Melanoma

Definition

A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.

Thanks to darker skin pigmentation, African Americans are less likely than members of other racial and ethnic groups in the United States to develop skin cancer. However, this does not mean that African Americans should ignore the possibility of skin cancer completely. Although the rates of occurrence of various types of skin cancer are lower in African Americans, they are not zero. African Americans can develop skin cancer, and when they do, the outcome is often more serious than it is for other Americans.

One reason why the outcome of skin cancer is often poorer in African Americans is that the disease is often diagnosed at a more advanced stage, when treatment is more difficult. Also, the type of melanoma most frequently found in African Americans is acral lentiginous melanoma, which is more dangerous than the types of melanoma that predominate in white Americans.

Statistics from various parts of the United States indicate that survival rates for African American patients diagnosed with melanoma are lower than those of white patients. For example, the California cancer registry reported a five-year survival rate of 70% for African American melanoma patients, as compared to 87% for white patients. Similarly, at the Washington Hospital Center in Washington, DC, the five-year survival rate for African American patients was 59%, compared to 85% in whites.

Causes

Studies have shown that the following are risk factors for the three most common types of skin cancer:

• Sunlight: Sunlight is a source of UV radiation. It’s the most important risk factor for any type of skin cancer. The sun’s rays cause skin damage that can lead to cancer.
• Severe, blistering sunburns: People who have had at least one severe, blistering sunburn are at increased risk of skin cancer. Although people who burn easily are more likely to have had sunburns as a child, sunburns during adulthood also increase the risk of skin cancer.
• Lifetime sun exposure: The total amount of sun exposure over a lifetime is a risk factor for skin cancer.
• Tanning: Although a tan slightly lowers the risk of sunburn, even people who tan well without sunburning have a higher risk of skin cancer because of more lifetime sun exposure.
• Family history: Melanoma sometimes runs in families. Having two or more close relatives (mother, father, sister, brother, or child) who have had this disease is a risk factor for developing melanoma. Other types of skin cancer also sometimes run in families. Rarely, members of a family will have an inherited disorder, such as xeroderma pigmentosum or nevoid basal cell carcinoma syndrome, that makes the skin more sensitive to the sun and increases the risk of skin cancer.
• Certain medical conditions or medicines: Medical conditions or medicines (such as some antibiotics, hormones, or antidepressants) that make your skin more sensitive to the sun increase the risk of skin cancer. Also, medical conditions or medicines that suppress the immune system increase the risk of skin cancer.

Symptoms

Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. Melanoma may also appear as a new mole. Thinking of “ABCDE” can help you remember what to look for:

• Asymmetry: The shape of one half does not match the other half.
• Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
• Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
• Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
• Evolving: The mole has changed over the past few weeks or months.

Exams and Tests

If you have a change on your skin, your doctor must find out whether or not the problem is from cancer. You may need to see a dermatologist, a doctor who has special training in the diagnosis and treatment of skin problems.

Your doctor will check the skin all over your body to see if other unusual growths are present.

If your doctor suspects that a spot on the skin is cancer, you may need a biopsy. For a biopsy, your doctor may remove all or part of the skin that does not look normal. The sample goes to a lab. A pathologist checks the sample under a microscope. Sometimes it’s helpful for more than one pathologist to check the tissue for cancer cells.

You may have the biopsy in a doctor’s office or as an outpatient in a clinic or hospital. You’ll probably have local anesthesia.

There are four common types of skin biopsies:

• Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth
• Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area
• Incisional biopsy: The doctor uses a scalpel to remove part of the growth
• Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it. This type of biopsy is most commonly used for growths that appear to be melanoma.

Treatments

Treatment for skin cancer depends on the type and stage of the disease, the size and place of the tumor, and your general health and medical history. In most cases, the goal of treatment is to remove or destroy the cancer completely. Most skin cancers can be cured if found and treated early. Sometimes all of the skin cancer is removed during the biopsy. In such cases, no more treatment is needed. If the cancer has spread to nearby lymph nodes, these lymph nodes may also be removed. After surgery, you may receive a medicine called interferon.

Treatment is more difficult when the melanoma has spread to other organs. When it spreads to other organs, it usually cannot be cured.

Treatment involves shrinking the skin cancer and making you as comfortable as possible. You may receive:

• Chemotherapy: Medicines are used to kill cancer cells. It is usually given if the melanoma has returned or spread.
• Immunotherapy: Medications such as interferon or interleukin help your immune system fight the cancer. They may be used along with chemotherapy and surgery.
• Radiation treatments: These may be used to relieve pain or discomfort caused by cancer that has spread.
• Surgery: Surgery may be done to remove cancer that has spread to other parts of the body. This is done to relieve pain or discomfort associated with the growing cancer.

Possible Complications

Melanoma can spread to other parts of the body very quickly. Treatment can cause side effects, including pain, nausea, and fatigue.

When to Contact a Medical Professional

Call your health care provider if you notice a new growth or any other changes in your skin. You should also call if an existing spot becomes painful or swollen, or if it starts to bleed or itch.

Preventions

The best way to prevent skin cancer is to protect yourself from the sun:

• Avoid outdoor activities during the middle of the day. The sun’s rays are the strongest between 10 a.m. and 4 p.m. When you must be outdoors, seek shade when you can.
• Protect yourself from the sun’s rays reflected by sand, water, snow, ice, and pavement. The sun’s rays can go through light clothing, windshields, windows, and clouds.
• Wear long sleeves and long pants. Tightly woven fabrics are best.
• Wear a hat with a wide brim all around that shades your face, neck, and ears. Keep in mind that baseball caps and some sun visors protect only parts of your skin.
• Wear sunglasses that absorb UV radiation to protect the skin around your eyes.
• Use sunscreen lotions with a sun protection factor (SPF) of at least 15. (Some doctors will suggest using a lotion with an SPF of at least 30.) Apply the product’s recommended amount to uncovered skin 30 minutes before going outside, and apply again every two hours or after swimming or sweating.

Natural Remedies

Clinical trials are currently studying many alternative treatments for melanoma. These include new forms of immunotherapy, such as monoclonal antibodies and vaccines. Your doctor may recommend that you join a clinical trial if one is available in your area.

What You Need To Know:

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

• Acupuncture, to relieve pain.
• Meditation or yoga, to relieve stress.
• Massage and biofeedback, to reduce pain and ease tension.
• Breathing exercises for relaxation.

Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments. Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies.

Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.