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Medical & Legal Information on Melanoma Skin Cancer: Causes & Treatment Options
• Melanoma Skin Cancer Overview
• The Warning Signs
• Melanoma Causes
• Treating Melanoma
• Genetic Counseling
Melanoma Skin Cancer
Melanoma Skin Cancer Overview
Melanoma Skin Cancer involves the abnormal development of melanocytes (pigment cells) that become cancerous, leading to serious illness and death. Cancerous melanoma growth can develop when DNA is unable to repair itself because of damage caused by ultraviolet radiation’s, tanning beds and other environmental factors. Instead of normal healthy skin tissue that grows, reproduces (divides) and dies, cancerous melanoma cells never die and continually grow and reproduce more abnormal cells and eventually form tumors from the accumulating cells.
While melanoma is a significantly less common form of skin cancer than other types, it is the deadliest form of the disease and is more likely to metastasize (spread) to other areas of the body. The disease originates in the basal layer of the epidermis and often resembles a mole that is usually either brown or black in color but can present as white, blue, purple, red, pink or skin color.
An estimated 10,000 individuals die each year in the United States from melanoma. In 2016, approximately 76,000 men and women were diagnosed with invasive melanomas (men — 46,870 cases, women — 29,510 cases). These deaths are unfortunate because the disease is almost always curable when it is identified and treated during its early stage. If left untreated, cancer can progress rapidly and spread (metastasize) to other body parts and organs.
The Warning Signs
While most skin growths, moles, and brown spots are usually harmless, it is still essential to seek out immediate medical attention by a competent dermatologist who can recognize the signs of benign and malignant skin growths. The doctor will look for ABCDE indicators of melanoma cancer that include:
- A – Asymmetry: Moles are usually considered benign when they are symmetrical in shape where both sides match. Alternatively, an asymmetrical shape where both sides do not match is usually a warning indicator for melanoma.
- B – Border: Benign moles typically have even, smooth borders which are contrary to melanoma moles that have notched or scalloped edges.
- C – Color: Nearly every type of benign mole has a single unifying color that could be a dark or light shade of brown. Variant (irregular) colors are often an indicator of a melanoma mole if it has different shades of black, brown, tan, blue, white, red or other color and appearance.
- D – Diameter: Nearly every type of benign mole has a smaller diameter when compared to a malignant mole, which is usually larger in diameter measuring six millimeters (one-quarter inch) or the size of the eraser end of the pencil.
- E – Evolving: Over time, the appearance of benign moles never changes. If the mole begins to change or evolve in its shape, size, elevation, color or another trait, or takes on other symptoms including cresting, itching or bleeding, it is essential to see a competent dermatologist right away.
While most moles never develop into melanoma cancer, there are significant changes to genes deep within the mole cell that can cause melanoma to develop. Melanoma, like most cancers, is caused by damage to DNA that turns off tumor suppressor genes, causing them to never die and instead continuously reproduce new abnormal (faulty) cells.
UV (ultraviolet) rays have clearly been linked as a major cause of developing melanoma or skin cells that are reproduced with damaged DNA. The sun is the primary source of ultraviolet rays, where direct sunlight during the hottest times of the day tends to cause the most damage. However, exposure to man-made ultraviolet rays, like using tanning beds or lamps, can cause significant damage that leads to the life-threatening disease.
It can take years or decades before melanoma appears. Children and young adults who have received intense exposure to sun rays might not have cancer appear until later in life.
Treatments recommended by the doctor will often be based on the cancer’s stage, the patient’s treatment preferences and other factors. The most common treatments include:
- Surgery – Surgical procedures are considered the primary option for treating most melanoma cancer’s, especially during the early stage. Melanoma cancer is initially diagnosed by the doctor through a skin biopsy that can be viewed under a microscope to detect cancerous cells. Often, the doctor will recommend Mohs Surgery performed by a trained surgeon or dermatologist. Other times, amputation is required if the melanoma is located on the toe or finger.
Surgery is usually the first option for treating metastatic cancer that has spread to other areas of the body including the brain, lungs or liver. Surgerical procedures are not considered a cure for the disease but simply a way to control it.
- Chemotherapy – Chemotherapy is often used to treat melanoma in its advanced age, but is often less recommended in the early stage of the disease. Common chemo medications use in the treatment of melanoma include Vinblastine, Carboplatin, Cisplatin, Temozolomide, DTIC (Dacarbazine) and Nab-paclitaxel.
- Radiation Therapy – To avoid recurrence of the disease, high-energy rays are often used in conjunction with surgery where the radiation kills tissue surrounding the tumor after it is excised through surgical procedures. In addition, radiation is used as an effective solution for relieving many of the symptoms associated with melanoma, especially after metastasize to the bone or brain.
- Targeted Therapy – Targeted medications work very differently than chemotherapy by targeting mutations (changes) in the BRAF genes and related proteins. Medications used in this procedure include Tafinlar (dabrafenib) and Zilboraf (vemurafenib) are administered in capsule or pill form twice each day. However, these medications produce significant side effects that include hair loss, fatigue, joint pain, headaches, sun sensitivity, itching, rash, thickening of the skin, and nausea.
- Immunotherapy – Certain prescription medications can stimulate the patient’s immune system to ensure it recognizes and kills the cancer cell as efficiently as possible. Doctors will use medications including Keytruda (pembrolizumab) and Opdivo (nivolumab) designed to target an immune system protein cell PD-1 in the hopes of shrinking the tumor.
Most drugs to treat melanoma are administered through IV (intravenous) infusion 2 to 3 weeks apart. However, the medications often have serious side effects including joint pain, constipation, decreased appetite, skin rash, nausea, itching, cough, fatigue, and diarrhea.
Mutating gene changes can cause melanoma or increase the potential of developing the disease if one or more of the following factors exists:
- Several family members of either the father or mother have developed melanoma
- At least one member of the family has had more than one form of melanoma
- At least one member of the family has developed both pancreatic and melanoma cancer
- The patient has experienced more than one form of melanoma
Genetic testing is available for individuals interested in understanding what it means to carry the mutated genes. Healthcare professionals and genetic counselors can provide insight into how the mutation affects the potential of developing the disease. However, according to the American Cancer Society, it has not yet been determined how useful genetic testing can be.
Even so, family members with an extensive history of melanoma should see their doctor or dermatologist and get routine skin exams, learn how to perform self-exams on the skin and avoid the harsh rays of the sun.
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