Understanding Melanoma: Causes, Risks, and Treatment Options
Doctor explains melanoma, a serious skin cancer. Learn about its causes, risk factors, clinical features, and treatment options from a recent video lecture. Stay informed!
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Topic Breakdown
Melanoma, or malignant melanoma, is a type of skin cancer that originates from melanocytes—the cells responsible for producing melanin, the pigment that colors our skin. This blog post will delve into the definition, causes, risk factors, clinical features, and treatment options for melanoma, based on a recent video lecture.
Melanoma arises from melanocytes located at the junction between the epidermis and dermis, specifically in the stratum basale of the epidermis. While the skin is the most common site, melanomas can also occur in the eyes, intestines, and mouth—essentially, any location where melanocytes are present. In men, melanomas are most commonly found on the back, whereas in women, they frequently appear on the legs.
The primary concern for melanoma development is excessive exposure to UVA and UVB light, whether from the sun or artificial sources like sunbeds. Individuals who spend a lot of time in the sun or use sunbeds extensively are at higher risk. Other significant risk factors include fair skin that burns easily, immunosuppression, and a personal or family history of melanoma. Conditions like xeroderma pigmentosum and atypical mole syndrome also increase the risk. Atypical mole syndrome, characterized by having over 50 moles, with three or more being atypical (over five millimeters or unusual in shape or color), significantly elevates the risk of melanoma.
The Fitzpatrick skin type classification scale is a useful tool for assessing melanoma risk. This scale ranges from type I, where individuals always burn and never tan, to type VI, where individuals always tan and never burn. Those with type I skin are at a much greater risk of developing melanoma compared to those with type VI, though all skin types remain susceptible.
Clinically, melanoma presents as an evolving, bleeding, or itching mole that changes over time. The ABCDE criteria—Asymmetry, Border, Color, Diameter, and Evolving—are instrumental in assessing suspicious moles.
- **Asymmetry**: If a mole is asymmetrical, it raises suspicion.
- **Border**: Uneven, jagged borders are concerning.
- **Color**: Multiple colors within a single mole can indicate melanoma.
- **Diameter**: Moles larger than six millimeters in diameter warrant further investigation.
- **Evolving**: Any changes in size, shape, or color over time are red flags.
Specialists like dermatologists often use a dermatoscope to examine suspicious lesions further. Histologically, melanomas can be categorized into different subtypes, with superficial spreading melanoma accounting for about 70% of cases and nodular melanoma for 10-20%. Nodular melanomas tend to grow more in depth than width, making them particularly dangerous.
Melanomas can be classified as in situ (confined to the epidermis) or invasive (having penetrated the basement membrane into the dermis). Invasive melanomas pose a higher risk as they can spread to other parts of the body. The American Joint Committee on Cancer (AJCC) uses the TNM system for staging melanomas, assessing the tumor's thickness and ulceration, lymph node involvement, and metastasis.
Management of melanoma often begins with an excisional biopsy, where the suspicious lesion is surgically removed. The extent of the excision depends on the melanoma's size and location, but typically involves removing a margin of at least one centimeter around the lesion. Techniques like wide local excision (WLE) and Mohs surgery are common.
In cases where the melanoma has spread to lymph nodes, a sentinel lymph node biopsy may be performed. More advanced melanomas may require additional treatments like chemotherapy or immunotherapy. Follow-up care, including regular self-examinations and professional check-ups, is crucial for monitoring and managing melanoma.
Prognosis varies significantly based on the stage of the disease. Localized melanomas have a high survival rate of 99%, but this drops to 65% if it has spread to lymph nodes and as low as 25% for distant metastases. Early detection and prevention, such as using sunscreen and avoiding sunbeds, are vital in improving outcomes.
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