Melanoma is a kind of skin cancer but less common to other skin cancer as a result of malignancy of of melanocytes, which is the cell produced dark pigment for your skin. Approximate 120,000 new cases of melanoma in the US are diagnosed in a year. melanoma tends to spread along the skin in most of the cases, but also can grow downward to the deeper layers of the skin. At the later stage, it can spread to distant parts of the body, including organs.
Types of melanoma
1. Superficial spreading
This is a most common type of melanoma, accounted for over 70% of all cases. It usually starts with a normal mole, but for what ever reason, it begins to change malignantly with irregular borders, and has color variations.
2. Nodular type
This type of melanoma is more aggressive growth than superficial spreading and found most on the trunk, upper arms, and thighs. The nodular type of melanoma is usual detected as a lump with blue and black color.
3. Acral melanoma
Acral melanoma mostly founded on the hands, feet, and nail beds. The risk increases for people with darken-skin color.
4. Lentigo maligna melanoma
Found mostly on the face of elderly in the eye, back at the eye. around the mouth, the anus or vagina with great exposure to sunlight.
Causes and risk factors
1. Sun light
Melanoma is best known as it caused by ultraviolet light of the sun, if you expose yourself in the sun light for a prolonged period of time, it can damage the melanocytes, in some cases, it can cause alternation of cell DNA, leading to melanoma skin cancer.
2. Family history
Having many of abnormal, or atypical, moles on your skin is a sign that melanoma may run in your family.
3. Moles and birthmarks
Melanoma risk increased if there are many moles and birthmarks on your skin.
4. Inherited
Certain genes have been identified as increasing the risk of developing melanoma.
5. UV radiation from tanning beds
In July 2009, the IARC released a report, risk of melanoma increased by more than 75%, if you use tanning devices before age 30.
6. Previous melanoma
Increased risk of melanoma if you had developed melanoma before.
7. Etc.
Symptoms
1. Asymmetry
The mole on your skin is no longer symmetric as one half of the mole is different from the other half.
2. Borders irregular
Border of the mole has become irregular, such as uneven or notched.
3. Color
The color of the mole is different than other mole on the skin.
4. Diameter
The mole is lager than other mole and evolved over time
5. Pain
6. Swelling
7. Bleeding
8. Etc.
Diagnosis and tests
If you have some of above symptoms, careful visualization of the effect area is one of the first examination by you doctor aft er family history is record.
1. Skin biopsy
In skin biopsy, a sample of mole or the effected area is taken by a thin, tube-like instrument under local anesthesia and examined by a pathologist under microscopy to review the stage of the cancer.
2. Lymph nodes examination
Lymph nodes closed to the skin effects area will be careful examine for sign of enlargement and to see if cancer has spread to the lymph nodes.
3. CT Scan (computerized tomography)
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. CT scan can only review the existence of cancer, but it can not tell it is a primary or secondary cancer.
4. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the lymph nodes and surrounding areas.
5. Positron emission tomography (PET scan)
Positron emission tomography (PET scan) is a type of nuclear medicine imaging with the uses of small amounts of short-lived radioactive material, either injected into a vein, swallowed or inhaled as a gas which will appear in the area of the body being examined, where it gives off energy in the form of gamma rays detected by a camera of positron emission tomography that produces a three-dimensional image or picture of functional processes of the organs in the body, such as the lungs, brain, liver, or other organs.
6. Etc.
Grades
The Grades of melanoma skin cancer are depending to the tendency of spreading. Low grade cancers usually g row more slowly and are less likely to spread while high grade cancer indicates otherwise.
Stages of Melanoma skin cancer
Stages of melanoma skin cancer can be classified by using the TNM system, where
* T stands for tumor
1. T0
No No evidence of primary tumor.
2. Tis
Melanoma in situ, the earliest stage of melanoma skin cancer.
3. T1
a. T1a
The melanoma is less than or equal to 1.0 mm thick (1.0 mm = 1/25 of an inch), without ulceration and with a mitotic rate of less than 1/mm2.
b. T1b
The melanoma is less than or equal to 1.0 mm thick. It is ulcerated and/or the mitotic rate is equal to or greater than 1/mm2.
4. T2
a. T2a
The melanoma is between 1.01 and 2.0 mm thick without ulceration.
b. T2b:
The melanoma is between 1.01 and 2.0 mm thick with ulceration.
