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Melanoma cancer

Melanoma is the type of skin cancer that develops from the pigment producing cells known as melanocytes. Melanoma typically occurs in the skin but sometimes occurs in the mouth, intestines or eye (uveal melanoma).

Skin
Skin is the largest organ in the body. It acts as a barrier to protect the body from injury and infection, storing water and fats, control of body temperature and production of vitamin D. like all other body tissues, skin is made up of different cells. Skin is made of three layers.
• Epidermis. The outer layer of skin.
• Dermis. The middle layer of skin.
• Subcutaneous layer. The inner most layer of skin containing fats.
Epidermis is the layer where melanoma originate. Epidermis is mainly made up of three types of cells.
• Squamous cells. These are flat cells that are tightly parked together to make up the top layer of skin and form the thickest layer of the epidermis. These cells eventually die and become the surface of your skin. As time goes our body sheds these dead skin cells.
• Basal cells. These are the cells making the lower layer of epidermis. Basal cells multiply continuously and move upward to replace squamous cells that are shed out of the skin. As they move up, basal cells flattens and change into squamous cells.
• Melanocytes. These are melanin pigment producing cells. Melanin is the pigment that gives skin its colour. On exposure to sun ultraviolet radiations, melanocytes make extra melanin to try to protect the skin from getting burnt. Melanocytes are the cells that can change and lead to development of melanoma.
Melanoma is less common type of skin cancer compared to basal and squamous cell carcinoma, however melanoma is very dangerous one because of its ability to invade lymph nodes and blood vessels then spread to distant parts of the body.

Risk factors of melanoma
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but it does not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. Risk factors of melanoma include the following;
• Over exposure to ultraviolet radiations. Ultraviolet radiations are naturally produced by sun but also can be produced by other artificial sources such as tanning beds. People who spend a lot of time exposed to sunlight have increased risk of developing melanoma.
• Family history of the disease. To those in families where close relatives have suffered from melanoma, have increased risk of developing melanoma at some point in their life. This risk increases if several family members who live in different locations have been diagnosed with melanoma.
• Mole. People with unusual moles called dysplastic nevi or atypical moles have a higher risk of developing melanoma. Dysplastic nevi are large moles that have irregular color and shape.
• Childhood history of sunburn or tanning. Those with history of sunburn at one point of their life have high risk of developing melanoma at some point of their life.
• Some inherited conditions. Conditions like xerodema pigmentosum, retinoblastoma and li-fraumen syndrome are said to increase possibility of development of melanoma.
• Weakened immune system
• Personal history of melanoma. Those who had melanoma at some point of their life, have a risk of developing melanoma at some point of their life.
• Light-coloured eyes (blue), and fair or blond hair
• History of other types of skin cancer. Someone who had other skin cancer such as basal and squamous cell carcinoma, have the risk of developing melanoma at some point of life.

Prevention of melanoma
To prevent something you need to know its cause but since there is no known specific cause of melanoma, there is no sure way of preventing development of melanoma but there are ways that can help reduce the risk of developing the disease. These include the following ways.
• Avoid and reduce exposure to ultraviolet radiations. This is trough reducing time you while exposed to the sun and avoid using tanning beds.
• Avoid weakening your immune system. Since low immunity increase your chance of developing melanoma then avoiding to weaken your immune system will reduce your risk of developing the disease. This include avoiding practices that may lead to HIV transmission (infection).
• Seeking treatment for abnormal moles. Since having moles increase your chance of developing melanoma, so seeking help from your doctors before they even develop into melanoma is a good choice.

Early detection and screening of melanoma
Screening is the process of running some tests to someone with no signs and symptoms of a certain disease with the intention of testing for presence or absence of that disease. Screening process helps in detecting the disease while it is still early. Melanoma can often be found early, while there is high possibility of being cured. Some people are at higher risk of getting melanoma than others, but it’s important to know that anyone can get melanoma. For melanoma there are two main ways that may help in early detection of the disease.
• Self-examination. It is good to examine your skin to check for presence of anything abnormal including abnormal moles. It is crucial to know the pattern of moles, blemishes, freckles, and other marks on your skin so that you’ll notice any new moles or changes in existing moles. It is recommended to perform Self-examinations in front of a full-length mirror in a brightly lit room. Also it can be helpful if you ask someone to check the scalp and your back.
• Medical examination. This is done by health care professionals. If your doctor finds something abnormal from your skin including abnormal moles, he/she may recommend that you visit a doctor specialized in skin diseases (dermatologist) for more examination.

Melanoma is among cancers that can be detected at an early stage. Symptoms of melanoma can easily be seen by naked eyes because it involved skin and any abnormal change can be seen easily. The most important warning symptom of melanoma is a new spot on the skin or a spot which is not new but suddenly it start changing in size, shape, or color. Another important symptom is a spot that looks different from all other spots (mole) on your skin (known as the ugly duckling sign). Upon experiencing any of these warning signs, it is important to see a doctor. Since new sport and change in existing moles are the important signs for melanoma, it is very important that you should examine your skin more often and if you notice any of the following, you should have your skin checked by a doctor.
• Size. Spot may appear or start growing large.
• Colour. The mole may become increasingly blotchy with different depth and shades of colour including brown, dark, red or skin coloured.
• Shape or borders. The spot may increase in height, become scaly, have an irregular edge (scalloped or notched) or lack symmetry (asymmetry) meaning the halves of the mole look different.
• Itching or bleeding. Spot that start itching or bleeding at times.
• Elevation. The spot may start as a raised nodule or develop a raised area, which is often reddish brown or reddish (to someone of white skin).

