Melanoma Skin

Melanoma (Skin Cancer)

What is Skin?

The skin is the largest organ in the body, acting as a protective barrier against infections, injuries, and environmental factors. It also helps regulate body temperature, stores water and fat, and plays a role in producing vitamin D. The skin has three layers:

• Epidermis: The outermost layer.

• Dermis: The middle layer.

• Hypodermis: The innermost fat layer.

What is Melanoma?

Melanoma is a type of skin cancer that begins in melanocytes—the cells in the epidermis that produce melanin, the pigment responsible for skin color. These cells grow uncontrollably to form tumors, sometimes starting as a mole or dark spot. Melanoma is the most dangerous type of skin cancer, as it can spread through blood vessels and lymph nodes to other parts of the body. Early detection can lead to complete removal through surgery, but if left untreated, it becomes more severe.

Statistics

• India: Annually, 3,916 cases of melanoma are detected, ranking 32nd among all cancers.

• Deaths: Approximately 2,296 deaths occur annually due to melanoma, making it the 31st most fatal cancer.

Risk Factors

Several factors increase the risk of melanoma, though they may not directly cause it:

• Sun exposure: UV radiation from sunlight is the primary cause. Those who work outdoors have a higher risk.

• Indoor tanning: Using tanning beds or parlors increases the risk.

• Moles: Certain types of moles, such as dysplastic or atypical nevi, are more prone to turning cancerous.

• Fair skin: People with less melanin are more vulnerable to UV rays. This explains the lower incidence of melanoma among Indians compared to Caucasians.

• Family history: In 10% of cases, melanoma occurs in individuals with a family history of the disease.

• Previous skin cancer: Individuals who have had melanoma or other skin cancers are at higher risk of recurrence.

• Age: Most cases occur around 50 years of age.

• Weakened immune system: Those with compromised immunity are more susceptible.

Prevention

Reducing UV exposure can significantly lower the risk of melanoma:

• Avoid direct sun exposure between 10 AM and 4 PM.

• Cover exposed skin during outdoor activities.

• Apply sunscreen regularly.

Symptoms

Changes in the size, shape, or color of an existing mole or skin lesion are early signs of melanoma. To help recognize symptoms, use the ABCDE rule:

• A – Asymmetry: One half of the mole is different from the other.

• B – Border: The edges are irregular or blurred.

• C – Color: Varies in shades of black, brown, or tan.

• D – Diameter: Larger than 6 mm.

• E – Evolving: Changes in size, shape, or color over time.

Diagnosis

• Biopsy: A small tissue sample is taken for microscopic examination to confirm the presence of cancer cells. In some cases, the entire tumor and surrounding tissue are removed during the biopsy.

• Ultrasound

• CT Scan

• MRI

• PET-CT

Stages of Melanoma

1. Stage 0: Cancer cells are confined to the outer layer (epidermis).

2. Stage I: Cancer has not spread beyond the skin.

3. Stage II: Cancer extends from the epidermis to the dermis but hasn’t spread to lymph nodes.

4. Stage III: Cancer has spread to nearby lymph nodes.

5. Stage IV: Cancer has spread to distant organs through the bloodstream.

6. Recurrent: Melanoma that returns after treatment.

Treatment Options

1. Surgery

• The primary treatment involves removing the melanoma along with some surrounding healthy tissue (wide excision).

• Lymph node mapping and sentinel node biopsy help determine if cancer has spread to lymph nodes.

• Lymph node dissection may be performed if the nodes are affected.

2. Radiation Therapy

• High-energy radiation targets and destroys cancer cells.

• Radiation is given 5 days a week and can be used:

• When surgery is not possible.

• To prevent recurrence after surgery.

• To relieve pain if melanoma spreads to the bones.

• Side effects: Fatigue, skin irritation, and itching, which improve after treatment.

3. Immunotherapy

• Uses drugs to help the immune system fight cancer.

• Common immunotherapy drugs for melanoma:

• Nivolumab (Opdivo)

• Pembrolizumab (Keytruda)

• Atezolizumab (Tecentriq)

• Ipilimumab (Yervoy)

4. Targeted Therapy

• Targets specific mutations in cancer cells.

• Drugs used include:

• Dabrafenib (Tafinlar)

• Encorafenib (Braftovi)

• Vemurafenib (Zelboraf)

• Trametinib (Mekinist)

• Cobimetinib (Cotellic)

• Binimetinib (Mektovi)

5. Chemotherapy

• Uses drugs to kill cancer cells.

• Common drugs:

• Dacarbazine (DTIC)

• Temozolomide (Temodar)

• Cisplatin, Fotemustine, Paclitaxel (Taxol)

• Side effects: Fatigue, nausea, vomiting, hair loss, and nerve damage.

6. Treatment for Brain Metastases

• If melanoma spreads to the brain, treatments include:

• Radiation

• Immunotherapy

• Surgery

Follow-up Care

After treatment, regular follow-up is crucial to monitor for recurrence and manage side effects. Follow-up care includes:

• Physical exams

• Blood tests

• Imaging tests to ensure cancer has not returned.

Melanoma is a severe form of skin cancer, but early detection and treatment can lead to better outcomes. With advances in surgery, immunotherapy, targeted therapy, and radiation, melanoma is becoming more manageable, even in advanced stages. Regular follow-up and preventive care remain essential in ensuring long-term health.

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