TREATMENT FOR MELANOMA

Melanoma, the most serious type of skin malignant, develops in the cells (melanocytes) that produce melanin — the pigment that gives your skin its color. Melanoma can also form in your eyes and, rarely, in internal organs, such as your intestines.

The exact cause of all melanomas isn’t clear, but exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds increases your risk of developing melanoma. Limiting your exposure to UV radiation can help reduce your risk of melanoma.

The risk of melanoma seems to be increasing in people under 40, especially women. Knowing the warning signs of skin malignant can help ensure that changes are detected and treated before the malignant has spread. Melanoma can be treated successfully if it is detected early.

Symptoms

Melanomas can develop anywhere on your body. They most often develop in areas that have had exposure to the sun, such as your back, legs, arms and face.

Melanomas can also occur in areas that don’t receive much sun exposure, such as the soles of your feet, palms of your hands and fingernail beds. These hidden melanomas are more common in people with darker skin.

The first melanoma signs and symptoms often are:

• A change in an existing mole

• The development of a new pigmented or unusual-looking growth on your skin

Melanoma doesn’t always begin as a mole. It can also occur on otherwise normal-appearing skin.

Normal moles

Normal moles are generally a uniform color — such as tan, brown or black — with a distinct border separating the mole from your surrounding skin. They’re oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter — the size of a pencil eraser.

Most people have between 10 and 45 moles. Many of these develop by age 50, although moles may change in appearance over time — some may even disappear with age.

Unusual moles that may indicate melanoma

To help you identify characteristics of unusual moles that may indicate melanomas or other skin malignant, think of the letters ABCDE:

• A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves.

• B is for irregular border. Look for moles with irregular, notched or scalloped borders — characteristics of melanomas.

• C is for changes in color. Look for growths that have many colors or an uneven distribution of color.

• D is for diameter. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters).

• E is for evolving. Look for changes over time, such as a mole that grows in size or that changes color or shape. Moles may also evolve to develop new signs and symptoms, such as new itchiness or bleeding.

Malignant moles vary greatly in appearance. Some may show all of the changes listed above, while others may have only one or two unusual characteristics.

Hidden melanomas

Melanomas can also develop in areas of your body that have little or no exposure to the sun, such as the spaces between your toes and on your palms, soles, scalp or genitals. These are sometimes referred to as hidden melanomas because they occur in places most people wouldn’t think to check. When melanoma occurs in people with darker skin, it’s more likely to occur in a hidden area.

Hidden melanomas include:

• Melanoma under a nail. Acral-lentiginous melanoma is a rare form of melanoma that can occur under a fingernail or toenail. It can also be found on the palms of the hands or the soles of the feet. It’s more common in blacks and in other people with darker skin pigment.

• Melanoma in the mouth, digestive tract, urinary tract or vagina. Mucosal melanoma develops in the mucous membrane that lines the nose, mouth, esophagus, anus, urinary tract and vagina. Mucosal melanomas are especially difficult to detect because they can easily be mistaken for other far more common conditions.

• Melanoma in the eye. Eye melanoma, also called ocular melanoma, most often occurs in the uvea — the layer beneath the white of the eye (sclera). An eye melanoma may cause vision changes and may be diagnosed during an eye exam.

Causes

Melanoma occurs when something goes awry in the melanin-producing cells (melanocytes) that give color to your skin.

Normally, skin cells develop in a controlled and orderly way — healthy new cells push older cells toward your skin’s surface, where they die and eventually fall off. But when some cells develop DNA damage, new cells may begin to grow out of control and can eventually form a mass of malignant cells.

Just what damages DNA in skin cells and how this leads to melanoma isn’t clear. It’s likely that a combination of factors, including environmental and genetic factors, causes melanoma. Still, physicians believe exposure to ultraviolet (UV) radiation from the sun and from tanning lamps and beds is the leading cause of melanoma.

UV light doesn’t cause all melanomas, especially those that occur in places on your body that don’t receive exposure to sunlight. This indicates that other factors may contribute to your risk of melanoma.

Risk factors

Factors that may increase your risk of melanoma include:

• Fair skin. Having less pigment (melanin) in your skin means you have less protection from damaging UV radiation. If you have blond or red hair, light-colored eyes, and freckle or sunburn easily, you’re more likely to develop melanoma than is someone with a darker complexion. But melanoma can develop in people with darker complexions, including Hispanics and blacks.

• A history of sunburn. One or more severe, blistering sunburns can increase your risk of melanoma.

• Excessive ultraviolet (UV) light exposure. Exposure to UV radiation, which comes from the sun and from tanning lights and beds, can increase the risk of skin malignant, including melanoma.

• Living closer to the equator or at a higher elevation. People living closer to the earth’s equator, where the sun’s rays are more direct, experience higher amounts of UV radiation than do those living in higher latitudes. In addition, if you live at a high elevation, you’re exposed to more UV radiation.

• Having many moles or unusual moles. Having more than 50 ordinary moles on your body indicates an increased risk of melanoma. Also, having an unusual type of mole increases the risk of melanoma. Known clinically as dysplastic nevi, these tend to be larger than normal moles and have irregular borders and a mixture of colors.

• A family history of melanoma. If a close relative — such as a parent, child or sibling — has had melanoma, you have a greater chance of developing a melanoma, too.

• Weakened immune system. People with weakened immune systems, such as those who’ve undergone organ transplants, have an increased risk of skin malignant.

Treating early-stage melanomas

Treatment for early-stage melanomas usually includes surgery to remove the melanoma. A very thin melanoma may be removed entirely during the biopsy and require no further treatment. Otherwise, your surgeon will remove the malignant as well as a border of normal skin and a layer of tissue beneath the skin. For people with early-stage melanomas, this may be the only treatment needed.

Treating melanomas that have spread beyond the skin

If melanoma has spread beyond the skin, treatment options may include:

• Surgery to remove affected lymph nodes. If melanoma has spread to nearby lymph nodes, your surgeon may remove the affected nodes. Additional treatments before or after surgery also may be recommended.

• Chemotherapy. Chemotherapy uses substances to destroy malignant cells. Chemotherapy can be given intravenously, in a tablet form or both so that it travels throughout your body.

Chemotherapy can also be given in a vein in your arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in your arm or leg isn’t allowed to travel to other areas of your body for a short time so that the chemotherapy substances travel directly to the area around the melanoma and don’t affect other parts of your body.

• Radiation therapy. This treatment uses high-powered energy beams, such as X-rays, to kill malignant cells. Radiation therapy may be recommended after surgery to remove the lymph nodes. It’s sometimes used to help relieve symptoms of melanoma that has spread to another area of the body.

• Biological therapy. Biological therapy boosts your immune system to help your body fight malignant. These treatments are made of substances produced by the body or similar substances produced in a laboratory. Side effects of these treatments are similar to those of the flu, including chills, fatigue, fever, headache and muscle aches.

• Targeted therapy. Targeted therapy uses treatments designed to target specific vulnerabilities in malignant cells. Side effects of targeted therapies vary, but tend to include skin problems, fever, chills and dehydration.