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The Hunger Project Bolen Report
Ohm Society
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Malignant Melanoma Print E-mail
by Ron Kennedy, M.D., Santa Rosa, CA

Dr. Kennedy Melanoma is the most serious type of skin cancer and begin in skin cells called melanocytes. These are the cells that make melanin, which gives skin its color. Melanin also protects the deeper layers of the skin from the sun's ultraviolet (UV) rays. When you spend time in the sun, melanocytes make more melanin which spreads out evenly resulting in a "tan." This also happens when skin is exposed to other forms of UV, such as in a tanning booth. If the skin receives too much ultraviolet light, the melanocytes may cancerous. This condition is called melanoma. The first sign of melanoma is often a change in the size, shape, or color of a mole. But a melanoma can also appear on the body where there was no leasion previously. In men, melanoma most often shows up on the upper body, between the shoulders and hips on the head and neck. In women, melanoma often develops on the lower legs. In dark-skinned people, melanoma often appears under the fingernails or toenails, on the palms of the hands, on the soles of the feet, in other words areas not protected by dark skin. Although these are the most common places on the body for melanomas to appear, they can appear anywhere on the skin. That's why it is important to always examine your skin to check for new moles or changes in moles. With early diagnosis and treatment, the chances of recovery are very good. The chance of getting melanoma increase with age, but melanoma can appear at any age. In fact, melanoma is one of the most common cancers in young adults. Each year, more than 50,000 people in the U.S. develop melanoma. Melanoma can become a life-threatening cancer. If found and treated in its early stages, chances of recovery are very good. If not found early, melanoma can grow deeper into the skin and spread to other parts of the body (metastasis). Once melanoma has spread to other parts of the body beyond the skin, it is difficult to treat.

Diagnosis

A mole that looks unusual or that has grown or changed color or shape in the last few months should receive the attention of your doctor. If your doctor also thinks the mole looks suspicious, you should be referred you to a dermatologist (a physician who specializes in diseases of the skin). The dermatologist may do a biopsy and remove a small piece of the mole or the entire mole. A pathologist (another specialty) looks at the sample under a microscope to check for cancer cells. If the mole turns out to be melanoma, your dermatologist will need to find out more about the disease, based on how thick the tumor is and, how far it may have spread. This is called staging. Staging the melanoma is a very important step as it may determine the choice of treatment.

To find out how thick the melanoma is, the doctor will remove the entire tumor along with some skin around it (if this wasn't already done during diagnosis). At the same time, or in a later step, the doctor may do a procedure called a sentinel lymph node (SLN) biopsy. This will help determine whether, and where, the melanoma has spread. Other tests may also play a role in staging. These include blood tests, chest x-rays, CT (computed tomography), MRI (magnetic resonance imaging), PET scan (positron emission tomography scan).

Treatment

If the melanoma has spread to the nearby lymph nodes, the affected lymph nodes may also be removed surgically. Surgery is usually the only treatment needed for people with early-stage melanomas (thinner melanomas that have not spread to the lymph nodes). However, these people still need regular follow-up visits to the doctor, to make sure the melanoma has not come back and that other moles do not need biopsies. Once a person has had melanoma, there is a higher chance of getting it again. After all traces of the tumor have been removed, you may be referred to an oncologist (cancer specialist). If the melanoma has spread to other areas or if there is a good chance the melanoma might come back, the oncologist may prescribe additional treatment such as immunotherapy (also called biochemical therapy or biotherapy) - a form of therapy that stimulates the immune system to kill or control cancer cells. Chemotherapy and/or radiation therapy may also be employed for melanoma which has metastisized. Melanoma that has spread to distant sites in the body, or to other organs (such as the lungs or liver) may not be curable, although one hears of miracle cures from time to time. In these cases, treatment usually focuses on relieving symptoms and keeping the patient as comfortable as possible.

Prevention

The main cause of melanoma is too much exposure to ultraviolet (UV) rays. The best way to prevent melanoma is to reduce the amount of time you spend in the sun, especially at certain times of the day, and to make sure you are well protected when you are in the sun. Childhood is an especially important time for sun protection. Protecting the skin during the first 18 years of life can reduce the risk of some types of skin cancer by up to 78%. Also do a skin self-exam every 6 to 8 weeks. This helps ensure that you find suspicious moles early and have them checked promptly by your doctor.

A method for determining the prognosis with melanoma is known as "Breslow's thickness." The thickness of a melanoma is related to the 5-year survival rate after surgical removal of the tumor. Named for the physician Alexander Breslow who in 1975 observed that as the thickness of the tumor increases, the chance of survival goes down. For example, a thickness of the melanoma of less than 0.76 millimeters is associated with a 5-year survival of 97% of patients whereas a tumor thickness of more than 8.0 millimeters is associated with 5-year survival of 32%.



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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