Melanoma (Malignant Melanoma)

What is melanoma?

Melanoma is a severe type of skin cancer resulting from the uncontrolled growth of pigment cells called melanocytes. Often, the first sign is a new mole or freckle that's dark brown or black. Though it primarily develops on the skin, melanoma can also manifest in the mouth, intestines, or eyes. This form of skin cancer is particularly aggressive as it can metastasize (spread) rapidly, accounting for the majority of skin cancer-related deaths. Timely detection is crucial for effective management.

What causes melanoma?

Melanoma arises from the uncontrolled growth of melanocyte precursors due to DNA damage. This damage is primarily from ultraviolet light exposure, either from the sun or artificial sources like tanning beds. Genetics can also influence melanoma development. The associated risk factors include:

• A history of melanoma

• Family history of melanoma or atypical moles

• Dysplastic nevus syndrome

• Presence of numerous freckles, moles, large moles, or atypical moles

• Extensive sun exposure, or sunburn, especially before age 18

• Aging

• Having fair skin, being sun-sensitive, or having limited tanning ability

• Weakened immune system

What are the symptoms of melanoma?

Melanoma might begin in a pre-existing mole or freckle, or it might emerge as a new spot. Any alteration in the color or shape of an existing mole, or the appearance of a peculiar new mole, can be indicative of melanoma. While melanomas are generally black or brown, they can display various shades like pink, tan, blue, or even be unpigmented. They might become itchy or bleed in advanced stages. To spot early signs of melanoma, remember the "ABCDEF" mnemonic:

• Asymmetry

• Border irregularity

• Color variability

• Diameter over 6 mm (similar to a pencil eraser's size)

• Evolution or change

• Funny-looking (Unusual appearance)

How do I treat melanoma?

The key to treating melanoma is early detection. If diagnosed in its initial stages, the condition is usually curable. As the disease progresses, it can spread, becoming life-threatening. Treatment options vary depending on factors like the melanoma's size, thickness, location, and stage. Following a biopsy, the standard approach is a wide excision to eliminate the melanoma entirely. Additional surgical procedures may be necessary to remove more adjacent tissue or assess nearby lymph nodes. For advanced cases, consultation with oncologists or cancer surgeons is essential. In cases where metastasis is suspected, supplementary medical treatments, or adjuvant treatments, may be recommended:

• Immunotherapies: such as interleukin-2 or interferon alfa 2b

• BRAF inhibitors: including dabrafenib and vemurafenib

• MEK inhibitors: like trametinib

• C-KIT inhibitors: e.g., imatinib or nilotinib

• CTLA-4 antagonist: ipilimumab

• PD-1 blocking antibodies: nivolumab and pembrolizumab

• Combination therapies of the above options are popular, especially ipilimumab/nivolumab

How do I prevent melanoma?

The primary preventive measure against melanoma is limiting sun and UV light exposure. Here are some strategies:

• Wearing protective clothing against the sun

• Refrain from using tanning beds

• Stay away from UV nail lamps

• Apply sunscreens on sun-exposed skin (SPF 50+ recommended)

• If limiting sun exposure, consider a Vitamin D supplement

• Regular full-body checks, especially if there's a personal or family history of melanoma