Melanoma

Melanoma can develop anywhere on the body but is most common in sun-exposed areas like the face, arms, legs, and back. In darker skin tones, it may appear in less exposed areas such as the palms, soles, or nail beds, known as hidden melanomas. Some of the earliest symptoms of melanoma can be:

• A change or development in a pre-existing mole.
• A new mole, pigmented skin, or growth starts developing on your skin.

However, it is important to note that melanoma doesn’t always start from a mole. There are some easy ways to differentiate between a normal mole and a mole that can become cancerous. To remember this, all you need to think of are the letters ABCDE:

• A stands for asymmetry: A potentially cancerous mole is often asymmetrical, with uneven halves and an irregular shape.
• B stands for border: In a cancerous mole, the border will be irregular. It will not be circular or oval, like normal moles. Instead, it might have a notched or scalloped border.
• C stands for color: Carcinogenic (cancerous) moles may show uneven or changing colors, so watch for unusual growths with irregular color patterns.
• D stands for diameter: Usually, moles are about ¼ inch or 6 millimeters. Anything larger than that can be carcinogenic.
• E stands for evolving: The most significant indicator of a cancerous mole is that it changes over time. Try to see if the mole grows in size or changes its colors. It might even change its shape or become itchy. In some cases, one might even note bleeding.

Melanoma happens when melanocytes, the cells that produce skin color, become damaged. It usually starts in moles, but most moles aren't cancerous. Normally, old skin cells are shed, but DNA damage can cause cells to multiply abnormally, forming cancerous clusters. The cancerous moles can be a result of DNA mutations. DNA mutations can cause different types of cancers. The gene mutations resulting in melanoma can be of two types:

• Acquired gene mutations: Melanoma is typically caused by gene mutations acquired during life, not inherited. These mutations can happen randomly or be triggered by external factors like UV exposure. UV rays from the sun or tanning beds damage skin cells and can lead to melanoma over time. Melanoma is more common in adults due to long-term UV exposure, but can also occur in areas not exposed to the sun, often due to genetic changes.
• Inherited gene mutations: People can also inherit the gene changes that are responsible for melanoma from their parents. However, this is a rare scenario. These individuals have specific DNAs that are more likely to develop melanomas, especially in regions exposed to the sun.

There are several risk factors for melanoma. Some of these include:

• Dysplastic moles: A dysplastic nevus is a type of mole that appears different from a common mole (nevi). The risk of melanoma is greatest for individuals with a large number of dysplastic nevi.
• Fair skin: Melanoma occurs more frequently in individuals with fair skin that burns or freckles easily. These individuals often have red or blond hair and blue eyes, compared to those with darker skin.
• Ethnicity: Caucasians tend to develop melanoma significantly more often than black individuals, likely due to the increased susceptibility of light skin to sun damage.
• Personal or family history of melanoma or other skin cancers: Individuals who have been treated for melanoma have a high risk of developing a second melanoma. Additionally, melanoma can run in families, making having two or more close relatives with this disease a risk factor.
• Atypical mole syndrome: This inherited condition leads to the growth of multiple unusual moles. If a close relative has had melanoma, this is referred to as familial atypical multiple mole and melanoma syndrome (FAMMM).
• Age: Melanoma is more common in older individuals, with a median age of diagnosis around 50; however, it can also affect younger individuals, especially those with a family history.
• Environmental factors:
  • Ultraviolet (UV) radiation
  • Indoor tanning
  • Severe, blistering sunburns
• Weakened immune system: Individuals with a weakened immune system due to certain cancers, medications following organ transplantation, or HIV are at an increased risk of developing melanoma.
• Other inherited conditions:
  • Xeroderma Pigmentosum
  • Retinoblastoma
  • Li-Fraumeni Syndrome
  • Werner Syndrome
  • Hereditary Breast and Ovarian Cancer Syndromes

Several tests and procedures can be conducted to diagnose melanoma. Some of the standard tests include:

1. Physical exam
   The doctor will first ask you various questions about your medical and health history. After that, they will inspect your skin to find any symptoms or signs that might indicate melanoma.
2. Biopsy
   
