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Melanoma Symptoms
What Is Melanoma?
Skin cancer is the most common type of cancer diagnosed in the USA. If found at an early stage, it can be treated with certain procedures and the use of topical medications by a dermatologist or through outpatient surgery. This is why skin cancers are responsible for less than 1 percent of all deaths caused by cancer.
Skin cancer has 4 main types:
- Basal cell carcinoma
- Squamous cell carcinoma
- Merkel cell carcinoma
- Melanoma
The first three types of skin cancers are referred to as “non-melanoma skin cancer” to separate them from a more serious skin cancer, “melanoma.” [1]
Melanoma develops in the melanocytes. These cells, which are responsible for producing the melanin pigment in the skin, start to grow out of control and likely spread to other parts of the body. Melanoma is a more aggressive type of cancer as compared to other skin cancers, and if it is not diagnosed early, it develops into a dangerous disease. [2]
Melanoma skin cancer has different types, but the most common ones are cutaneous. Cutaneous melanomas develop on skin areas that are exposed to the sun. [3]
Melanoma diagnosis begins with an examination of the skin, and a confirmed diagnosis of skin cancer is made after biopsy test results are generated.
Types of Melanoma
Melanoma is divided into many types, which are defined by pathologists or by gene mutations.
Histologic Types of Melanoma
Different melanoma types have different forms and appearances, but they are treated in usually the same way. Some of the melanoma types are discussed below.
Superficial Spreading Melanoma
The most common type (more than 70%) of melanomas. Superficial spreading melanoma develops from an existing mole and spreads outwards rather than deep in the skin.
Nodular Melanoma
Nodular melanoma grows deeper into the skin and grows rapidly. It can create a raised area on the skin which can be black, pink, or red. Nodular melanoma accounts for almost 15% of all melanomas.
Lentigo Maligna Melanoma
Lentigo malignant melanoma develops slowly from Hutchinson’s melanotic freckle. This type of melanoma occurs most often in older people and begins on the face, arms, ears, and other areas which are exposed to skin.
Acral Lentiginous Melanoma
These melanomas are developed on the palms of hands, soles of feed, around the toenail, or under the nail bed. This type of melanoma is a rare type and develops in 5-10 people out of a hundred who are diagnosed with melanoma. It is a common type of melanoma in people with darker skin.
Amelanotic Melanoma
Amelanotic melanoma appears without melanin, and they are usually skin-colored or red in appearance. This type of melanoma is again rare, occurring in 8 out of 100 people diagnosed with skin cancer, but difficult to diagnose. [6]
How Is Melanoma Diagnosed?
Doctors order a biopsy to test any suspicious area on the skin, which is known as a lesion. A biopsy sample is examined in a laboratory for the presence of skin cancer and to make a definite diagnosis.
After the diagnosis, a pathologist creates a pathology report, which states the following information about cancer:
- The thickness of the melanoma
- Presence of ulceration
- Subtype of melanoma
- The speed at which melanoma cells are dividing
- Presence of tumor-infiltrating lymphocytes
- Margin status of the biopsy sample
- Response of different therapies by the melanoma
- Presence of biomarkers that affect prognosis. [5]
Melanoma Staging
The TNM staging system classifies melanoma on 3 factors:
- T: Thickness of melanoma
- N: Whether the melanoma has spread to the lymph nodes.
- M: Whether cancer has spread to other parts of the body.
Melanoma has the following stages:
Stage 1
Stage 1 primary melanoma is thin and contained only in the skin. Melanoma doesn’t spread to lymph nodes and is divided into the following subtypes:
- IA
- IB
Stage 2
Stage 1 melanoma is thicker than stage 1 and extends into the dermis. Melanoma doesn’t spread to lymph nodes and is divided into the following subtypes:
- IIA
- IIB
- IIC
Stage 3
Stage 1 melanoma has spread locally or to a regional lymph node. Stage 3 melanoma is divided into the following subtypes according to the tumor thickness and lymph node involvement:
- IIIA
- IIIB
- IIIC
- IIID
Stage 4
Stage 4 melanoma spreads to other parts of the body through the bloodstream, such as soft tissues, distant lymph nodes, or organs like the liver, lungs, brain, and bone. Stage 4 is divided into the following subtypes:
- M1a
- M1b
- M1c
- M1d. [7]
Is Melanoma Hereditary?
Family history highly influences the risk of developing melanoma sometime in life. If one or more first-degree relatives like parents, siblings, and children have had melanoma, then the risk of getting melanoma is higher. Almost 10% of the patients have a family history of melanoma. [8]
Melanoma Symptoms
Melanoma is also known as malignant melanoma or cutaneous melanoma. Melanoma can appear as either:
- Brown and black: When affected, melanocytes are still producing melanin.
- Or pink, white, or tan: When the melanoma cells do not produce melanin.
Melanoma mostly appears on the neck and face, but people who have darkly pigmented skin develop melanoma less commonly at these sites. However, melanomas in African Americans can develop on the palms, under the nails, and on the feet soles.