6. T3
a. T3a
The melanoma is between 2.01 and 4.0 mm thick without ulceration.
b. T3b
The melanoma is b etween 2.01 and 4.0 mm thick with ulceration.
7. T4
a. T4a
The melanoma is thicker than 4.0 mm without ulceration.
b. T4b
The melanoma is thicker than 4.0 mm with ulceration.
* N stands for spread to nearby lymph nodes
The possible values for N depend on whether or not a sentinel lymph node biopsy was done.
The clinical staging of the lymph nodes, which is done without the sentinel node biopsy, is listed below.
1. NX
Nearby (regional) lymph nodes cannot be assessed.
2. N0
No spread to nearby lymph nodes.
3. N1
Spread to 1 nearby lymph node.
4. N2
Spread to 2 or 3 nearby lymph nodes, OR spread of melanoma to nearby skin or toward a nearby lymph node area (without reaching the lymph nodes).
5. N3
Spread to 4 or more lymph nodes, OR spread to lymph nodes that are clumped together, OR spread of melanoma to nearby skin or toward a lymph node area and into the lymph node(s).
* M stand of whether the melanoma has spread to distant parts of the body
1. M0
No distant metastasis.
2. M1a
Metastasis to skin, subcutaneous (below the skin) tissue, or lymph nodes in distant parts of the body, with a normal blood HDL level.
3. M1b: Metastasis to the lungs, with a normal blood HDL level. 4. M1c: Metastasis to other organs, OR distant spread to any site along with an elevated blood LDH level.
Stage grouping
Once the T, N, and M groups have been determined, they are combined to give an overall stage, using Roman numerals I to IV (1 to 4) and sometimes subdivided using capital letters. This process is called stage grouping. In general, patients with lower stage cancers have a better outlook for a cure or long-term survival.
1. Stage 0
Tis, N0, M0: The melanoma is in situ, meaning that it is in the epidermis but has not spread to the dermis (lower layer).
2. Stage I
a. Stage IA
T1a, N0, M0: The melanoma is less than 1.0 mm in thickness. It is not ulcerated and has a mitotic rate of less than 1/mm2. It has not been found in lymph nodes or distant organs.
b. Stage IB
T1b or T2a, N0, M0: The melanoma is less than 1.0 mm in thickness and is ulcerated or has a mitotic rate of at least 1/mm2, OR it is between 1.0 1 and 2.0 mm and is not ulcerated. It has not been found in lymph nodes or distant organs.
3. Stage II
a. Stage IIA
T2b or T3a, N0, M0: The melanoma is between 1.01 mm and 2.0 mm in thickness and is ulcerated, OR it is between 2.01 and 4.0 mm and is not ulcerated. It has not been found in lymph nodes or distant organs.
b. Stage IIB
T3b or T4a, N0, M0: The melanoma is between 2.01 mm and 4.0 mm in thickness and is ulcerated, OR it is thicker than 4.0 mm and is not ulcerated. It has not been found in lymph nodes or distant organs.
c. Stage IIC
T4b, N0, M0: The melanoma is thicker than 4.0 mm and is ulcerated. It has not been found in lymph nodes or distant organs.
4. Stage III
a. T1a to T4a, N1a or N2a, M0: The melanoma can be of any thickness, but it is not ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area, but the nodes are not enlarged and the melanoma is found only when they are viewed under the microscope. There is no distant spread.
b. Stage IIIB
One of the following applies:
b.1. T1b to T4b, N1a or N2a, M0: The melanoma can be of any thickness and is ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area, but the nodes are not enlarged and the melanoma is found only when they are viewed under the microscope. There is no distant spread.
b.2. T1a to T4a, N1b or N2b, M0: The melanoma can be of any thickness, but it is not ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area. The nodes are enlarged because of the melanoma. There is no distant spread.
b.3. T1a to T4a, N2c, M0: The melanoma can be of any thickness, but it is not ulcerated. It has spread to small areas of nearby skin or lymphatic channels around the original tumor, but the nodes do not contain melanoma. There is no distant spread.
c. Stage IIIC
One of the following applies:
c.1. T1b to T4b, N1b or N2b, M0: The me lanoma can be of any thickness and is ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area. The nodes are enlarged because of the melanoma. There is no distant spread.
c.2. T1b to T4b, N2c, M0: The melanoma can be of any thickness and is ulcerated. It has spread to small areas of nearby skin or lymphatic channels around the original tumor, but the nodes do not contain melanoma. There is no distant spread.
c.3. Any T, N3, M0: The melanoma can be of any thickness and may or may not be ulcerated. It has spread to 4 or more nearby lymph nodes, OR to nearby lymph nodes that are clumped together, OR it has spread to nearby skin or lymphatic channels around the original tumor and to nearby lymph nodes. The nodes are enlarged because of the melanoma. There is no distant spread.
