Melanoma

Melanoma is considered the most dangerous type of skin cancer. In 2015, it affected about 3.1 million people around the world which resulted in 59,800 deaths. Australia and New Zealand are most severely affected by this disease, while Asia, Africa, and Latin America are comparatively less affected (12Opens in a new tab.

The rates of people diagnosed with melanoma are increasing each year. It is vital for people to take preventative measures to reduce the risk of developing melanoma due to its aggressive nature. In this post, I will explore the dangers of melanoma, and what you can do to reduce your risk of developing one in the future.

What is melanoma?

Melanocytes are the Melanin producing cells that give colour to the skin in humans. These cells are located in the bottom layer of the epidermis of humans. If these cells began to abnormally reproduce themself that develop the ability to invade or spread to the adjacent cells, it is known as Melanoma. It mostly develops on the skin but in some cases may appear in inner organs of the body such as eyes, nose, throat, and intestine (1Opens in a new tab.

Black spots on the skin can be cause of concern especially in relation to the risk of melanoma

In 2016, the 4th most common cancer diagnosed in Australia was melanoma, and it is estimated that by 2020 it will be the 3rd most diagnosed cancerOpens in a new tab.

America also has high incidence rates of melanoma, with 21.8 per 100,000 peopleOpens in a new tab.

Types of skin cancer

There are different types of skin cancer, but Melanoma is the most deadly and aggressive by far. Squamous Cell Carcinoma and Basal Cell Carcinoma will be covered in future posts. Today we will be focusing primarily on Melanoma.

You can see from the image below that Melanoma is fast growing, aggressive and invades the surrounding tissues much more rapidly than the other two types of skin cancer.

What are the causes of Melanoma?

The Role of UV Radiation

Mostly it is caused by the Damage in DNA. This damage may occur when the cells are exposed to Ultraviolet radiation of the sun or any other source. The international agency for cancer research found that the people who use Tanning devices or bed before the age of 30 have 75% more chances to develop melanoma. That’s why the beds are also known as “carcinogenic to humans”(2Opens in a new tab.

The effects of unprotected skin when exposed to sunlight. Increased risk of DNA mutation and melanomas

Thymine dimerization is the major damage in the DNA by UV radiation. If this damage remains unrepaired it causes changes in genes of cells, called mutations. When these damaged cells divide and produce more cells, the growth of tissue becomes out of control and develops a tumour (3Opens in a new tab.

The Role of Genetics

Some rare mutations may transfer from parents to offspring and make them more susceptible to different types of cancers. A gene CDKN2A may be mutated and cause to develop melanoma. Other mutations that caused xeroderma pigment (XP) development, also a major cause of melanoma development. Genetic testing is a technique that is used to find out these mutations in a person and if found early these symptoms can be controlled (4Opens in a new tab.

BRAF is a gene in human that develop a protein B-RAF. This gene is involved in normal cell growth and division. If a mutation takes place at is 600th codon, its normal physiological ability is rendered and it began to produce a tumour. RAS genes i.e. NRAS, HRAS, and KRAS can also be mutated a start oncogenic activity (5Opens in a new tab.

The Phases of Melanoma

Melanocytes are cells found between the outer epidermis and the inner dermis layer of skin. The radial growth phase of the disease starts when these cells began to start of control growth. At this stage, the tumor has a size of about less than 1mm and does not reach the blood vessels. If the tumor is detected at this phase it can be removed by surgery and it does not spread to other parts of the body (6Opens in a new tab.

Phases of melanoma

In the next phase, the cells acquire the ability to invade and melanoma began to spread. This phase is known as the invasive radial growth phase. After that vertical growth phase (VGT) starts. The tumour at this phase invades the dermis and affects the surrounding tissues. It also spread through bloody and lymphatic tissues. Body immune systems also respond at this phase and try to destroy the tumour cells. In many cases, the cells of the primary tumour were destroyed but the metastatic tumours were discovered in the body (7Opens in a new tab.

Diagnosis of Melanoma

Early detection of Melanoma is essential for a successful recovery. Melanomas can appear on any surface area of the body that may be exposed to the sun or not. Regular examine of the mole and other skin areas are necessary, and if noticed any change in colour, size, shape or bleeding consult with a qualified physician (8Opens in a new tab.

Mostly brown spot, moles, or any growth on the skin surface is considered harmless but it is not always. Five alphabets letters help us to understand the difference between a harmless spot to melanoma spot. 

ABCDE of Melanoma

ABCD of melanoma assessment

A for asymmetrical: Melanoma spot does not have a symmetrical shape i.e. if we cut the spot into two halves, each part is different in shape from the other. This spot is not in oval, round, or any other symmetrical shape. 

B for Border: Focusing on the border of the spot is also important. The normal moles usually have smoother and even border. While in the melanoma the border area is scalloped or notched edges and seemed to be uneven.

C for color: Normal moles are usually brown while Melanoma has different colors. It may be brown or black in the beginning but changed into red, white, or blue as it grows. 

D for diameter or dark: For a successful recovery it is crucial to detect when the lesion is a size less than 6mm in size. For some experts, every lesion that is darker than the other needs to be taken seriously, without considering the size. In rare cases, melanoma may be colorless.

E for Evolving: Any elevation of a spot on the skin, or itching, crusting, or bleeding in it may a sign of melanoma (9)Opens in a new tab.

Early diagnosis of melanoma is vital, the earlier the melanoma is removed, the better the outcome. According to the journal “Cancer Australia”, between 2012- 2016, people diagnosed with melanoma of the skin had a 92%Opens in a new tab.

Signs and symptoms of melanomas and moles

These warning signs require you to act now and see your local Health Care Professional for further advice.

