Melanoma is the most serious type of skin cancerwhich develop from melanocytes. Melanocytes are cells in skin which form a pigment called melanin when exposed to sun .Melanin causes the skin to tan in fair-skinned people. Dark-skinned people have more active melanocytes

How common is melanoma?

Melanoma is the least common form of skin cancer, but it is the most serious. It is the one most likely to spread to other parts of the body. Melanoma is the second most common cancer in people aged 15-34.

What causes melanoma?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control.

Sun damage to skin

The main risk factor which damages skin and can lead to a melanoma is theultraviolet (UV) radiation in the sunshine.People most at risk to UV skin damage are people with fair skin , red or blond hair, green or blue eyes. Melanoma is uncommon in dark-skinned people, as they have more protective melatonin in their skin. Children's skin is most vulnerable to damage. People who had a lot of freckling in childhood, or had frequent or severe sunburn in childhood, are most at risk of developing melanoma as adults.

Other risk factors which increase the risk of developing melanoma include the following:

A family history. If a close blood relative develops melanoma then your risk is approximately doubled. As a rule, if you have a family history of melanoma you should take extra care to protect your skin from sun damage. Also, check your skin regularly for early signs of melanoma (see below).

Having many moles. These are the small brown marks which occur on almost everybody. If you have many (especially 100 or more) you have an increased risk that one will develop into a melanoma.

Atypical (non-typical) moles. People with moles which are bigger than usual, with an irregular shape or colour have an increased risk. Mp=ore so in people with a strong family history .

Using sunbeds or similar tanning machines which emit UV light.

Having a weakened immune system (for example, due to HIV infection, or if you are taking immunosuppressive drugs, perhaps after an organ transplant).

What are the symptoms of melanoma?

A typical melanoma starts as a small dark patch on the skin. It can develop from a normal part of skin, or from an existing mole.
 A melanoma is often different to a mole in one or more of the following ways (summed up as ABCDE) - that is:
A symmetry - the shape of a melanoma is often uneven and asymmetrical, unlike a mole which is usually round and even.
B order - the border or edges of a melanoma are often ragged, notched or blurred. A mole has a smooth well-defined edge.
C olour - the colourof a melanoma is often not uniform. So there may be 2-3 shades of brown or black. A mole usually has one uniform colour.
D iameter - the size of a melanoma is usually larger than 6 mm and it continues to grow. However, they can sometimes be smaller than this.
E volving - any change in size, shape, colour, elevation or any new symptom such as bleeding, itching or crusting may be due to a melanoma.

However, some melanomas are not dark, and some melanomas are not typical in how they look. As a melanoma grows in the skin, it may itch, bleed, crust or ulcerate.
Always see a doctor if you develop a lump or patch on the skin, which you are unsure about, or if a mole changes in its shape, border, colour or size.
A melanoma can develop on any area of skin. The most common place for a melanoma to develop in a woman is on the legs; whereas for men it is on the chest or back. Rarely, a melanoma can develop in the iris or back of the eye

If some cells break off and spread (metastasise) to other parts of the body, various other symptoms can develop. A common early symptom of spread is for the nearby lymph glands (nodes) to swell.

How is a melanoma diagnosed?

If a melanoma is suspected then your doctor is likely to advise an excisional biopsy. This is where the entire abnormal area of skin is removed by a minor operation and examined.
The excisional biopsy may be curative in some cases.

When doing an excisional biopsy (described above) the doctor will remove a margin of normal skin around the melanoma. When the biopsy is looked at under the microscope, if the doctor is sure that all the melanoma cells have been removed, and the melanoma cells are confined to the top layer of skin, then no further treatment may be needed.
Otherwise, a second operation called a wide local excision is usually advised.

Area of normal skin around where the melanoma was is removed too, this is to make sure that any cells which may have grown in the local area of skin have been removed. The amount of normal looking skin removed varies - depending on the thickness of the melanoma . This operation may be done under local or general anaesthetic. In some cases a skin graft may be needed to cover the wound.

Staging of melanoma

The aim of staging is to find out how much a cancer has grown and spread. Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).
Most cases of melanoma are diagnosed at stage one when there is a very good chance that treatment will cure the condition
 Stages (2-4) are diagnosed if the tumour has spread. The stage diagnosed depends on how much and how far the the original tumour has spread to other parts of the body.

How is melanoma assessed and staged?

If the initial biopsy show that the melanoma is just in the top layer of skin and is less than 0.76 mm thick, then no further tests are usually needed. It is highly unlikely that it will have spread. This is an early stage 1 melanoma.

It is possible that there may be some early spread without causing symptoms if the melanoma is thicker than 0.76 mm on the initial biopsy. In particular, there may be spread of some cells to the nearest lymph node without it yet causing it to swell. Therefore, a test called sentinel node biopsy, and sometimes other tests, may be advised.

Other tests. Tests which may be advised depend on: whether you have symptoms; whether the lymph nodes are found to be involved; the thickness of the primary melanoma (the thicker the primary tumour, the greater the chance of spread). The tests aim to detect if the cancer has spread to other parts of the body. For example, you may be advised to have X-rays, blood tests, scans, etc.

What is the treatment for melanoma?

The treatment depends on the stage. Generally, if the melanoma is thin then a small operation to cut out the tumour (the biopsy or wide local excision described above) is usually all the treatment . This is likely to clear all the cancer cells. Though regular follow up may be required..

If the melanoma is deeper then you may need a larger operation which may include removing the local lymph nodes. You may also be given additional treatment, depending on where the cancer has spread to and what symptoms you have. This may include:

Chemotherapy. This is a treatment which uses anti-cancer medicines to kill cancer cells or to stop cancer cells from multiplying.

Radiotherapy. This treatment uses high-energy beams of radiation whichkills cancer cells, or stops the cells from multiplying.

Immunotherapy. This aims to boost the immune system to help to fight cancer.

What is the outlook (prognosis)?

The outlook depends on the stage. Most cases of stage 1 melanoma are cured with a minor surgical operation to remove the tumour (
For people with deeper melanomas then there is still a chance of cure.

People with advanced melanoma that has spread to other parts of the body are not likely to be cured, but treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

Can melanoma be prevented?

Most skin cancers are caused by excessive exposure to the sun. We should all limit our sun exposure in the summer months as much as possible between 11 am and 3 pm.
Covering up with clothes and a wide-brimmed hat when out in the sunshine.

Applying sunscreen with a sun protection factor (SPF) of 15 (SPF 30 for children or people with pale skin) which also has high ultraviolet A (UVA) protection.

In particular, children should be protected from the sun. Sunburn or excessive exposure to the sun in childhood is thought to be the biggest risk factor to the developing of skin cancer as an adult. Also, people with a family history of melanoma should take extra care to protect their skin from the sun.

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