5. Stage IV
Any T, any N, M1(a, b, or c): The melanoma has spread beyond the original area of skin and nearby lymph nodes to other organs such as the lung, live r, or brain, or to distant areas of the skin, subcutaneous tissue, or distant lymph nodes. Neither spread to nearby lymph nodes nor thickness is considered in this stage, but typically the melanoma is thick and has also spread to the lymph nodes. (Source provided by american cancer society)
Prevention
How to avoid
1. Sun exposure
Reduce the times exposed to the sun, especially in the afternoon. If you really have to such as outside worker, please take all necessary pre-cautious, such as sun creams, protective sun glass, clothing etc.
2. Monthly self exam
Previous studies have found that performed monthly self-exams reduces the dealth of melanoma by 63%.
3. Avoid tanning bed
Risk of melanoma increased by more than 75%, if you use tanning devices before age 30.
4. Avoid sunburns
Sunburn in childhood can increase the risk of melanoma skin cancer.
5. Etc.
B. With Diet
1. Coffee
Res earchers recently reported that drinking a couple of Starbucks' venti coffees at 20 ounces apiece, reduced risk of melanoma skin cancer by 30%..
2. Red wine
A compound resveratrol found in red wine inhibits the abnormal cells of the skin. in the study from the Marshall University School of Medicine Researcher suggested that resveratrol causes apoptosis in human melanoma cells.3. Soy
Soy contains high amount of apigenin and quercetin. In a study of flavonoids apigenin and quercetin inhibit melanoma growth and metastatic potential, researchers found that quercetin and apigenin inhibit melanoma growth and invasive and metastatic potential, therefore, they may constitute a valuable tool in the combination therapy of metastatic melanoma.
4. Food containing carotenoids and vitamin D
In a study ofDiet and Melanoma in a Case-Control Study, researchers found that diets consisting of foods rich in vitamin D and carotenoids and low in alcohol may be associated with a reduction in risk for melanoma. These analyses should be repeated in large, prospective studies.
5. Brocolli and cabbage
In a study on mice , researchers found that compounds extracted from broccoli and cabbage could be a potent drug against melanoma. Also in tests on mice suggested these compounds, when combined with selenium, target tumors more safely and effectively than conventional therapy..
6. Etc.
C. With nutritional supplements
1. Antioxidants
Antioxidants contain a class of many vitamins, minerals, supplements, etc. which reduce the risk of melanoma by preventing the abnormal cell growth and protect the cells again mutation of cells division due to DNA alternation.
2.Resveratrol
has been shown to halt the harmful, unwanted growth characteristic of melanoma cancer cells, A study conducted by Albert Polans, PhD, the Associate Director of the Eye Research Institute at the University of Wisconsin-Madison showed that resveratrol halts the harmful, unwanted growth characteristic of melanoma cancer cells.
3. Carotenoids, vitamins C, E, D, and A
In a study of Diet and Melanoma in a Case-Control Study, researchers found that Intake of carotenoids and vitamins C, E, D, and A are hypothesized to reduce risk of developing melanoma. Carotenoids, vitamin C, and vitamin E, because of their photoprotective and antioxidant properties, are hypothesized to protect against the p hotooxidative damaging effects of solar radiation on skin.
4. Apigenin and and icariin
In a sudy of Flavonoids, apigenin and icariin exert potent melanogenic activities in murine B16 melanoma cells.5. researchers found apigenin and icariin exert potent melanogenic activities through, at least in part, upregulating the protein expression levels of melanogenic enzymes in B16 cells. Thus, further investigations are merited to ascertain their potential application in treating hypopigmentation disorders.
