Melanoma
What Is Melanoma?
Melanoma is the most serious form of skin cancer. However, if it is recognized and treated early, it is nearly 100 percent curable. But if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. The American Cancer Society estimates that in 2008, there will be 8,420 fatalities in the U.S., 5,400 in men and 3,020 in women. The number of new cases of invasive melanoma is estimated at 62,480; of these, 34,950 will be in men and 27,350 in women.
Melanoma is a malignant tumor that originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair, and eyes. The majority of melanomas are black or brown. However, some melanomas are skin-colored, pink, red, purple, blue or white.
Am I at Risk?
Everyone is at some risk for melanoma, but increased risk depends on several factors: sun exposure, number of moles on the skin, skin type and family history (genetics).
-
Sun exposure
Both UVA and UVB rays are dangerous to the skin, and can induce skin cancer, including melanoma. Blistering sunburns in early childhood increase risk, but cumulative exposure also is a factor. People who live in locations that get more sunlight — like Florida, Hawaii, and Australia — get more skin cancer. Avoid using a tanning booth or tanning bed, since it increases your exposure to UV rays, increasing your risk of developing melanoma and other skin cancers. -
Moles
There are two kinds of moles: normal moles — the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone — and atypical moles, also known as dysplastic nevi. Regardless of type, the more moles you have, the greater your risk for melanoma. -
Skin Type
As with all skin cancers, people with fairer skin are at increased risk. You can read more about skin type and risk here. -
Family History
About one in every ten 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. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece or nephew, there is still an increase in risk, although it is not as great. Read more on family history, below. -
Personal History
Once you have had melanoma, you run an increased chance of recurrence. Also, people who have or had basal cell carcinoma and squamous cell carcinoma are at increased risk for developing melanoma. -
Weakened Immune System
Compromised immune systems as the result of chemotherapy, an organ transplant, excessive sun exposure, and diseases such as HIV/AIDS or lymphoma can increase your risk of melanoma.
If you are in any of these risk groups, you can protect yourself and your children by practicing safe sun habits, remembering to examine yourself regularly, watching for the warning signs and getting yearly exams by a dermatologist or other physician experienced in skin care.
More about Family History
We are all at risk for melanoma. However, some people are more at risk than others. Heredity plays a major role. If your mother, father, siblings, or children (first-degree relatives) have had a melanoma, you are part of a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than members of the general public who do not have a family history of the disease. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece, or nephew (second-degree relatives), there is still an increase in risk compared to the general population, though it is not as great.
About one of every ten patients diagnosed with the disease has a family member with a history of melanoma. If melanoma is present in your family, you can protect yourself and your children by being particularly vigilant in watching for the early warning signs and finding the cancer when it is easiest to treat.
Close Relatives Examined
When this skin cancer is diagnosed, it is standard practice for physicians to recommend that close relatives be examined immediately for melanoma and for the presence of unusual or atypical moles. These moles are also called "dysplastic nevi." You can read more about atypical moles here.
Family Syndrome
When atypical moles are found in an individual belonging to a melanoma family, the condition is known as FAMMM, standing for Familial Atypical Multiple Mole Melanoma Syndrome. People with this syndrome are at the greatest risk of developing melanoma. In contrast, a research study found that those family members who did not have atypical moles were much less likely to develop melanoma.
Genetic Risk Factors
A mutation (alteration) in a recently discovered gene, the BRAF, may play a part in causing melanoma. In one study, this mutated gene was found in two-thirds of the melanoma cells analyzed. BRAF is called a "switch" gene, because it turns on to allow the cells to grow and divide. Mutations in this gene can lead to uncontrolled cell growth and cancer. The discovery is an exciting research breakthrough, but physicians and patients are still years away from reaping the rewards. Ultimately, the understanding of the BRAF gene could lead to the development of diagnostic tools and drug therapies. The mutations most commonly seen in familial melanoma occur in another gene, p53. When this gene is in its normal state, its main function is to give damaged cells time to repair themselves and not progress to cancer. However, when the gene is altered, it becomes unable to perform this function, and cancer can result. A number of gene mutations in addition to p53 and BRAF have been associated with familial melanoma. In the future, families might be screened so as to identify those members who are carrying a defective gene.
Moles in an Active Stage
Moles in people belonging to melanoma-prone families are subject to change at certain times of life. They may get larger or show alterations in color or elevation, so for those periods, they are described as being active. While the reasons for these changes are not fully known, there could be a hormonal component: Moles are more active at puberty and during pregnancy. Many — but not all — physicians advise high-risk individuals not to take hormonal medications, such as oral contraceptives or hormone replacement therapy.
Examination Scheduling
Individuals with the Atypical Mole Syndrome can improve their chances of early detection by increasing the frequency of skin self-examination and by visiting a physician more often. The clinician may take photographs to document whether there are new moles or changes in older ones.
Children: A Special Case
Children in melanoma-prone families need special care, because familial melanoma is likely to make its appearance early in life. Even though these cancers usually do not appear until after adolescence, they may arise in much younger children who have a family history of melanoma. Most physicians, therefore, advise parents to make a point of studying a child's skin frequently from infancy on.
Physician examination should start at the age of ten and continue on a twice-a-year basis thereafter. Particular care should be taken at puberty and during adolescence when hormonal changes activate the moles. Here is some encouraging news: Because melanoma families are on the lookout for the disease and seek professional consultation early, the survival rate for familial melanoma is even higher than that for non-familial melanomas.
