Melanoma is a type of skin cancer that begins in the skin’s pigment-producing cells, called melanocytes. These cells make melanin, which is responsible for the color in skin, eyes and hair. The word ‘melanoma’ comes from the Greek word ‘melas’, meaning black.
Melanoma is a type of skin cancer. There are three main types of skin cancer that are named after the cells that are affected: squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and melanoma. Melanoma develops from the melanocytes (pigment cells).
It usually occurs on parts of the body that have been overexposed to the sun. However, rare melanomas can also start in a part of the skin or another part of the body that has never been exposed to the sun, such as the nervous system, eye and mucous membrane (lining of the mouth and digestive tract), as well as under the feet and nails.
Melanoma is one of the least common skin cancers. However, it is one of the most serious types because it is more likely to spread to other parts of the body, especially if not detected early. If melanoma is found early, treatment is often successful.
Melanocytes produce melanin to help protect the skin from ultraviolet (UV) radiation i.e. sunlight. When melanocyte cells aggregate together in the skin during childhood or adolescence they form a mole.
Most moles are quite safe, however sometimes the melanocytes in a mole begin to grow and divide in an uncontrolled way. If they start to grow in a unregulated way, either expanding outwards or down into the lower layers of the skin, they can become a melanoma.
Melanoma is the most serious form of skin cancer and grows very quickly if left untreated. It can spread to the lower part of your skin (dermis), enter the lymphatic system or bloodstream and then spread to other parts of the body e.g. lungs, liver, brain or bone.
Melanoma kills an estimated 10,130 people in the US annually.
Types of Melanoma
Skin melanomas (cutaneous melanomas) are categorised by their appearance, thickness and how far they have spread.
- Superficial spreading melanoma – This is the most common type of melanoma, making up almost 50% of all cases. It starts as a brown or black spot that spreads across the outer layer of the skin (epidermis). This type of melanoma becomes dangerous when it invades the lower layer of the skin (dermis).
- Nodular melanoma – This type makes up about 10% of melanomas. It is usually a raised lump on the surface of the skin that is often red, pink, brown or black and feels firm to touch. It is a fast growing and aggressive form of melanoma, so if suspected it is important to see your GP (general practitioner) without delay.
- Lentigo maligna melanoma (LMM) – This type of melanoma is most common in older people. It makes up about 10% of melanomas and begins as a large freckle (lentigo maligna) in an area of skin that has had a lot of sun exposure, such as the face, ears, neck and head. It may grow slowly and superficially over many years until it penetrates more deeply into the skin.
- Acral lentiginous melanoma – This is an uncommon type of melanoma that is most commonly found on the palms of the hands, soles of the feet or under the fingernails or toenails. These commonly present as a lightly pigmented, sometimes warty area and do not respond to treatments for warts or tinea. In the nails, they most often present as a long streak of pigment in the nail or discolouration in the skin around the nail.
- Desmoplastic melanoma – This is another uncommon type of melanoma that presents as a firm, progressively growing lump, often on the head or neck. Many are skin-coloured and not pigmented.
- Other types of melanoma – There are some other rarer types of melanoma, which start in the eyes, nervous system, anus, genital tract (urethra and vagina) and tissues that line the inside of the nose.
- Melanoma in-situ – This is when the abnormal cancer cells are only in the epidermis and have not penetrated into the dermis.
Causes
Exposure to ultraviolet (UV) rays from sunlight is a leading cause behind melanoma. When sunlight hits melanocytes, they make more of the pigment melanin, darkening the skin. This can result in a tan, freckles or moles – the vast majority of which are benign.
Researchers believe that enough UV radiation exposure can damage the DNA in melanocytes, causing them to grow out of control into a tumor. Blistering sunburns in childhood, use of tanning beds and any excessive exposure to UV radiation increases the risk for melanoma.
The most important preventable cause is exposure to too much ultraviolet light in sunlight, especially during the first 20 years of life. There is lots of evidence linking melanoma to this, and melanomas are especially common in white-skinned people who live in sunny countries. The use of artificial sources of ultraviolet light, such as sun beds, also raises the risk of getting a melanoma.
Some people are more likely to get a melanoma than others –
- People who burn easily in the sun are particularly at risk. Melanoma occurs most often in fair-skinned people who tan poorly. Often they have blond or red hair, blue or green eyes, and freckle easily. Melanomas are less common in dark-skinned people.
- Past episodes of severe sunburn, often with blisters, and particularly in childhood, increase the risk of developing a melanoma. However, not all melanomas are due to sun exposure, and some appear in areas that are normally kept covered.
- People with many (more than 50) ordinary moles, or with a very large dark hairy birthmark, have a higher than average chance of getting a melanoma.
- Some people have many unusual (atypical) moles (known as ‘dysplastic naevi’). They tend to be larger than ordinary moles, to be present in large numbers, and to have irregular edges or colour patterns. The tendency to have these ‘dysplastic naevi’ can run in families and carries an increased risk of getting a melanoma.
- The risk is raised if another family member has had a melanoma.
- People who have already had one melanoma are at an increased risk of getting another one.
- People with a damaged immune system (e.g. as a result of an HIV infection or taking immunosuppressive drugs, perhaps after an organ transplant) have an increased chance of getting a melanoma.
Risk Factors
Anyone can develop melanoma. However, the following factors may increase a person’s risk:
- Skin type – Some people have skin that is more sensitive to UV radiation. This includes people who have pale, fair or freckled skin; skin that burns easily and doesn’t tan; and people with light-coloured eyes or fair or red hair.