5. Etc.
Treatments
A. In conventional medicine
The aim of treatment is to remove the lesion with little disturbance to the functions and cosmetic appearance.
a. Surgery
Surgery is one of the treatment offered high chance to cure of the disease, depending to the grade and stage of the affected area.
b. Radiotherapy
By using high-energy x-rays or other types of radiation, radiation therapy kills lung cancer cells and kee p them from growing or regrowing. Depending to stage or grade there are two types of radiation therapy. Radiotherapy is effective to shrink the individual lesion and control symptoms but not primary treatment for melanoma.
a. External radiation
By using a machine outside the body to send direct high-energy x-rays or other types of radiation toward the cancer.
b. Internal radiation
By placing a radioactive substance direct into or near the cancer by a medical instrument with the aim to kill nearby cancer cells.
c. Side effects
c.1.. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.
3. Chemotherapy
a. Chemotherapy is most use to treat with advance stage of indolent lymphomas, as it has spread to a distant parts of the body by using drugs, such as chlorambucil, with or without steroid agent, prednisone, melphalan, etc. taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells. Chemotherapy used effectively with advanced case of melanoma.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.
4. Biological therapy
By enhancing the body's own immune or hormonal system to kill cancer cells, while leaving healthy cells relatively intact with the use of antibodies to attack cancer cells or block their activities or interrupting the hormonal or chemical pathways of the cancers with certain drugs composed of small molecules. biological agents used in treating advanced melanoma including interleukin-2 and interferon-a.
b. Side effects
b.1. Allergic reactions,
b. 2. Difficulty breathing, swelling,
b. 3. Nausea,
b.4. Fever or chills, and
b. 5. Dizziness and fatigue
b.6. Etc.
5. Hyperthermia
a. By exposing the body tissue high temperatures (up to 113F), hyperthermia kill cancer cells and used effectively with lesion in the skin. Normally, it is used conjunction radiotherapy.
b. Side effcets
b.1. Burns,
b.2. Blisters,
b.3. Discomfort or pain
b.4. Tissue swelling,
b.5. Blood clots,
b.6. Bleeding
b.7. Etc.
6. Adjuvant therapy
a. The main objective of adjuvant therapy is to prevent the recurrence of the cancer after removing the lesion by surgery and in general, with interferon
b. Side effects
b.1. Tiredness
b.2. Fever
b.3. Muscle ache
b.4. Etc.
7. Etc.
B. Herbal medicine
1. Maitake mushroom
Clinical studies indicate that maitake mushroom extract helps reduce side-effects of conventional chemotherapy (and radiation) while at the same time enhancing its effectiveness. In 1994, a group from China published findings from a pilot s tudy on 63 cancer patients reporting a total effective rate against solid tumours at higher than 95 percent and an effective rate against leukemia higher than 90 percent.
2. Dandelion Root
In a study of The efficacy of dandelion root extract in inducing apoptosis in drug-resistant human melanoma cells, researchers found that treatment with this common, yet potent extract of natural compounds has proven novel in specifically inducing apoptosis in chemoresistant melanoma, without toxicity to healthy cells.
3. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.
4. Curcumin
In a study conducted by S. Uddin and colleagues at the Department of Human Cancer Genomic Research at King Faisal Specialist Hospital and Research Center in Saudi Arabia, researchers found that Cur cumin in turmeric may inhibit the proliferation of lymphoma cancer by modulating cell cycling and inducing apoptosis.
5. Etc.
C. Traditional Chinese medicine
1. Keishi-ka-kei-to
In a study of Keishi-ka-kei-to, a traditional Chinese herbal medicine, a a mixture of crude extracted from Cinnamomi cortex, Paeoniae radix, Zizyphi fructus, Zingiberis rhizoma and Glycyrrhizae radix) inhibits pulmonary metastasis of B16 melanoma, researchers found that Keishi-ka-kei-to inhibits pulmonary metastasis in mice bearing B16F10 melanoma cells through the stimulation of CD8+ T cells.
2. Jiu Zi (Chinese leek)
In a study of A Pilot Study on Anticancer Activities of Chinese Leek researchers found that Chinese leek extract inhibited cancer cell growth and induced apoptosis in vitro. Oral administration of leek extract significantly reduced lung metastases in the present animal model.
3. Wu bei zi (Chinese Galls)
In a study of melanogenesis inhibition by gallotannins from Chinese galls in B16 mouse melanoma cells, researchers indicated that Chinese galls inhibit melanin biosynthesis, associated with hyperpigmentation and can be used as skin-whitening cosmetics for skin care.
4. Bai Hua She She Cao
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.
5. Etc.
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