Melanoma

Skin cancer is the most common cancer diagnosed in the United States and occurs on the largest organ of the body, the skin. Fortunately, most skin cancers are easily and completely cured with surgical removal. The exception to this rule is melanoma. According to the American Cancer Society, in 2009, it is estimated that 68,000 melanomas will be found and 8,000 Americans will die of this cancer.

Finding melanoma in its early stage is the key in preventing these deaths. When melanoma is limited to the skin and removed the 5 year survival rate is 95-99%. If the melanoma is found too late and has spread to internal organs, the survival rate is only 15%.

 

Risk factors for melanoma:
Patients who are at high risk for developing a melanoma should perform self skin exams each month.

  • This includes people who have had a history of melanoma,
  • A family history of melanoma,
  • Greater than 50 moles or many moles that are dysplastic (moles that are large with many different shapes and colors).
  • Other risk factors are having many freckles, red hair, blue eyes, history of non-melanoma skin cancer, history of sunburns or indoor tanning.

 

Risk reduction steps for melanoma:

  • Sun protection: using sun block, sun protective clothing
  • Avoiding being out in the sun 10 a.m.-3 p.m., is a good way to prevent getting a melanoma.
  • Avoid tanning booth. The only safe tan comes out of a bottle (self tanning products).

 

To be alert of a possible melanoma, you should be aware of your moles and pay attention to dark spots that are changing in color, shape or size. Generally this happens over two to three months.

  • Other warning signs include a constantly itchy or bleeding mole. Also beware of new dark spots that appear on normal skin but look different than your “normal” moles

 

Diagnosis:
A complete skin exam is very helpful in finding melanomas.

  • In particular, examination should include the back and extremities because this is where most melanomas are found.
  • Dermatologists are skin specialists that in addition to skin exams may use specialized techniques to aid in the early detection of melanoma.
  • These include dermoscopy (a magnifying lens that makes the skin layer more transparent and allows easier classification of skin spots) and total body photographs (useful in patients with many moles).

 

Treatment for localized melanoma:
Once a melanoma has been found, the chance it will recur or spread internally depends on its thickness, ulceration, mitotic rate and lymph node status (checked by sentinel node procedure) or physical exam.

  • The primary treatment for melanoma is surgical excision.
  • If the melanoma has spread beyond the skin into the lymph nodes or internal organs, then an oncologist reviews treatment options which include chemotherapy, radiation or immunotherapy.

 

Treatment for metastatic melanoma:
Treatment for metastatic melanoma has not been very effective.

  • Chemotherapy rarely helps to control the cancer.
  • Immunotherapy using interferon and interleukin-2 has also had very limited efficacy.
  • However, in recent years several experimental drugs being tested are showing promising results.
    • One particular experimental drug targeting a gene called BRAF was found to shrink tumor in up to 70% of patients whose tumors carried a mutated BRAF gene. The phase III trial is being conducted nationwide currently.
    • Another experimental drug, called anti-CTLA-4 antibody, is aimed at helping the immune system attack melanoma cancer cells.

When you meet with your oncologist, a thorough treatment plan will be discussed that is specific for your condition. You are encouraged to participate in available clinical trials.

 

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