- Having lots of moles – Adults with more than 10 moles on their arms and more than 100 on their body have an increased risk
- Childhood tanning/sunburn – Too much sun exposure during childhood and adolescence greatly increases the chance of getting melanoma in later life because damaged cells have more time to develop into cancer. Studies show that people who move after childhood from low to high UV radiation countries, such as from England to Australia, develop melanoma at a lower rate than people born in Australia.
- UV exposure – Melanoma risk is related to the pattern of UV exposure and not just the amount. People with occasional high UV exposure and sunburn, such as on weekends and holidays, are at increased risk.
- Age – Melanoma is more common in people over 50 years of age. However, it is the most commonly diagnosed cancer in 15–29 year olds.
- Cancer history – People with a previous melanoma or other type of skin cancer (BCC or SCC) have an increased risk.
- Family history – People with a strong family history of melanoma have an increased risk.
Symptoms
As with other forms of cancer, the early stages of melanoma may not produce any symptoms. This is why active surveillance is heavily promoted by cancer charities and public health organisations, so as to spot early signs of the disease. Changes in the appearance of the skin are key indicators of melanoma and are also used in the diagnostic process).
- Skin change – a new spot or mole, or a change in color, shape or size of a current spot or mole
- Skin sore that fails to heal
- Spot or sore that becomes painful, itchy, tender or bleeds
- Spot or lump that looks shiny, waxy, smooth or pale
- A firm red lump that bleeds or appears ulcerated or crusty
- A flat, red spot that is rough, dry or scaly.
All melanomas do not look the same, and there are several different types. The ABCD system (below) tells you some of the things to look out for.
A melanoma may show one or more of the following features –
- Asymmetry – the two halves of the area differ in their shape.
- Border – the edges of the area may be irregular or blurred, and sometimes show notches.
- Colour – this may be uneven. Different shades of black, brown and pink may be seen.
- Diameter – most melanomas are at least 6 mm. in diameter.
Melanomas can appear on any part of the skin but they are most common in men on the body, and in women on the legs.
Complications
Melanoma can spread to other parts of the body very quickly. Melanoma treatment can cause side effects, including pain, nausea, and fatigue.
Treatment
Treatment is more difficult when the melanoma has spread to other organs. In this case, it usually cannot be cured. Treatment involves shrinking the skin cancer and making you as comfortable as possible. People 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.
Alternative Treatment
Antioxidants are compounds in foods and supplement pills that may prevent oxidation, which can damage cells. The compounds are widely consumed by both healthy people and people with cancer for their supposed ability to prevent and fight cancer.
Omega-3 fatty acids are essential fatty acids found in some plants and fish. A balance of omega-6 and omega-3 fatty acids is advised for health. Several population studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing several different types of cancer.
Copper – Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis).
Vitamin D has been shown to block the growth of cancer tumors. The active form of vitamin D, calcitriol, provides numerous benefits against cancer. This form of vitamin D encourages cells to either adapt to their organ or commit apoptosis (cell suicide). Calcitriol also limits blood supply to the tumor and reduces the spread of cancer.
Chlorophyll – Preliminary evidence in suggest that chlorophyll may aid in the reduction of side effects associated with photodynamic therapies, such as those used in management of malignant tumors.
Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings), may be a risk factor for developing cancer.
Gamma linolenic acid (GLA) – GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate that GLA may have anti-tumor activity and may be used as a cancer treatment adjunct.
Vitamin B (Thiamin) deficiency has been observed in some cancer patients, possibly due to increased metabolic needs.
Vitamin A is a fat-soluble vitamin, which is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources such as livers, kidneys, eggs, and dairy products. Carotenoids like beta-carotene (which has the highest vitamin A activity) are found in plants such as dark or yellow vegetables and carrots.
Ginseng – Early studies report that ginseng taken by mouth may be of benefit in cancer prevention, especially if ginseng powder or extract is used
Curcumin is an extract from turmeric spice, natural curcumin supplements are available as capsule over the counter. Since this herb has many benefits, it is of benefit to add it to one’s diet.
Cordyceps is a mushroom, orally administered cordycepin inhibits melanoma cell growth in mice with no adverse effects.
Garlic should certainly be tried for this condition.
Green tea extract has a potent extract EGCG, which is becoming very popular
Melatonin has been studied, it is a pineal hormone.
Mistletoe herb has lectins which kill cancer cells.
Nicotinamide enhances repair of ultraviolet radiation-induced DNA damage in primary melanocytes. Exp Dermatol.
Quercetin is a flavonoid
Rosemary extract contains carnosol, a constant constituent of Rosmarinus officinalis extracts, is a phenolic diterpene shown to have antioxidant and anticarcinogen properties.
Resveratrol found in skin of grapes
Ginseng – Early studies report that ginseng taken by mouth may be of benefit in cancer prevention, especially if ginseng powder or extract is used.
Meditation – Not enough research has shown meditation to be of benefit in cancer prevention. More studies are needed.
Psychotherapy is an interactive process between a person and a qualified mental health care professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner).
Acupuncture, or the use of needles to manipulate the “chi” or body energy, originated in China over 5,000 years ago.
Aromatherapy – Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being.
Reference –
http://www.cancer.ca/en/cancer-information/cancer-type/skin-melanoma/melanoma/?region=on
https://www.macmillan.org.uk/information-and-support/melanoma
http://www.medicalnewstoday.com/articles/154322.php
http://www.cancer.gov/types/skin
http://www.raysahelian.com/melanoma.html
http://www.hopkinsmedicine.org/kimmel_cancer_center/types_cancer/melanoma.html
http://www.mayoclinic.org/diseases-conditions/melanoma/basics/definition/con-20026009
http://www.nhs.uk/conditions/Malignant-melanoma/Pages/Introduction.aspx
http://www.melanoma.org.nz/melanoma/overview/
https://www.melanoma.org.au/understanding-melanoma/what-is-melanoma/