Melanoma

The initial presentation is either an abnormal growth on the skin or a change in an existing mole. Melanoma can develop anywhere on the skin but are more common in the parts of the body that have more exposure to the sun. They can occur in anyone so it is important to check your skin for any signs of growth or change.

A normal mole is symmetrical in shape, has distinct borders, and is uniform in color. Causes for suspicion in otherwise healthy skin include the following:

A mole with an asymmetrical shape. If you draw a line down the middle of it and both halves are not mirrored images of each other then it is asymmetrical.

The edges are blurry and abnormally formed. This is cause for concern. In a normal mole, the border is sharp and clearly demarcated from the surrounding skin.

Uneven coloration. The coloration of the melanoma is usually black or brown but can vary between shades of pink and purple and may resemble a mole.

Large size, or change in size. Check for any kind of change in already existing moles including growth or itching.

Melanomas can occur at sites where individuals may not normally think to check and are thus termed hidden melanomas. These can be on the soles of the feet or under a fingernail.

The skin has an upper layer called the epidermis that contains the melanocytes, and an inner layer called the dermis. Production of the pigment melanin from melanocytes gives our skin its natural color. Skin becomes tanned when exposed to sunlight because there is increased production of melanin. Exposure to ultraviolet radiation for prolonged periods causes damage to the DNA of skin cells. When this damage goes uncorrected it can trigger mutations that cause the cells to rapidly proliferate giving rise to cancer. Harmful UV rays are not only from sun exposure but also from tanning beds. Individuals who get sunburned and those with significant family histories are at higher risk of developing melanoma. Since this cancer can develop in areas not exposed to the sun, it is unclear what exactly the underlying cause may be. Other important risk factors include having fair or light-colored skin that burns easily and does not tan well.

Diagnosis requires a thorough skin examination by a dermatologist. The most accurate way to make a definitive diagnosis is from a biopsy. This is a procedure in which all or a portion of the abnormal skin growth is removed and sent for laboratory examination. There are several types of biopsy procedures used when diagnosing melanoma. These include a punch biopsy in which a round piece of skin with the growth is removed, an excisional biopsy that removes the growth but also a small portion of the normal surrounding skin, and an incisional biopsy in which only the most abnormal part of the growth is removed. The results of the biopsy will verify whether or not an individual has melanoma and also what stage it is at. The different stages of the disease are described according to the size, location, and spread of cancer.

The treatment options vary depending on the stage of cancer. When diagnosed in the early stages, the melanoma is localized to the epidermis and it can be removed in its entirety. Such surgical procedures are curative and no other forms of treatment may be required. However, if the melanoma has spread to other parts of the body then surgical removal of the skin growth is not the only step in management. The patient is given chemotherapy and targeted drug treatments that help fight the cancer. Also, radiation is given to the affected area.

Surgical intervention is the primary form of treatment for melanoma along with chemotherapy, immunotherapy, and targeted therapy if cancer has spread. Alternative treatments may help to relieve the side effects of medical treatment and help to relieve the stress and pain that often accompanies therapy. If you are interested in trying complementary and alternative treatments, talk with your doctor to make sure they are safe and do not interfere with any current medications you are taking. With your doctor’s approval, you can consult a naturopathic physician that will help you add complementary therapies to your treatment regime. Some alternative therapies include:

• Acupuncture and acupressure
• Herbal medicine
• Hydrotherapy
• Massage therapy
• Meditation
• Nutrition therapy
• Physical therapy

The most important step in the prevention of melanoma is decreasing exposure to harmful ultraviolet radiation. Try to avoid being outdoors between the hours of 10 am to 3 pm when the sun is most intense. If you are going outside always wear sunscreen, even if it is cloudy. The recommended sunscreen is broadband SPF 30, at the very least. It should be applied half an hour before sun exposure and then reapplied every two hours. In cases where an individual is perspiring a lot or swimming, the application should be more frequent. Wear clothing that covers your arms and legs. Broad-brimmed sun hats and UV protectant sunglasses are also important preventative measures. Avoid getting sunburned and tanning since both are harmful.

Clinical trials recruit volunteers to participate in research that looks for new ways to treat, detect, or prevent disease. The National Cancer Institute lists the current clinical trials specific to melanoma at the following webpage here.

American Cancer Society Medical and Editorial Content Team. (2019, August 14). Melanoma skin cancer causes, risk factors, and prevention. Retrieved from American Cancer Society: https://www.cancer.org/content/dam/CRC/PDF/Public/8824.00.pdf

Cummings, M. D. et al. (2006). Cutaneous Malignant Melanoma. (pp. 500-507). Mayo Clinic Proceedings. DOI: https://doi.org/10.4065/81.4.500

Hodgetts, J. (2013, July 17). Causes and treatment of malignant melanoma. Nursing Times, 109(28). Retrieved from EMAP: https://cdn.ps.emap.com/wp-content/uploads/sites/3/2013/07/170713-Causes-and-treatment-of-malignant-melanoma.pdf

Shenenberger, D. W. (2012, January 15). Cutaneous malignant melanoma: A primary care perspective. American Family Physician. Retrieved from AAFP: https://www.aafp.org/afp/2012/0115/p161.html

Walker, T. (2019, September 26). Melanoma alternative treatments. Retrieved from Healthline: https://www.healthline.com/health/melanoma-alternative-treatments

Ward, W. H., et al. Clinical Presentation and Staging of Melanoma. Retrieved from? NCBI: https://www.ncbi.nlm.nih.gov/books/NBK481857/