   • Shave (tangential) biopsy: A shave biopsy is useful in diagnosing many types of skin diseases and in sampling moles when the risk of melanoma is very low.
   • Punch biopsy: The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin. The sample is removed and the edges of the biopsy site are often stitched together.
   • Excisional biopsy: This is done to examine a tumor that might have grown into deeper layers of the skin.
   • Incisional biopsy: An incisional biopsy removes only a portion of the tumor.
3. Biopsies of melanoma that may have metastasized (spread)
   
   • Fine needle aspiration cytology (FNAC): This may be used to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread to them.
   • Surgical (excisional) lymph node biopsy: This procedure can be used to remove an enlarged lymph node through a small incision in the skin.
   • Sentinel lymph node biopsy: If melanoma has been diagnosed and has any concerning features (such as being at least a certain thickness), a sentinel lymph node biopsy (SLNB) is often done to see if the cancer has spread to nearby lymph nodes.
4. Imaging tests
   
   • Chest x-ray: This test might be done to help determine if melanoma has spread to the lungs.
   • Ultrasound: It uses sound waves to create images of the inside of your body on a computer screen.
   • Ultrasound-guided needle biopsy: It helps assess melanoma by creating detailed images of nearby lymph nodes or tissues to check for cancer spread.
   • Computed tomography (CT) scan: It helps detect melanoma spread to internal organs or lymph nodes with detailed cross-sectional images.
   • CT-guided needle biopsy: CT scans can also be used to help guide a biopsy needle into a suspicious area within the body.
   • Magnetic resonance imaging (MRI) scan: MRI scans use radio waves and strong magnets and can be very helpful in looking at any tumor in the brain and spinal cord.
   • Positron emission tomography (PET) scan: A PET scan can help show if the cancer has spread to lymph nodes or other parts of the body. It is most useful in people with more advanced stages of melanoma.
   • PET/CT scan: This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.
5. Blood tests
   
   • Lactate dehydrogenase (LDH)
   • Complete blood count (CBC)
   • Liver function tests (LFT)
   • Kidney function tests (KFT)

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Prevention of Melanoma

There are several ways to reduce the risk of developing melanoma and other types of skin cancer:

1. Protect yourself from the sun
   • Avoid sun exposure between 10 AM and 4 PM when UV rays are the strongest.
   • Steer clear of tanning and sunburns.
   • Apply sunscreen with SPF 30+ daily, even on cloudy days, and reapply every two hours.
2. Cover yourself
   • Wear full-sleeved clothing, broad-brimmed hats, and UV-blocking sunglasses for added protection.
3. Avoid tanning beds or lamps
   • Do not use artificial tanning devices as they emit harmful UV radiation.
4. Examine your skin regularly
   • Check your skin for new or unusual changes and visit a dermatologist annually.
   • Early detection of cancer can be life-saving and easier to treat if diagnosed in the initial stage.

Learn about 8 common signs of cancer that you should be aware of.

In its early stages, the easiest way to treat melanoma is through surgery. However, when melanoma spreads beyond the skin, several different methods might be used for treatment in its later stages.

• Removal of lymph nodes: This surgical method is used if the melanoma has spread beyond the skin to the lymph nodes. The doctor will remove the affected lymph nodes along with a small portion of the surrounding area to prevent further spread.
• Immunotherapy: This drug treatment is commonly recommended after surgery. There are two major types of drugs used in immunotherapy:
  • Immune checkpoint inhibitors: These drugs enable proteins in the immune system that are disabled by cancerous cells, allowing the immune system to attack the cancer cells again. Some common drugs include:
    • Nivolumab
    • Pembrolizumab
    • Ipilimumab
  • Cytokines: These are proteins produced by the body that help boost the immune system. In some cases, doctors recommend artificial cytokines for melanoma, which make it difficult for cancer cells to divide and multiply. Some common drugs include:
    • Interferon Alpha 2A
    • Interferon Alpha 2B
    • Pegylated Interferon Alpha 2B
    • Pegylated Interferon Alpha 2A
• Targeted therapy: In targeted therapies, drugs are aimed at specific points in the cancer cells responsible for abnormal multiplication and division. This therapy is tailored to each patient, depending on how their cancer cells respond to the drug.
• Chemotherapy: These drugs are designed to kill cancer cells. Some common chemotherapy drugs include:
  • Carboplatin
  • Abraxane
• Radiation therapy: This procedure involves administering X-rays or other high-energy beams to kill cancer cells. It is recommended if melanoma has spread to the lymph nodes and beyond and cannot be treated by surgery.