Diagnosis Diagnosis is simply an identification of nature of an illness. Doctors use tests to find illnesses including cancer. Through tests doctors are able to determine if cancer has spread to other organs in the body or not. Tests can help doctors to decide suitable treatment for the disease and predict prognosis (outcome of treatment).
Diagnosis of melanoma involve the following tests; • Physical examination and medical history. Physical examination is first done by you (self-examination). When you notice anything suspicious, your doctor will examine you, paying particular attention to any spots you have identified as changed or suspicious. The doctor will also want to know if you or your family have a history of melanoma. When assessing the spots, doctors use ABCDE rule as to know if those spots may be cancer or not. ABCDE rule represent the following;
• Asymmetry. Whether the halves of the spot (mole) are different.
• Border. Whether borders of moles are irregular, scalloped or notched..
• Colour. Are there differing shades and colour patches?.
• Diameter. Is diameter of spots (moles) more than 6mm?.
• Evolve. Whether the spots have changed over time (shape, size, colour and surface).
• Biopsy. This involve taking sample of a mole (spot) for assessment of cells under the microscope in the laboratory. This is done by a pathologist (specialized doctor in assessing cells under microscope). Biopsy is normally taken by removing the whole spot for examination of tissues. This is called excision biopsy. .
• Lymph node examination. Lymph nodes are part of lymphatic system, which deals with removing excess fluid from tissues, absorbing fatty acids, and produces immune cells. Sometimes melanoma can travel through the lymph vessels to other parts of the body. Lymph nodes may be sampled for examination in the laboratory if suspected..
• Imaging tests. Although are not the main diagnostic tests for melanoma, but imaging tests like CT scan, MRI scan and PET scan can be used to examine lymph node and other organs involvement..

Following cancer diagnosis the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps.
After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option. Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored. In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These types of treatments are called clinical trials. If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time

Treatment options Treatment of melanoma requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. But generally multidisciplinary team for treatment of melanoma include surgical oncologist, medical oncologist, radiation oncologist, dermatologist, pathologist and other health care professionals like oncology nurses, reconstructive surgeon, physiotherapist and palliative care team.
Surgery
Surgery is the treatment option that involves removing the affected area and surrounding tissues by operation. For those cases at an early stage, it is preferred as the only treatment option. But for advanced cases it can be given in combination with other treatment options like radiotherapy. Surgery is done by surgical oncologist. Surgery for melanoma can be done in the following ways;
• Wide excision. This involves removing the area where the affected area and surrounding normal-looking skin. Removing more tissue around the melanoma will reduces the risk of cancer coming back. Pathologist has to verify if the removed skin
• Surgery for advanced melanoma. Most of advanced melanomas are likely to have metastasized to other organs. In this situation, surgery is not a curative treatment of choice, but surgery is done to control cancer rather than curing.

Side effects of surgery Some of the possible side effects of surgery include the following;
• Wound pain. After surgery, it is common to have pain after surgery. Sometimes pain can go away as wound heals but sometimes pain can stay for a longer period and can be relieved by medication.
• Lymphoedema. If lymph nodes have been surgically removed, swelling of the neck, arm or leg is the most common problem that can occur. Lymphoedema happens due to a build-up of lymph fluid in the affected part of the body. Sometimes this fluid needs to be drained by having a needle inserted into the fluid-filled cavity.
Immunotherapy
Immunotherapy is the treatment of cancer by using drugs that stimulate immune system of the body to recorgnize and destroy cancer cells. Our body has immune system but melanoma has ability of turning off special proteins called checkpoints. Checkpoints are special proteins responsible for recognizing danger and stimulating immune response. These drugs have ability to turn on checkpoints and stimulate immune response against cancer cells (melanoma).

Side effects of immunotherapy Side effects of immunotherapy vary depending on the drugs used. Some of the possible side effects of this therapy include,
• Fatigue
• Diarrhea
• Skin rashes and itching
• Inflammation
• Joint pain.
These side effect can be managed, so it is important to contact your cancer care team as soon as they start to show.
Radiation therapy Radiation therapy is the use of high energy x-ray or other radiation particles to destroy or kill cancer cells. It is normally used when cancer has spread to lymph node and having surgery alone cannot help, or after surgery so as to prevent cancer from coming back ,or it is for palliation purpose to those at very advanced stage and there is no possibility of cure. When dealing with melanoma, External beam radiation therapy is the type of radiation therapy used. External beam radiation therapy involve directing radiation to the tumor from the source (machine) positioned outside the body.

Side effects of radiation therapy Side effects of radiation therapy depends on the location of tumor and dose given. The side effects normally disappear soon following completion of treatment but some of them can be managed if they become too severe during treatment period. Side effects of radiation therapy include the following;
• Fatigue
• Nausea
• Skin reactions (sunburn like) and change in colour.
• Loss of hairs at the site where radiations enters the body.

Side effects of radiation therapy Targeted therapy is an option that involves targeting specific molecules in the cancer cells using drugs. The drug will stop the growth and spread of cancer cells and at the same time limit harm to normal cells. Drugs for this kind of treatment work differently to that of normal chemotherapy drugs. The drugs for this option can sometimes help even when chemo isn’t, but they can also be used along with normal chemotherapy to help it work better. Targeted therapy is most commonly used for advanced melanoma that has spread to other organs or if the melanoma has come back after treatment. Targeted therapy is normally taken orally.
Side effects of targeted therapy Side effects will vary depending on the type of drug used and dose given. These side effects can sometime disappear on their own or managed when they become severe. Some of the possible side effects of targeted therapy include the following;
• Tiredness
• Nausea
• Skin rashes
• Fever
• Joint pain and aches
• High blood pressure.

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