Melanoma skin cancer

Melanoma refers to a very serious type of skin cancer caused by the uncontrolled growth of melanocytes (also known as pigmented cells). 

The outer layer of skin, known as a basal layer, contains normal melanocytes. Melanocytes produce melanin, a special protein that protects the skin cells by absorbing ultraviolet (UV) radiation.  Non-cancerous growth of melanocytes results in the formation of moles and freckles on one’s body. However, the cancerous growth of melanocytes results in melanoma. 

Typically, the onset of melanoma begins with an uncontrolled proliferation of melanocytic stem cells which already went though genetic transformation. 

Melanoma can affect any adult at any age. Even children are rarely affected.  Melanoma is triggered by various factors, such as older age, family history of melanoma, Parkinson disease, presence of multiple irregular looking naevi, and a large number of melanocytic naevi on one’s body. Individuals with white skin tend to burn much easier. Even though individuals with white and black skin tend to have the same number of melanocytes, melanocytes found in black skin produce way more melanin. Therefore, individuals who have darker skin are at less risk to be damaged by UV radiation. 

Melanoma can occur anywhere on the body, even on the areas that were not exposed to the sun. It is usually considered as a skin lesion. However, due to complications associated with the given condition, it can occur on the eye, mouth, or brain. 

The unusual looking mole or freckle can be suspicious for melanoma. Melanoma may appear in various colours, such as dark brown, black, red, light grey, and tan. During the horizontal growth phase, melanoma is usually flat. During vertical phase growth, the lesion becomes more raised and thickened. Some melanomas can cause itching and/or bleeding.

Very often the initial screening is based on the ABCDEs of melanoma or by the Glasgow 7-point checklist.  The ABCDEs scale represents the following: ABCDEs scale: A(Asymmetry), B (irregular border), C (colour change), D (diameter of lesion exceeding 6 mm), E(Evolving: changing and increasing in size). The Glasgow 7-point checklist has major and minor features relevant for diagnosis. Major features include a change in size, irregular shape, and irregular colour. The minor features include inflammation, the diameter of lesion greater than 7 mm, oozing, and changes in sensation.

Generally, melanomas are classified according to their appearance and behaviour. Moreover, melanoma can also be classified based on its relationship with exposure to the sun, age, and number of melanocytic naevi. For example, early-onset melanoma is more prevalent in women than men. It is linked with many melanocytic naevi present on one’s body. It is also associated with the irregular exposures to the sun. The late-onset melanomas are more prevalent in men than in women. Head and neck are the most common sites. This particular type of lesion is linked with prolonged exposure to the sun.

Melanoma is identified based on its clinical features or due to history of lesion change. Dermatoscope is used to diagnose melanoma. Usually, biopsies are done as well in order to confirm the diagnosis with the pathology report. 

Melanomas are removed completely through the surgical procedure or excision.

In rare cases, if melanoma is widely spread over one’s body, the surgical method may not always be successful. Therefore, some patients are offered experimental treatment methods like immunotherapy and PD-1 blocking antibodies.

Patients who had melanoma are usually scheduled for the follow up appointments with their dermatologist in order to check the scar where the initial melanoma was excised and to perform additional skin examination in order to avoid further risks. Those patients who have more advanced primary disease, may be scheduled for regular blood tests  and imaging (i.e. X-ray, CT, MRI, and ultrasound). Tests are not prescribed to patients who have stage 1 and 2 melanoma. Lastly, the tests are not needed for healthy individuals who have remained healthy for over five years after their melanoma was removed. 

Centre for Medical and Surgical Dermatology offers different skin cancer treatments unique to each patient. For more information on dermato-oncology, visit the following link:

Dermato-oncology

Centre for Medical and Surgical Dermatology offers the whole spectrum of diagnosis and surveillance of melanoma skin cancer. For more information on surgical dermatology visit the following link:

Surgical Dermatology