What is melanoma?
Melanoma skin cancer can also appear in other parts of the body! Melanoma starts in cells of the skin called melanocytes. A cancerous (malignant) tumor is a group of cancer cells that can invade and destroy nearby tissue. A tumor can also spread (metastasize) to other parts of the body.
Melanocytes make melanin. Melanin gives color to the skin, body hair, hair and eyes. The skin is the largest organ in the human body and covers your entire body. It protects you from possible damage from things around you, such as the sun, hot temperatures, and germs. The skin controls body temperature, flushes waste products from the body through the sweat glands, and provides touch. It also helps make vitamin D.
Melanocytes can cluster together and form moles on the skin. They appear as bumps or spots that are usually brown or pink. Most people have a few moles. These are non-cancerous (benign) tumors.
But in some cases, changes in melanocytes can lead to melanoma. A change in the color, size or shape of a mole is usually the first sign of melanoma. There are 4 main types of melanoma. Superficial extensive melanoma is the most common type. The other types are lumpy melanoma, lentiginous melanoma, and lentiginous melanoma of the extremities.
Melanoma can also appear in other parts of the body where melanocytes are found, but these forms of melanoma are rare. Mucosal melanoma starts on the thin, moist lining of certain organs or other parts of the body, such as the nasal passages, mouth and anal canal. Intraocular melanoma starts in the eye.
There is another type of skin cancer called skin cancer other than melanoma. This type of cancer is more common than melanoma. Skin cancer other than melanoma starts in the basal cells or in the squamous cells of the skin.
Types of melanoma skin cancer
Melanoma can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Melanoma is also called cutaneous melanoma or malignant melanoma of the skin.
There are 4 main types of melanoma – superficial extensive melanoma, lumpy melanoma, lentigo-malignant melanoma, and lentiginous melanoma of the extremities.
Superficial extensive melanoma
Superficial extensive melanoma is the most common type of melanoma. It accounts for about 70% of all melanomas.
Superficial extensive melanoma tends to spread outwards, horizontally (radial growth), over the entire surface of the skin, but it can also begin to descend deep into the skin (vertical growth). It is often flat and thin (less than 1mm thick) with irregular contours. Superficial extensive melanoma comes in a variety of colors and can have different shades of red, blue, brown, black, gray, and white. Sometimes it starts from a mole already on the skin.
Superficial extensive melanoma usually occurs in the central part of the body (trunk), arms and legs. It tends to appear on the back of men and on the legs of women.
Lumpy melanoma is the second most common type of melanoma. It accounts for about 15-20% of all melanomas.
Lumpy melanoma descends deep into the skin. It grows and spreads faster than other types of melanoma. It appears as a raised lump that protrudes from the surface of the skin (polypoid), and it may look like a fungus with a stem or head (pedicled). Lumpy melanoma is usually black, but it can be red, pink, or the same color as your skin.
Lumpy melanoma usually occurs on the face, chest, or back. It can be seen on areas of the skin not exposed to the sun.
Lentigo malignant melanoma
Lentigo malignant melanoma most often affects the elderly. It accounts for about 10 to 15% of all melanomas.
Lentigo malignant melanoma usually appears as a large, flat, ocher or brown patch with irregular contours. It tends to become darker as it grows, and it exhibits several shades of brown or black. It often starts from an in situ tumor called lentigo malignant, which is an early form of tumor found only on the top or outer layer of the skin (epidermis). Lentigo malignant melanoma usually spreads outward over the entire surface of the skin for many years before it begins to descend deep into the skin.
Lentigo malignant melanoma usually occurs in areas of skin that are regularly exposed to the sun without protection, such as the face, ears and arms.
Lentiginous melanoma of the extremities
Lentiginous melanoma of the extremities occurs most commonly in people with dark skin, such as those of African, Asian and Hispanic descent. It is not related to sun exposure. It represents less than 5% of all melanomas.
Lentiginous melanoma of the extremities appears as a small, flat, discolored spot that is often dark brown or black in color. It usually spreads outward over the entire surface of the skin for a long time before it begins to descend deep into the skin.
Lentiginous melanoma of the extremities usually occurs on the soles of the feet, on the palms of the hands, or under the fingernails. Lentiginous melanoma of the extremities is often difficult to diagnose because it is difficult to see abnormal areas on the soles of the feet or under the fingernails.
