanning beds and lamps. These emit ultraviolet (UV) light, which can damage your skin and increase your risk of skin cancer. Also, try to avoid the sun's strongest rays. In many parts of the world, this is typically between 10 a.m. and 4 p.m. Plan outdoor activities for other times, even on cloudy days. Winter sun can still be harmful.

2. Know Your Skin:

Regularly check your skin for any changes. This includes checking for new growths, or noticing any changes in existing moles, freckles, bumps, or birthmarks. Use mirrors to inspect your face, neck, ears, and scalp. Don't forget to examine your chest, back, arms, hands, legs, feet (including soles and spaces between toes), genitals, and the area between your buttocks. If you notice anything unusual, see a doctor right away.

3. Wear Protective Clothing:

When outdoors, wear clothing that shields your skin from the sun. Dark, tightly woven fabrics that cover your arms and legs are best. A wide-brimmed hat provides better sun protection than a baseball cap or visor. Special protective clothing is also available; a dermatologist can recommend suitable brands. Don't forget sunglasses that block both UVA and UVB rays from the sun.

4. Sunscreen is Essential:

Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 every day, even on cloudy days. Apply a generous amount and reapply every two hours, or more often if you're swimming or sweating.

By following these simple steps, you can significantly reduce your risk of skin cancer. Early detection is key, so make it a habit to regularly check your skin and consult a dermatologist if you have any concerns.

Diagnosing and Treating Melanoma: A Guide

Melanoma is a type of skin cancer. Doctors use different tests and procedures to diagnose and understand how far the cancer has spread. Understanding these procedures can help you feel more informed and involved in your treatment.

Biopsy Procedures:

• Excisional Biopsy: A doctor uses a scalpel to cut out the suspicious lump (mole) and some healthy skin around it. This is often done to remove the entire growth. Stitches are usually needed to close the wound.

• Punch Biopsy: A tool with a round tip is used to remove a small, deeper sample of skin. This is helpful for looking at the cells in the deeper skin layers. Stitches may or may not be needed, depending on the size of the sample taken.

Diagnosing Melanoma:

Before any tests, your doctor will ask about your health history and examine your skin for signs of melanoma. This includes looking for changes in moles or new spots.

Staging Melanoma:

After a diagnosis, doctors need to determine the "stage" of the melanoma, which tells them how far it has spread. This is done by looking at a few key factors:

• Thickness: The thickness of the melanoma is a crucial factor in determining its stage. The thicker the melanoma, the more likely it is to have spread. Doctors examine the melanoma under a microscope and use special tools to measure its thickness. This measurement helps determine the best treatment plan.

  • Thinner melanomas: Often, just removing the affected area of skin and some surrounding healthy tissue is enough.
  • Thicker melanomas: If the melanoma is thicker, doctors may need to do more tests to see if it has spread to other parts of the body. This might include checking if the cancer has reached lymph nodes.

• Lymph Node Involvement: If there's a concern that the cancer has spread to nearby lymph nodes, a sentinel node biopsy might be recommended.

  • Sentinel Node Biopsy: A special dye is injected near the melanoma. The dye travels to the nearby lymph nodes. The first lymph nodes to absorb the dye are removed and examined for cancer cells. If these lymph nodes are clear of cancer, it's a good sign that the melanoma hasn't spread.

• Spread Beyond the Skin: If there's a suspicion that the melanoma has spread to other areas of the body, imaging tests like X-rays, MRIs, CT scans, or PET scans might be used. These tests are more likely to be done for thicker melanomas with a higher risk of spreading.

• Other Factors: Other factors, like whether the skin over the melanoma has an open sore (ulceration), or the rate at which the cancer cells are dividing (mitotic rate), also help doctors determine the melanoma's stage.

Melanoma Stages:

Melanoma stages are numbered 0 through 4. Lower stages (0 and 1) usually indicate thinner, smaller melanomas that are less likely to have spread. As the melanoma grows deeper, the stage increases, making treatment more complex. Stage 4 melanoma means the cancer has spread beyond the skin to other parts of the body, like the lungs or liver.