Cheryl Skinner, MD, is an oncologist at Atrium Medical Center in Middletown.
Q. What makes melanoma so deadly? What are the warning signs? What are some treatment options?
A. Melanoma is the most serious form of skin cancer. If recognized and treated early, it is almost always curable. Without early detection, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While melanoma is not the most common type of skin cancer, it causes the most deaths.
American men have a one in 52 chance of getting melanoma. For women, the odds are slightly better; they have a one in 77 chance of being diagnosed with the disease over their lifetime. Men are more likely to have thicker, open skin lesions that can be more difficult to treat.
However, young women are particularly vulnerable. Did you know that melanoma is the most frequently diagnosed cancer in young women today in the U.S.? From 1979 to 2004, the incidence rate climbed from 5.5 to 13.9 cases per 100,000 women. The biggest risk factor for melanoma is ultraviolet (UV) light exposure. Tanning – both outside and in tanning beds – is clearly a contributing factor.
Heredity also plays a major role in melanoma. In 1994, the CDKN2A (p16) gene was first discovered as a known genetic risk factor for developing melanoma. About one in every 10 patients diagnosed with the disease has a family member with a history of melanoma. If your mother, father, siblings or children have had a melanoma, you are in a melanoma-prone family and have a 50 percent greater chance of developing the disease than people who do not have a family history.
Other risk factors are fair skin, eyes and hair color; freckles; dysplastic nevi (funny-looking moles); UV light exposure; and, of course, previous personal history of melanoma. People who have or had the most common skin cancers — basal and squamous cell carcinoma — are also at increased risk for developing melanoma.
We all fear that moles and pigmented lesions, or marks, on our skin might be cancerous. How do we recognize that a melanoma has developed? Look for the ABCDEs of melanoma:
- Asymmetry of the mole: One half is different from the other half.
- Border may be irregular, scalloped or poorly defined.
- Color of the mole varies from one area to another. The mole may have shades of tan, brown or black, or is sometimes white, red or blue.
- Diameter of the mole: Melanomas usually are greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.
- Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.
For more information, check out some very good videos on YouTube or learn more at the Skin Cancer Foundation
I always recommend that if you’re concerned about a lesion’s itching, irritation or appearance, the best approach is to have it removed. See your family doctor or a dermatologist.
If the lesion on your skin turns out to be melanoma, the primary treatment remains surgical removal with wide borders around it. A newer technique called sentinel node evaluation identifies if the cancer has spread to lymph nodes. If so, there are therapies that can be used to try to prevent the disease from recurring.
What has always intrigued researchers is how the immune system plays a role in controlling melanoma and several other cancers. A new drug called ipilumumab was recently approved by the Food and Drug Administration for treatment of recurrent melanoma. It is a monoclonal antibody that is delivered into a patient to treat the cancer lesions. It acts by blocking the function of T cells (lymphocytes involved with immune function). This is one of many monoclonal antibodies used to treat medical diseases.
An exciting new class of medications is being studied in patients with dysplastic nevi (funny-looking moles) to help prevent melanoma from developing. Currently the best prevention is to use sun block and to limit sun and tanning bed exposure as much as possible. The future is very promising for preventing and treating this deadly disease.
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