Rare types of melanoma
Some rare types of melanoma do not appear on the skin. The following types of melanoma are rare.
Mucosal melanoma starts on the thin, moist lining of certain organs or other parts of the body (mucous membrane or mucous membrane), such as the nasal passages, mouth, throat (pharynx), rectum, anal canal, and the vagina. This type of melanoma is not related to sun exposure like most melanomas. It is usually diagnosed at a late stage and tends to develop and spread quickly.
Intraocular melanoma starts in the eye. It is the most common type of eye cancer.
Desmoplastic melanoma appears on the thick, inner layer of the skin (dermis) or on the connective tissue layer that surrounds the lining (submucosa). It often appears as a lump that is the same color as your skin. It tends to go deep into the skin. Desmoplastic melanoma often appears on the head, neck, upper back, or areas of the body where there is a mucous membrane.
Risk factors for melanoma skin cancer
A risk factor is something, like a behavior, substance, or condition that increases the risk of developing cancer. Most cancers are caused by many risk factors. The most important risk factor for melanoma is ultraviolet (UV) rays from the sun and from artificial tanning.
The number of new cases of melanoma has increased in men and women over the past 30 years. More men than women have it. The risk of one day developing melanoma increases with age, but it is also seen in adolescents and young adults (15 to 29 years old).
Lentigo malignant is a very early form of skin cancer (melanoma in situ). It is sometimes described as a precancerous condition of the skin. If left untreated, it can develop into melanoma that invades deeper layers of the skin or surrounding tissue. Certain risk factors for melanoma can also cause lentigo malignant.
Risk factors are usually ranked from most important to least important. But in most cases, it is impossible to rank them with absolute certainty.
Ultraviolet (UV) rays
Presence of many moles
Congenital melanocyte nevus
Dysplastic nevus syndrome
Other hereditary conditions
Pale colored skin, eyes, hair and hair
Personal history of skin cancer
Family history of skin cancer
CDKN2A gene mutation
Weakened immune system
There is convincing evidence that the following factors increase your risk for melanoma.
Ultraviolet (UV) rays
Being in contact with ultraviolet (UV) rays is the most important risk factor for skin cancer. The sun is the main source of UV rays. Indoor tanning devices, such as tanning beds and sunlamps, are also a source of UV rays.
Being tanned means your skin has been damaged by UV rays. UV rays can cause sunburn, premature aging, cataracts and skin cancer.
Most melanomas are caused by UV rays from the sun. For example, we talk about exposing yourself to the sun intermittently throughout your life or being in the sun when you are young. A person who had at least one sunburn with blisters in childhood or adolescence is more likely to develop melanoma later in life. The younger you get sunburned, the more likely you are to get melanoma as an adult.
Presence of many moles
A mole (melanocyte nevus) is a bump or spot on the skin that is usually brown or pink and has a smooth, even border. The mole is made up of a group of melanocytes, the cells that give color to the skin, hair, hair and eyes. Most people have a few moles.
Most moles are harmless. But you are more likely to get melanoma if you have a lot of moles.
The atypical mole (dysplastic nevus) looks different from the normal mole. The atypical mole tends to be more than 6mm in diameter while the normal mole is usually less than 6mm. The shape of the atypical mole is irregular (uneven) and its edges are undefined, while the normal mole is usually round. The atypical mole is often multicolored, varying from pink to dark brown. It may look like melanoma, but it is not cancerous.
If you have atypical moles, you are more likely to have melanoma. The more atypical moles you have, the greater the risk.
Congenital melanocyte nevus
Congenital melanocyte nevus is a wine spot or mole that is present at birth or that appears soon after. It can be classified as small (less than 1.5cm), medium (1.5-19.9cm) or large (it occupies more than 5% of a preteen’s body area or is over 20 cm in an adolescent or an adult).
The larger the congenital melanocyte nevus, the greater the risk of developing melanoma.
Dysplastic nevus syndrome
Dysplastic nevus syndrome is an inherited condition characterized by the presence of many moles (usually over 50) that often look different from normal moles. People with dysplastic nevus syndrome also have one or more close relatives who have melanoma.
People with congenital melanocytic nevi patients have a very high risk of developing melanoma.
Other hereditary conditions
The following hereditary conditions can also increase the risk of melanoma.