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Diet might not be closely linked to melanoma, but it can help in building immunity and mitigating the side effects of drug treatments. Here are some things you can do to take care of melanoma at home:

1. Eat right
   • Include protein-rich foods such as lean meats, eggs, low-fat dairy products, and nuts.
   • Incorporate whole grains into your diet, including whole-wheat bread, oatmeal, and brown rice.
   • Choose healthy sources of fat like olive oil, nuts, and seeds. Limit sweets and added sugars.
   • Consume foods rich in antioxidants and consider taking antioxidant supplements if necessary.
   • Studies have shown that green tea, known for its healing properties and high antioxidant content, can inhibit the growth of melanocytic cells.
2. Stay hydrated

   Fluids carry nutrients to cells, flush bacteria from the bladder, and prevent constipation. Staying hydrated can lessen the severity of treatment side effects and reduce the likelihood of missing or delaying cancer treatments.

3. Exercise

   Daily exercise can help relieve stress and reduce fatigue. Walking for 30 minutes each day can improve the quality of life in advanced cancer patients.

Some common complications of melanoma are:

• Recurrence: Cancer always has a chance of recurring in your lifetime, even after it has been completely removed. It is best to check yourself regularly, even when the treatment is complete.
• Metastasis: In this scenario, cancer can spread beyond the skin to the muscles, organs, and nerves of the body.
• Secondary infection: This is seen due to disruption of the normal skin barrier.
• Scarring: Can result from the lesion itself or treatments.
• Lymphedema: It refers to tissue swelling caused by an accumulation of protein-rich fluid. It commonly occurs secondary to the removal of lymph nodes but can also result from cancer alone.
• Depression and anxiety: A higher prevalence of anxiety and depression has been identified in patients with advanced melanoma compared to those with early disease.

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Always consult your doctor before starting anything new. Remember, these approaches complement your treatment plan and are not a substitute for medical care. Some standard alternative therapies include:

• Acupressure and Acupuncture
  These are physical therapies that can help in reducing pain experienced during cancer. In acupressure, energy is released by applying pressure to different body parts, while acupuncture involves the use of needles to release stored energy.
• Massage and Physiotherapy
  These techniques can assist in managing chronic pain. Massage and physiotherapy can help alleviate pain, improve mobility, and enhance the quality of life in advanced stages of cancer.
• Exercise and Wellness Therapy
  Exercise is one of the best ways to become healthier and stronger. It is highly recommended for patients dealing with melanoma. Regular light activities, such as walking and yoga, can help maintain a healthy body weight, which is vital during the treatment process.
• Hyperthermia
  This treatment involves heating body tissue to as high as 113 °F to damage and kill cancer cells with minimal harm to normal tissue. Hyperthermia for cancer treatment is also known as thermal therapy, thermal ablation, or thermotherapy; however, it is not widely available.

Having cancer can be a life-altering event. It can be tremendously difficult for someone to cope with it both mentally and physically. It can change the course of your life, and when you first receive the diagnosis, it can be quite confusing as to what to do. Here are some tips that might help:

1. Educate yourself
   • After receiving a diagnosis, ensure that you learn as much as you can about melanoma.
   • Ask your doctor all the questions you have.
   • Research treatment options, diet, and prognosis to make informed and confident decisions.
2. Maintain close relationships
   • Stay in close contact with your family and friends.
   • This will help you build a strong support system and maintain a healthy mental state.
   • They can also provide care during surgical procedures and be there for you during tough times.
3. Communicate
   • During a traumatic experience, finding someone to confide in can be invaluable.
   • This person can be a close friend or family member.
   • If you find it awkward to speak with people you know, consider visiting a therapist or counselor.
   • Cancer support groups can also be beneficial in these situations.

Cancer can be a complex disease to deal with. It can change your outlook on life and lead to feelings of depression, anxiety, and stress. We, at Tata 1mg, have created a platform to access all the information and care required to navigate through this journey.