Best prevention strategies

Get your skin checked if you have any doubt if you have a suspicious looking spot or mole

Check yourself

Once a month you need to completely examine the skin from head to toe so any melanoma development can be found out at the early stage. Use a mirror to examine the neck, face, scalp, and ears. 

If any existing mole or lesion seems to be abnormal in size, shape, or appearance, take it seriously and consult with a health care professional. Please don’t leave it to “see how it goes”, with any skin changes it is always important to play on the side of caution. 

When in doubt, check it out

Once the cancer is spread more, it is difficult to cure it. So, follow your doubt and consult if you found any abnormal spot or growth on your skin. Don’t rely on your monthly self-examine but visit the dermatologist or local health care professional.

There is some great technology around these days, where they can scan your body and determine if there are areas of high risk, and with this technology can compare any changes at your next scan.

Avoid direct sun rays

Sun rays are more severe during the middle of the day from 10:00 am to 4:00 pm. Avoid the direct exposure of your skin to sun rays as your skin may absorb Ultraviolet radiation. This UV is the major reason for sunburn and suntans, that increases the chance of developing melanomas (10Opens in a new tab.

Sun safety while in the sun is vital to reduce the risk of skin cancers such as melanomas

Use broad spectrum sunscreen 

If you exposed your skin to sunlight, apply sunscreen generously. Even during cloudy days don’t ignore this advice, as the cloud has almost negligible protection from the damaging effects of UV radiation.

Wear protective woven clothes 

You need to understand, road-brimmed hat and tightly woven dark clothes must be used on sunny days. Use these clothes to cover your legs and arms. Consult with a dermatologist before choosing a brand for these products. A sunglass that protects from both UVA and UVB must be used.

Avoid tanning lamps

Tanning lamps are fluorescent bulbs that emit mostly UVA, with a smaller amount of UVB. These UVA are more severe and intense than natural sunlight. Direct exposure to these radiations may lead to skin cancer (11Opens in a new tab.

Photos of Melanomas

Take home message

Take preventative measures such as applying sunscreen and not exposing yourself to too much UV radiation including tanning beds. Ensure you do regular skin checks and if there are any issues or concerns, see your local health care professional.

References

  1.  Melanoma Treatment – for health professionals”. National Cancer Institute. June 26, 2015. Archived from the original on 4 July 2015. Retrieved 30 June2015.
  2.  El Ghissassi F, Baan R, Straif K, Grosse Y, Secretan B, Bouvard V, et al. (WHO International Agency for Research on Cancer Monograph Working Group) (August 2009). “A review of human carcinogens–part D: radiation”. The Lancet. Oncology. 10 (8): 751–2. doi:10.1016/S1470-2045(09)70213-X. PMID 19655431.
  3.  Rünger TM, Farahvash B, Hatvani Z, Rees A (January 2012). “Comparison of DNA damage responses following equimutagenic doses of UVA and UVB: a less effective cell cycle arrest with UVA may render UVA-induced pyrimidine dimers more mutagenic than UVB-induced ones”. Photochemical & Photobiological Sciences. 11 (1): 207–15. doi:10.1039/c1pp05232b. PMID 22005748.
  4. Greene MH (December 1999). “The genetics of hereditary melanoma and nevi. 1998 update”. Cancer. 86 (11 Suppl): 2464–77. doi:10.1002/(SICI)1097-0142(19991201)86:11+<2464::AID-CNCR3>3.0.CO;2-F. PMIDOpens in a new tab.
  5. Goydos JS, Shoen SL (2016). “Acral Lentiginous Melanoma”. Cancer Treatment and Research. 167: 321–9. doi:10.1007/978-3-319-22539-5_14. ISBN 978-3-319-22538-8. PMID 26601870.
  6.  Hershkovitz L, Schachter J, Treves AJ, Besser MJ (2010). “Focus on adoptive T cell transfer trials in melanoma”. Clinical & Developmental Immunology. 2010: 260267. doi:10.1155/2010/260267. PMC 3018069. PMID 21234353.
  7. “ASCO Annual Meeting Proceedings Part I. Abstract: Protective effect of a brisk tumor infiltrating lymphocyte infiltrate in melanoma: An EORTC melanoma group study”. Journal of Clinical Oncology. 25 (18S): 8519. 2007. doi:10.1200/jco.2007.25.18_suppl.8519. Archived from the original on 2011-07-25.
  8. Friedman RJ, Rigel DS, Kopf AW (1985). “Early detection of malignant melanoma: the role of physician examination and self-examination of the skin”. Ca. 35 (3): 130–51. doi:10.3322/canjclin.35.3.130. PMID 3921200
  9. Daniel Jensen J, Elewski BE (February 2015). “The ABCDEF Rule: Combining the “ABCDE Rule” and the “Ugly Duckling Sign” in an Effort to Improve Patient Self-Screening Examinations”. The Journal of Clinical and Aesthetic Dermatology. 8 (2): 15. PMC 4345927. PMID 25741397.
  10.  Autier P (October 2005). “Cutaneous malignant melanoma: facts about sunbeds and sunscreen”. Expert Review of Anticancer Therapy. 5 (5): 821–33. 
  11. Greinert R, de Vries E, Erdmann F, Espina C, Auvinen A, Kesminiene A, Schüz J (December 2015). “European Code against Cancer 4th Edition: Ultraviolet radiation and cancer”. Cancer Epidemiology. 39 Suppl 1 (Suppl 1): S75-83. doi:10.1016/j.canep.2014.12.014. PMID 26096748.
  12. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease Injury Incidence Prevalence Collaborators) (October 2016). “Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet. 388(10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. 

Emilie Masi
Wound Management Clinical Nurse Consultant
Registered Nurse

Emilie MASI

Registered Nurse, Masters in Advanced Nursing Practice Graduate Diploma of Wound Care Masters of Wound Care

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