Xeroderma pigmentosum is an inherited skin condition that prevents it from repairing sun damage. People with xeroderma pigmentosum have skin that changes color and ages prematurely because it is very sensitive to UV rays. People with xeroderma pigmentosum are also at increased risk for melanoma and non-melanoma skin cancer.
Werner’s syndrome is an inherited condition that causes the skin to age prematurely. It is mostly seen in people of Japanese descent. People with this condition have a higher risk of developing melanoma.
Retinoblastoma is a type of eye cancer that starts in children. Hereditary retinoblastoma is passed from parent to child. It is caused by an inherited mutation in the RB1 gene. A child with an inherited retinoblastoma is more likely to have melanoma later in life.
Pale colored skin, eyes and hair
People with fair or pale complexions are more likely to have melanoma than people with different skin types. People who have blond or red body hair and hair and blue, green or gray eyes are also at higher risk for melanoma. Their risk is higher since people with these characteristics have less melanin. Melanin is the substance that gives color to the skin, eyes, body hair and hair. Experts believe it also helps protect the skin from UV rays. People who have a fair or pale complexion and who had severe sunburn at a young age are at greatest risk of developing melanoma.
People with dark skin (brown or black) are less likely to have melanoma. People with dark skin may be more likely to have a rare type of melanoma called lentiginous melanoma of the extremities. This type of melanoma appears on surfaces not exposed to the sun, such as the soles of the feet and the palms of the hands.
Personal history of skin cancer
People who have had melanoma are more likely to have another primary melanoma. Having had basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) is also linked to a greater risk of developing other skin cancer, including melanoma.
Family history of skin cancer
Your risk of developing melanoma increases if at least one of your first degree relatives is diagnosed with melanoma. This may be because the skin color and sun exposure patterns of family members are similar. It may also be due to similar genetic mutations, although this is rare.
CDKN2A gene mutation
Sometimes genes change (mutations) so that they increase the risk of cancer. These mutated genes can be passed from parents to their children. If several family members have the same type of cancer, or related types of cancer, this suggests that they share an inherited genetic mutation.
About 5% to 25% of families who are at higher risk of developing melanoma carry the inherited mutation in the CDKN2A gene. This gene is usually a tumor suppressor gene, which means it helps control the growth of cancer cells. When you see a mutation in the CDKN2A gene, cancer can develop.
Weakened immune system
People with weakened immune systems are at greater risk of developing melanoma. The immune system can be weakened by certain diseases, such as infection with the human immunodeficiency virus (HIV). It can also be caused by the medicines a person needs to take to suppress their immune system after an organ transplant.
Possible risk factors
The following factors have been linked to melanoma in some way, but there is not enough evidence to say that they are risk factors. More research is needed to clarify the role of these factors in the development of melanoma.
- Mutation of the melanocortin 1 receptor gene (MC1R)
- Ionizing radiation
- Working with products that contain a group of chemicals called polychlorinated biphenyls (PCBs)
- PUVA therapy (psoralen and ultraviolet A) is an ultraviolet light therapy treatment for skin diseases: eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large plaque parapsoriasis and cutaneous T-cell lymphoma using the sensitizing effects of the drug psoralen
- Tall adult height
Finding skin cancer in its early stages
Finding and treating skin cancer (melanoma or other than melanoma) at an early stage increases the chances of successful treatment. Have a regular check-up and see your doctor if you experience any symptoms or are concerned about your health.
If your risk is above average, you may need to see your doctor more often to check for skin cancer. Talk to your doctor about what can help you find early skin cancer, including checking your skin and having your skin examined with a qualified healthcare professional.
Check your skin
You should check your skin regularly to see if it has changed. This will help you know what is normal for your skin and notice anything unusual. See your doctor if you notice any changes.
How to check your skin
Check your skin in a well-lit room. Use a mirror to carefully observe your whole body.
Raise your arms and observe your left side and then your right side in the mirror. Observe your armpits and arms. Check your hands, each finger, the area between each of your fingers and your fingernails.
Look at the front, sides and back of your legs. Look at the top and bottom of your feet, your toenails, and the space between each toe. Also check your genital area and the space between your buttocks.
Observe your face, neck, neck, and scalp. Use a hand and full-length mirror, as well as a comb, to check your scalp.
Ask someone you trust to help you check out hard-to-see areas.
