Melanoma is a type of skin cancer that is also considered to be the most dangerous. The tumours are formed by skin cells that start to multiply out of control, as a result to damage to their DNA. These genetic mutations are caused by dangerous ultraviolet radiation, either sunlight or the one of tanning beds. Melanocytes, which are specialized cells that produce pigment located in the basal part of the epidermis, are the origin of these growths.

Skin tumours look similar to moles and can actually develop from them in some cases. They usually have a dark color but they can also be red, purple, white, blue or even the same color as normal skin. Strong occasional exposure to UV radiation is the cause of this disease. People with a genetic vulnerability to melanoma have a higher risk to develop it, as well as fair skin types, who are easily burnt by sunlight.

Melanoma is one of the diseases that can be cured successfully in most cases, if the treatment starts early. However, if it is diagnosed late, the tumours have already extended to other areas of the body and might become very difficult to treat. For this reason, it is the most lethal form of skin cancer, even if it is not the most widespread.

What are the symptoms of melanoma?

No area of the skin is immune to this type of cancer. However, it is usually found on the face, arms, legs or back, since these are the parts that get the most sun exposure.

People with darker skin colors have a higher risk to develop melanomas in unusual locations that are rarely exposed to the sun. These include palms, fingernail beds, feet soles and other hidden areas where the condition might be hard to spot.

Sometimes melanomas develop from a mole that already exists but they can also grow on healthy skin. You should always monitor your skin for any changes, such as the development of an existing mole or the appearance of any suspicious growths with strange pigmentation.

It is very easy to become overly concerned with skin changes but remember that many of these are harmless. Moles can appear, grow and have a raised profile, without being related to cancer in any way. Moles have a normal life cycle that lasts several years. They initially have a dark color and a flat profile but later become raised. Towards the end of the cycle they lose most of their dark pigmentation.

In order to recognize melanomas, public health services advise the use of a number of criteria grouped under the ABCDE acronym. The first one is asymmetry, a suspicious mole is not symmetrical and the halves look different. B comes from border irregularity, since melanomas don't have regular borders but jagged and uneven ones. Color is the third sign, a suspicious mole will have a different color from the normal ones or a strange pattern with several colors. Another criteria is diameter, a tumour will be larger than 6 mm in diameter, while smaller growths are not a threat. Finally, E comes from evolving, a cancerous growth will change its shape, size, texture, color or even start bleeding.

Using the ABCDE rules can be very helpful in self-diagnosis. The problem is that many types of benign skin lesions also have one or more of these symptoms. For example, some moles have more than one color or an asymmetrical shape. Even if a lesion has one or more of the ABCDE signs, it can still be a normal mole. The opposite is also possible, since some melanomas escape the normal description. Doctors and dermatologists can identify these rare types and also judge if a mole is harmless or not. Some melanomas have a flat profile and a normal color, which makes them very difficult to diagnose.

Amelanotic melanomas are often confused with traumatized benign nevi or basal cell carcinoma, due to the lack of pigmentation. Another tricky type is desmoplastic melanoma, which looks just like a normal skin scar. This makes it hard to determine the exact limit of the growth. However, the treatment of all of these tumours is the same. All melanomas respect one rule: there is no pain unless the tumour is injured. At most, the growth can be itchy, without any other serious or bothersome symptoms.

Treatment options

There are several treatment options, depending on the stage of the disease and the size of the lesions. You can also choose your treatment but your general health can restrict the available choices.

Treating early-stage melanoma

If a melanoma is detected early, surgery is usually the best idea, since it removes it completely. Growths that are very thin can even be eliminated while a biopsy is performed for testing purposes. The typical surgical procedure removes the tumour, and also a part of healthy skin around it and some of the deeper tissues, for prevention. In most cases, no further treatment is needed if the condition is identified in an early stage.

Treating melanoma that has spread beyond the skin

When the growth is diagnosed late and it has already expanded beyond the skin, there are multiple options. Surgery remains a possible treatment, especially if the tumour has spread to the local lymph nodes. In this case, the surgeon will remove them as well. Usually, surgery is combined with other treatments either before or after the procedure.

Chemotherapy uses chemical agents designed to kill mutated cancer cells. The agents must travel through the blood stream to reach all parts of the body and can be administered orally or as intravenous injections. Another option is the so-called isolated limb perfusion, when chemotherapy is delivered in an arm or leg vein only. The purpose of this procedure is to restrict the action of the drugs only to that area, in order to attack just the area affected by the melanoma and protect the rest of the body from the negative side effects.

Radiation therapy attempts to cure cancer by destroying the mutated cells with X-rays or other high-power beams. It is often used in combination with other treatments, for example after the lymph nodes have been surgically removed or in order to destroy tumours that appear in other parts of the body.

Biological therapies have a different approach. This treatment tries to make your immune system more efficient, so it can fight the disease alone. Body made substances or lab-produced copies are used in these therapies. They can have various side effects resembling flu, such as fever, child, muscle pain or headache.

Targeted therapies try to use some weaknesses that have been identified in cancer cells and destroy them with specific drugs. They can also have various side effects, for example chills, dehydration, skin issues or fever.

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