Melanoma can also appear (but less commonly) on the genitals, anal area, eyes, and mouth. [2]
What Are the Symptoms of Melanoma?
The most important symptom of melanoma is a new spot of lesion on the skin or an existing spot that changes in shape, size, and color.
Other types of spots on the skin that can suggest melanoma is developing are those that look different from other spots on the body. Here are some warning signs of melanoma you must not ignore.
- A spot on the skin that spreads its pigment onto the surrounding skin.
- A sore on the skin that doesn’t heal.
- Redness and swelling on the skin that goes beyond the mole border.
- Itchiness, bleeding, crusting, and tenderness on the skin.
- Changes in the appearance of the surface of a mole, such as oozing and scaliness.
The visual symptoms of melanoma are measured using the ABCDE rule, which is:
1. A
Stands for asymmetry. Asymmetrical growth on the skin means that if we divide the abnormal spot on the skin in half, one part will not match the other. The appearance of both parts is different in their color, texture, or shape.
2. B
B stands for border. The border of a mole or birthmark, or any other spot on the skin, is irregular and ragged or blurred. The borders of melanoma are uneven, which is in contrast to normal moles having smoother and even borders.
3. C
C stands for color. A spot on the skin that suggest melanoma doesn’t have a uniform color all over. The color of a malignant mole can have different shades of black, brown, red, pink, or white. As the melanoma grows, blue color may also appear on the cancerous mole.
4. D
D stands for diameter. If the spot on the skin is bigger than 6 mm across, it can be melanoma. Although melanomas sometimes tend to be smaller than ¼ inch, any spot on skin that looks bigger and darker than others is a warning sign.
5. E
E stands for evolving. If any new or existing spot on the skin is evolving in its shape, size, color, and elevation, then it can be a warning sign for melanoma. [9]
What Are Some Signs of Melanoma?
Cutaneous melanoma makes up the majority of skin cancers in the USA. A variety of screening tests can identify the presence and stage of melanoma.
Total Body Skin Examination
TBSE can improve the chances of detecting melanoma at an early stage. [10]
Other Indications of Metastatic Spread
Once it is suspected that melanoma is present, other symptoms can indicate its metastatic spread, including:
- Seizures
- Vision changes
- Headaches
- Hemoptysis
- Coughing
- Shortness of breath
- Changes in bowel habits. [11]
Symptoms of Melanoma in Women vs. Symptoms of Melanoma in Men
The common sites where melanoma can develop in men and women are different.1 [2] in men, melanoma commonly starts to develop on the trunk, which is the chest and back. In women, melanoma first starts developing in the legs.
1 Note that here, we are using the terms “women” and “men” to refer to female and male biological sex at birth, respectively.
Men
Head and neck melanoma is most commonly prevalent in non-Hispanic White men. The greater chances of a man dying from melanoma rather than a woman pose a huge question for dermatologists, but they suggest that the following factors are responsible for the sex-based differences in this disease.
- Men are more likely to off their shirts during outdoor activities like mowing the lawn and playing basketball.
- They are less enthusiastic about sun protection and skincare.
- Elevated levels of circulating sex hormones during puberty can lead to melanoma initiation and progression. [12]
Women
Even though death due to melanoma is more prevalent in men than women, women, especially those who are younger than 50 years of age, are more likely to develop melanoma than men.
Those individuals having fair skin and hair and lighter eyes are more vulnerable to the disease. Those people spending lots of time in sun and tanning salons are at a higher risk for developing this skin cancer.
Risk Factors for Melanoma
Risk factors of melanoma include:
- UV radiation exposure from the sun.
- Presence of unusual moles on the body.
- Fair skin, blond or red hair, freckles, and blue eyes.
- Indoor tanning.
- Familial melanoma.
- Previous basal cell or squamous cell skin cancer.
- A weakened immune system.
Melanoma Prevention
There is no accurate way to prevent melanoma, but certain protective measures can lower the risk of developing this skin cancer.
- Limiting direct exposure to sun between 10 am to 4 pm.
- Using sunscreen.
- Avoiding tanning devices.
- Regular skin examination.
- Including vitamin D in the diet. [13]
Melanoma Prognosis and Treatment
Skin cancers, if left untreated till they grow to an advanced stage, require treatment management by a team of healthcare professionals like surgical oncologists, dermatologists, radiation oncologists, and medical oncologists. [1]
Treatment of melanoma depends on its thickness, metastasis, and genetic mutations in the cancerous cells. [14]
The Melanoma Survival Rate
The five-year relative survival rate of melanoma of the skin is 93.7%. According to SEER cancer, the lifetime risk of developing melanoma is approximately 2.1%. In 2019, almost 1,361,282 people were living with melanoma 2019 in the USA. [4]
Melanoma Treatment Options
The common treatment procedures for melanoma are as below:
- Surgery
- Chemotherapy
- Radiation therapy
- Immunotherapy
- Targeted therapy [14]
Conclusion
Skin cancers are very common, which is why if you notice any change in your existing moles or a new spot appears on your skin, you must see a doctor immediately. Catching and treating melanoma at an early stage ensures the best chances of curing and surviving the disease.