What to look for
Skin cancer usually appears as an abnormal area or a change anywhere on the skin. Look for and note any changes including these:
- a sore that does not heal or comes back after it heals
- a mole or sore that oozes, bleeds, or crusts
- a change in the color, size or shape of a mole or wine stain
- a lump or area that is itchy, irritated, or sore
- rough or scaly red patches
- small, smooth and shiny masses of pearly white, pink or red color
- flat areas of pale white or yellow color that look like scars
- raised masses with a recessed center
What to do if you notice a change in your skin
Tell your doctor as soon as possible if you see that your skin has changed. Your doctor will then do a skin exam to specifically check that area and look for any signs of skin cancer. They may refer you to a specialist, such as a dermatologist or plastic surgeon. Your doctor can do a biopsy to find out if cancer is present.
Examining the skin allows your doctor or other qualified healthcare professional to look for any signs of skin cancer or an abnormal surface of skin. This is often done during the annual health check-up. Having your skin checked regularly and thoroughly can help detect early skin cancer.
Signs and symptoms of melanoma skin cancer
Melanoma can vary in appearance. It often starts as an abnormal mole anywhere on the skin. A mole is a common non-cancerous mass. It normally looks like a small, round, or oval spot that is usually brown, light brown, or pink in color. It can be raised or flat. Most people have a few moles.
A change in the color, size or shape of a mole is usually the first sign of melanoma. These changes may occur to a mole or spot that is already on your skin, or the changes may appear as a new mole. Other conditions can also look like melanoma.
The ABCDE rule below can help you in your review of common signs and symptoms of melanoma. Tell your doctor if you have any of the following changes to your skin:
A stands for asymmetry – One of the two halves of the mole is not the same shape as the other.
B means irregular border – The outline of the mole is uneven (irregular). It may have uneven, scalloped, or fuzzy edges. The color can spread to the area around the mole.
C stands for various colors – The color of the mole is not the same everywhere. The mole can show shades of light brown, brown and black. Sometimes we see areas of blue, gray, red, pink or white.
D stands for Diameter – The size of the mole is over 6 mm (1/4 inch) in diameter, about the size of an eraser at the end of a pencil.
E stands for evolution – There is a change in the color, size, shape or texture of the mole. The mole may itch or you may have a stinging or stinging sensation.
Other signs and symptoms of melanoma include the following:
- region that does not heal
- oozing or bleeding mole
- presence of broken skin with open lesion (ulceration)
Diagnosis of melanoma
Diagnosis is the process of identifying the cause of a health problem. The diagnostic process for melanoma usually begins with a visit to your family doctor. Your doctor will ask you about any signs or symptoms that are present and do a skin exam. Based on this information, your doctor may refer you to a specialist, such as a dermatologist or surgeon.
The diagnostic process can seem long and overwhelming. It’s okay to worry, but try to remember that other medical conditions can cause melanoma-like signs and symptoms. It is important that the healthcare team rule out any other possible cause of the condition before making a diagnosis of melanoma.
The following tests are usually used to rule out or diagnose melanoma. Many tests that can diagnose cancer are also used to determine its stage (how far the disease has spread).
Health history and physical examination
Your health history consists of a review of your signs and symptoms, your risk factors, and any medical events and conditions you may have had in the past. Your doctor will ask you questions about your personal history relating to the following:
- signs or symptoms that suggest melanoma
- sun exposure and indoor tanning
- sunburn with blisters
- atypical mole (dysplastic nevus) – it looks different from a normal mole
- skin cancer, both melanoma and non-melanoma skin cancer
Your doctor may also ask you questions about your family history relating to the following:
- skin cancer, both melanoma and non-melanoma skin cancer
- risk factors for melanoma, including FAMMM syndrome (familial multiple atypical melanoma)
- Your physical exam allows your doctor to look for any signs of melanoma. Examining the skin is often the first part of a physical exam. When examining your skin, your doctor will look at the entire surface of the skin for any abnormal moles or areas. The doctor will check the size, shape, color and texture of the moles.
During the physical exam, your doctor may also check for swollen lymph nodes by feeling your neck, groin or armpits.
Dermoscopy is used to see areas of the skin more clearly. This test also allows the doctor to see structures, such as blood vessels, that are not visible just by looking at the skin. A dermoscopy uses an instrument (a dermoscope) with a special light and a magnifying lens (microscope) that the doctor holds against the skin to observe the skin by looking through the lens. Dermoscopy is also called dermatoscopy, epiluminescence microscopy, surface microscopy, and incident light microscopy.
