A Family Doctor's Tale - MELANOMA

DOC I HAVE MELANOMA
Melonoma is said to be more common in people exposed to the sun but the patient that I saw was an elderly woman (my mother's good friend) who seldom goes under the sun. Luckily her melanoma was slow spreading but she had to have surgery to remove the melanoma and at least 1 inch margin of skin surrounding it.




Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine. 

It is a rare but dangerous cancer because of its rapid growth.

Melonoma is more common in :
1.People with fair skin than in those with darker skin.

2.People with multiple atypical nevi(moles)

3.Persons born with giant congenital melanocytic nevi(moles)

4.People with a family history of melanoma

Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.

4.People who spend time outdoors under the sun than those staying indoors.

Exposure to the sun is one of the most common causes of melanoma.

Risk factors are:
1.intensity of the sun

2.duration of sun exposure,

3.age when sun exposure takes place

4.degree of skin pigmentation

Types of primary melanomas:
1.superficial spreading melanoma

2.nodular melanoma

3.acral lentiginous melanoma

4.lentigo maligna melanoma

Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)

6.mucosal melanoma (Intestines)

7.uveal melanoma (Eye)


Symptoms that suggest melanoma are:
1.A skin mole with
Asymmetrical features
Border of the mole is irregular.
Color:  black, blue or brown with occasional reddish and white areas
Diameter: Any mole wth a diameter of  5 mm has a higher chance to become melanomas
Elevation: The mole is usually raised above the skin.
 
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
 
2.Excision biopsy of the suspected mole.

3.Lactate dehydrogenase (LDH) tests are used to detect metastases

4.Chest X-rays - to exclude spread to lungs

5.CT, MRI, PET scans of body to exclude metastases.

Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better

2.skin and lungs - have a better survival rate

3.brain , bone and liver - have the worst survival rates

Surgery is the only treatment for localized cutaneous melanoma. 

The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.

The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infltration outside the lesion.

The lymph nodes nearest to the lesion are also removed.

Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.

Radiation therapy is also used after surgery for patients with localmelanoma or for patients with unoperable distant metastases.

Immunotherapy with interleukin-2 or interferon has also been used with encouraging good results.

Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.

Prognosis depends on the following factors:
1.tumor thickness

2.depth related to skin

3.type of melanoma,

4.ulceration presence

5.lymphatic spread

6.tumor infiltrating lymphocytes (if present, prognosis is better),

7.location of lesion,

8.distant metastasis

Early diagnosis, biopsy and sugery usually means better prognosis.

Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.

Regional node spread and distant metastases usually suggest poor prognosis.

Prevention is by doing the following:
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)

2.Good nutrition and healthy lifestyle boost the immune system and helps prevant malignancy.

3.Patients with family history of skin cancer should be reviewed yearly

4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase  survival rates for melanoma patients.