A device called Verisante Aura is also sometimes used to scan a mole or lump to see if cancer is present. Health Canada has approved the Verisante Aura, but this device is not available in all centers and is not a standard method for diagnosing melanoma and other skin cancers.
During a skin biopsy, the doctor removes tissues or cells from the skin for analysis in the laboratory. The pathologist’s report will confirm whether or not there are cancer cells in the sample. The type of biopsy performed often depends on the appearance of the mass and its size.
An excisional biopsy is a type of surgical biopsy that removes the entire mass with a scalpel (surgical knife). It is used when the doctor thinks the lump may be melanoma. An excisional biopsy is the best type of biopsy for diagnosing melanoma.
A punch biopsy removes part of the lump in the shape of a circle using a sharp instrument called a punch, and can be done when the lump is very large and the doctor thinks it could be melanoma. With the punch biopsy, the doctor tries to remove most of the abnormal area of the lump, including part of the border. Sometimes the cookie cutter is large enough to remove all of the mass. An incisional biopsy, which removes part of the mass with a scalpel, is sometimes used, instead of a punch biopsy.
The shave biopsy shaves off the lump on the skin using a flexible razor blade or scalpel. It is sometimes used if the doctor can remove enough tissue.
Lymph node biopsy
A lymph node biopsy removes a lymph node or tissue from a lymph node so that it can be tested in the lab for cancer cells. This is done if the doctor thinks the cancer has spread to the lymph nodes. Lymph node biopsy is also often part of the treatment for melanoma.
In a fine needle biopsy (BAF), a fine needle is used to remove a small amount of fluid or cells from a lymph node. This procedure may be done if the doctor feels a swollen lymph node or if a swollen lymph node is seen on an imaging test such as an ultrasound.
A sentinel node biopsy (BGS) is done to identify and remove the sentinel node to see if it contains cancer cells. The sentinel node is the first lymph node in a group of nodes that receives lymph from the tumor. BGS may be done if the melanoma on the skin is more than 1 mm thick. Doctors may also consider BGS for slightly thinner tumors (0.75 to 1 mm thick).
Cell and Tissue Studies
Cells and tissues can be studied in the lab to look for any signs of cancer. Analysis may reveal certain bodily changes. Samples of melanoma tissue and cells are usually taken during a biopsy. Tissue removal can also be done during surgery.
For melanoma, the following cell and tissue studies can be done.
The frequency of mitosis is how quickly cancer cells divide and grow. This is the number of cells dividing (mitosis) in a certain amount of cancerous tissue. The frequency of mitosis is used to determine the stage of melanoma and decide on the best treatment.
The BRAF gene is a gene that has changed (mutated) in about half of all melanoma cases. A mutation in the BRAF gene can cause cancer cells to grow and divide rapidly. Usually, a tumor is tested to see if it has a genetic mutation in the BRAF gene in people with stage 4 melanoma. Melanomas that test positive for the BRAF gene mutation test may respond to certain drugs. targeted.
Computed tomography (CT)
A computed tomography (CT) scan uses special x-ray machines to produce 3-dimensional and cross-sectional images of the body’s organs, tissues, bones and blood vessels. A computer assembles the photos into detailed images.
A CT scan of the chest, abdomen and pelvis is done to see if the melanoma has spread to other parts of the body. It is usually used when the melanoma is more than 4mm thick. This test is also done if cancer cells have been found in a lymph node.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radio waves to produce cross-sectional images of the body’s organs, tissues, bones, and blood vessels. A computer assembles the photos into 3-dimensional images.
An MRI may be used when the doctor wants to check if the melanoma has spread to the brain and spinal cord.
In an x-ray, low-dose radiation is used to produce images of certain parts of the body on film. A chest x-ray can be done when the doctor wants to check if the melanoma has spread to the lungs.
Positron Emission Tomography (PET scan)
A positron emission tomography (PET) scan uses a radioactive material called a radiopharmaceutical to detect changes in the metabolic activity of body tissues. A computer analyzes patterns of radioactivity distribution and produces 3-dimensional, color images of the region under examination. PET can be combined with computed tomography (CT) using the same device. This is called PET / CT.
A PET or PET / CT scan may be used to see if the melanoma has spread to the lymph nodes or other parts of the body. It can be used before surgery to find out the extent of the cancer and help decide whether surgery should be done.
Blood tests measure the level of certain cells or substances in the blood. These tests often provide useful information about your general health, how certain organs are working, other conditions and how you might respond to treatment.
Lacticodehydrogenase (LDH) is a tumor marker that is used to help determine the stage of advanced melanoma and to establish a prognosis. High LDH levels may indicate that the melanoma has spread to other parts of the body, such as the liver. It can also mean that the cancer will be more difficult to treat.
Other blood tests, such as a complete blood count (CBC) and blood chemistry tests, may be done before you start treatment.
Stages of melanoma
Staging describes or categorizes cancer based on how much cancer is in the body and where it was initially diagnosed. This is often referred to as the extent of cancer. Information from tests is used to find out how big (thick) the tumor is, which parts of the skin have cancer, whether the cancer has spread from its place of origin and where it spread. Your healthcare team uses the stage to plan your treatment and predict the outcome (your prognosis).
The most frequently used staging system for melanoma is the TNM staging system. In melanoma, there are 5 stages, ie stage 0 followed by stages 1 to 4. For stages 1 to 4, the Roman numerals I, II, III and IV are often used. But in order to make the text clearer, we will use the Arabic numerals 1, 2, 3 and 4. In general, the higher the stage number, the more cancer has spread. Talk to your doctor if you have questions about staging.
When doctors describe the stage, they often use the words early stage, locoregional, or metastatic.
Early stage means the cancer is only found in the skin where it started and has not spread to other parts of the body. This includes stage 0, stage 1A, stage 1B, stage 2A, stage 2B, and stage 2C.
Locoregional means that the cancer has spread to nearby lymph nodes, or it has spread to nearby areas of the skin or to lymph vessels. This includes stage 3 melanoma.
Metastatic means the cancer is located in a part of the body farther from where it started. This includes stage 4 melanoma.
Stage 0 (melanoma in situ)
Cancer cells are present only on the top or outer layer of the skin (epidermis). Some doctors describe melanoma in situ as a precancerous condition of the skin.
The tumor is 0.8mm or less thick and there is no ulceration of the tumor (there is no broken skin or open lesion).
Or the tumor is more than 0.8mm, but not more than 1mm, thick. There may be tumor ulceration (presence of broken skin with open lesion).
The tumor is more than 1 mm, but not more than 2 mm, in thickness. There is no ulceration of the tumor.
The tumor is more than 1 mm, but not more than 2 mm, in thickness. There is an ulceration of the tumor.
Or the tumor is more than 2mm, but not more than 4mm, thick. There is no ulceration of the tumor.
The tumor is more than 2 mm, but not more than 4 mm, in thickness. There is an ulceration of the tumor.
Or the tumor is more than 4mm thick and there is no ulceration of the tumor.
The tumor is more than 4mm thick and there is an ulceration of the tumor.
The cancer has spread to at least 1 lymph node near where the cancer started (regional lymph nodes). After the lymph nodes have been removed and examined by a pathologist, the cancer may be assigned stage 3A, 3B, 3C or 3D. It depends on the following:
the number of lymph nodes containing cancer cells
the amount of cancer cells in the lymph nodes
if the cancer has spread to nearby areas of skin (satellite tumors) or lymphatic vessels (tumors in transit)
The cancer has spread to other parts of the body (distant metastasis), such as the lungs or liver. It is also called metastatic melanoma.
A recurrence of melanoma means that the cancer comes back after treatment. If it reappears where or near where it first started, it is called a local recurrence of melanoma. It may also reappear in another part of the body further away from the location where it originated. This is called metastatic melanoma or distant recurrence.
If melanoma spreads
Cancer cells can spread from the area of the skin where the cancer started to other parts of the body. This spread is called metastasis.
Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If melanoma spreads, it is likely to spread to the following structures:
- lymph nodes near where the cancer started (regional lymph nodes)
- other areas of the skin that are far from where the cancer started
- soft tissue located just under the skin (subcutaneous tissue)
- digestive tract, such as the small intestine
- adrenal gland
Prognosis and survival for melanoma
If you have melanoma, you may have questions about your prognosis. A prognosis is the act by which the doctor best assesses how cancer will affect an individual and how they will respond to treatment. The prognosis and survival depend on many factors. Only the doctor who is familiar with your medical history, the type and stage of cancer, the treatments chosen and the response to the treatment can look at all of this data together with the survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person (such as gender) that the doctor takes into account when making a prognosis. A predictor factor influences how cancer responds to a certain treatment. We often discuss prognostic and predictive factors together. They both play a role in choosing the treatment plan and in establishing the prognosis.
The following are prognostic factors and predictors of melanoma.
The thickness of the primary tumor is an important prognostic factor. This factor helps predict the risk of cancer spreading. The thicker the tumor, the worse the prognosis. A melanoma that is less than 1 mm in thickness has a low risk of spreading to other parts of the body. A melanoma that is more than 4 mm thick is at a higher risk of spreading to other parts of the body and of coming back (recurring) after treatment.
Ulceration is the presence of broken skin with an open lesion. When the primary tumor is ulcerated, it has a less favorable prognosis than a tumor without ulceration. The presence of an ulceration increases the risk that the cancer will spread to other parts of the body and come back after treatment.
Frequency of mitosis
The frequency of mitosis is how quickly cancer cells divide and grow. This is the number of cells dividing (mitosis) in a certain amount of cancerous tissue. A high frequency of mitosis is linked to a poor prognosis.
Location of cancer on the skin
Melanoma that develops in the arms or legs (extremities) has a better prognosis than melanoma that develops in the central part of the body (trunk), head or neck. Melanoma that occurs on the palms of the hands or the soles of the feet also has a poorer prognosis compared to other locations.
Women with melanoma tend to have a better prognosis than men with this disease. This could be because women have more melanoma of the extremities, while men have more often melanoma of the trunk, head or neck.
People under 35 are more likely to have melanoma that spreads to nearby lymph nodes. But overall, people who are older have a poorer prognosis.
Lumpy melanoma has a poor prognosis because it grows down deep into the skin (vertical growth pattern) and tends to be thicker at diagnosis.
Lymph nodes with cancer
If the cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer cells, the less favorable the prognosis. People with 4 or more neighboring lymph nodes have cancer have a poorer prognosis than people with 1 to 3 lymph nodes.
If swollen (palpable) lymph nodes can be felt or seen on an imaging test, the prognosis is poorer than if there are only a small amount of cancer cells (micrometastases) in them. lymph nodes.
Melanoma that has spread to other parts of the body (distant metastasis), such as the lung, liver or brain, has a poor prognosis. This prognosis is poorer than with cancer that has spread to other areas of the skin far from where it started, to tissue under the skin (subcutaneous tissue) or to distant lymph nodes.
In metastatic melanoma, a high level of lacticodehydrogenase (LDH) in the blood has a poorer prognosis than when the level of LDH is normal.
Treatments for melanoma
If you have melanoma, your healthcare team will make a treatment plan just for you. This plan will take into account your condition and specific cancer information. When your healthcare team decides what treatments to offer you for melanoma, they take the following into consideration:
- the stage of the cancer – whether the cancer is early stage, locoregional, or metastatic
- the risk of the cancer coming back (coming back)
- the location of the cancer
- the effects of treatments on your appearance
- your personal preferences (whatever you want)
You may be offered one or more of the following treatments for melanoma.
Surgery is the main treatment for most melanoma. Depending on the stage and risk of cancer recurrence, one or more of the following types of surgery may be performed.
Wide local excision removes the cancer as well as some normal tissue all around it (surgical margin). It is used as the first treatment for early-stage melanoma, locoregional stage melanoma, or local recurrence of melanoma.
A sentinel node biopsy (BGS) finds and removes the first (or first) lymph node in a group of lymph nodes to see if it contains cancer cells. It may be used for early-stage melanoma when the tumor is thick.
Complete lymph node dissection removes a group of lymph nodes from the body. It is done for locoregional melanoma or local recurrence of melanoma that has spread to nearby lymph nodes.
Reconstructive surgery repairs the skin and the surrounding area after a tumor has been removed. When a large area of skin has been removed to make sure there is no cancer at all, the doctor reconstructs the area using a piece of skin taken from another part of the body, called a graft. skin or skin flap.
Metastasis surgery can be done to remove metastatic melanoma that has spread to a single area or to a few areas on or just under the skin, or to the lung, liver, brain or small intestine.
Immunotherapy uses drugs to help the body’s immune system fight cancer cells. It is sometimes given after surgery to reduce the risk of the cancer coming back, or to reduce the size of melanoma and control its growth when surgery cannot be done. Find out more about immunotherapy.
In external beam radiation therapy, a device is used to direct a beam of rays to the area of the skin and a small amount of nearby tissue. It is sometimes used after surgery to reduce the risk of the cancer coming back, or as a palliative treatment to control symptoms of advanced melanoma.
In chemotherapy, anti-cancer drugs (cytotoxics) are used to destroy cancer cells. The drugs can be given throughout the body (systemic chemotherapy) for metastatic melanoma. Medicines can be given directly to an arm or a leg (regional chemotherapy) for local recurrence of melanoma that only appears in one limb. Find out more about chemotherapy.
In targeted therapy, drugs are used to target specific molecules (such as proteins) on the surface or inside of cancer cells to stop the growth and spread of cancer cells while limiting damage to normal cells. . It is usually used in people with metastatic melanoma, who have certain changes (mutations) in the BRAF gene.
If you cannot or do not want to be treated for cancer
You may want to consider receiving some type of care that makes you feel better without treating the cancer itself. This could be because cancer treatments are no longer effective, are no longer likely to improve your condition, or may cause side effects that are difficult to cope with. There could also be other reasons why you cannot or do not want to be treated for cancer.
Discuss this with your healthcare team. They can help you choose the care and treatment for advanced cancer.
Follow-up after treatment is an important part of caring for people with cancer. You will need to have regular follow-up visits, especially during the first 5 years after treatment. These visits allow your healthcare team to monitor your progress and learn how you are recovering from treatment.
Some melanoma clinical trials are available and are accepting participants in certain countries. Clinical trials aim to find new methods of preventing, detecting and treating cancer. Contact your healthcare provider if a clinical trial is available.
Supportive care for melanoma
Supportive care empowers people to overcome the physical, practical, emotional and spiritual barriers that melanoma creates. It is an important component of the care of people affected by this cancer. There are programs and services to meet the needs and improve the quality of life of these people and their loved ones, especially after treatment has ended.
Recovering from melanoma and adjusting to life after treatment is different for everyone, depending on the stage of the cancer, the type of treatment given and many other factors. The end of cancer treatment can lead to mixed emotions. Even if the treatment is finished, there may be other issues that need to be addressed, such as coping with long-term side effects.
You may want to discuss the following topics with your healthcare team.
Self-esteem and body image
Self-esteem is what you feel about yourself. Body image is how you see your own body. Melanoma and its treatments can cause changes to your skin, such as scarring and changes in skin color. Some of these changes may be temporary or lessen over time. Others will last a long time and some will be permanent. You might find that these changes are very noticeable, especially if they affect an area like your face.
Sometimes makeup can cover up scars and other skin changes.
Reconstructive surgery can also be used to repair the skin where the cancer was removed and the skin in the surrounding area.
You may consider wearing a prosthesis if reconstructive surgery does not repair the skin, if the area does not move normally, or if reconstructive surgery is not possible. A prosthesis is an artificial device that replaces a part of the body. It is possible to design a prosthesis for the face or other parts of the body, which is perfectly suited to the person who will use it.
Recurrence or appearance of another skin cancer
You may be concerned about the risk of the cancer coming back (coming back) after treatment, especially if your doctor has said there is a high risk of it coming back. When melanoma is detected and treated at an early stage, it is usually easier to treat. It is therefore important to check your skin and have regular follow-up visits with your doctor. Tell your doctor if you have a new mole or an abnormal lump or area on your skin.
Most melanomas are caused by too much exposure to ultraviolet (UV) rays from the sun or from artificial tanning. The best way to lower your risk of cancer recurrence or other skin cancer is to protect yourself from the sun and other ultraviolet (UV) rays.
The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.
Photo credit: Wikimedia Commons
Photo explanations: ABCD rule illustration: On the left side from top to bottom: melanomas showing (A) Asymmetry, (B) a border that is uneven, ragged, or notched, (C) coloring of different shades of brown, black, or tan and (D) diameter that had changed in size. The normal moles on the right side do not have abnormal characteristics (no asymmetry, even border, even color, no change in diameter).