Melanoma Cancer

Analysis and Early Detection of Melanoma Cancer

Authors: Aanandi Thakur, Meenakshi Sanikommu, and Dr. Lopamudra Das Roy

Published 2022

@BreastCancerHub, All Rights Reserved

Abstract

Melanoma, caused by the uncontrolled growth of melanocytes (cells that give the body its color), is the most dangerous type of skin cancer; its high likelihood of spreading to other parts of the body, if not identified and treated early, contributes to the fact. While the root cause of this cancer has not been clearly identified, gene changes, such as DNA mutations that turn off tumor suppressor genes (genes that regulate cell growth), and overexposure of ultraviolet rays have a considerable impact on the development of this cancer. This research paper aims to explain major aspects of melanoma cancer at a base level, with a primary focus on early detection for prevention and treatment methods that can aid in successful recovery. Treatment options for later developments of the cancer exist, however, identifying melanoma in its first stages is critical to treatment success. Self-examination and general knowledge of melanoma are the primary steps in order for efficient early detection of the cancer. While there have been advancements in treatment methods of the cancer, equality in the treatment of melanoma still demands attention.

Introduction and Origin

Skin cancer is the most common type of cancer, affecting nearly every one in five people globally [1]. It can generally be categorized into two types: melanoma cancer and nonmelanoma cancer. melanoma (which means “black-tumor”), also named malignant (infectious) and cutaneous (skin-affecting) melanoma, is a rare but deadly disease that is much more fatal than other cancers and the most lethal of skin cancers [2]. It is a result of an uncontrolled development that occurs within melanocytes, cells that determine the body’s pigment, creating a cancerous tumor [3]. Only when old melanocytes die, or become damaged, are new melanocytes formed. When the process fails to function in its entirety, an excess of new melanocytes form: causing skin cancer. melanoma often starts in the epidermis (the top layer of skin),as it becomes more advanced, grows deeper into the barrier and other layers of the skin [2]. As Melanoma cancer has a fast growth rate, it is critical for early detection or prevention for treatment success [1]. When caught in its earliest stages, Melanoma has been noted to have a higher cure rate. [1]. The formation of Melanoma skin cancer can occur on any part of the skin, with common sites being the neck and face, legs in females, and chest and back in males [2].

Risk Factors and Causes

As early detection and prevention are vital to the treatment of Melanoma cancer, it is important to note the causes of the cancer as well as its relation to genetics, family history, sex, and race. Under the age of fifty, females are more likely to be diagnosed with melanoma cancer; over the age of fifty, however, males are more likely to be diagnosed with the disease. People with low amounts of melanin (light skinned) contain a higher risk of developing skin cancer than those with higher amounts of melanin [4]. It is widely recognized that a main risk-factor (variable that increases the risk of infection) leading to the development of melanoma is ultraviolet radiation and overexposure to sunlight or man-made sources, damaging skin DNA; other significant causes have yet to be established [1]. Moles, which are characterized as benign (not cancerous) pigmented tumors, will almost never develop into cancer, however, having a large amount of moles or moles of an irregular shape can have a negative effect. Those with atypical mole syndrome (known as dysplastic nevi) have an extremely high lifetime risk of developing melanoma, this can be inherited or developed [5].  Exposure to trace elements, including arsenic, has been identified as a probable cause of melanoma, however, because of the sparse amount of studies and information available currently, these elements in relation to melanoma are very poorly understood [6]. Inherited gene mutations, while rare, are a proven cause of melanoma. Familial melanoma does not always develop into cancer but can contribute to irregular cell growth patterns [7]. Fortunately, some gene mutations actually help in the treatment of melanoma, providing ideal genes for drugs to effectively treat the disease [7].

Prevention

As with any cancer, there are no definite ways of preventing melanoma cancer, however, measures can be taken to help reduce the risk of getting melanoma and other skin cancers. Uncontrolled factors, such as age and family history, should not be focused upon, rather, focusing on controllable factors is more effective [8]. As ultraviolet (UV) exposure has been identified as a significant cause of melanoma, protecting the body from UV rays is one of the most effective prevention methods; practicing the regular application of sunscreen with SPF-15 or higher and staying in the shade can help. Man-made sources of ultraviolet exposure, such as tanning beds, can contribute to the development of skin cancer. Limiting the use of man-made sources can help reduce the risk of long-term skin damage [9]. Most importantly, looking out for changes in skin including the development of irregular moles or blemishes regularly can contribute to effective early detection and prevention.

Early Detection

Early detection, in specific relation to melanoma cancer, includes self skin examination (SSE), physician skin examination (PSE), and patient knowledge of skin cancer. The importance of patient knowledge of skin cancer and self skin examinations can be seen in higher rates of cancer detection in its earliest stages [10]. Using the “ABCDEF” mnemonic is a simple yet effective method of self-examination that can be used to detect abnormalities that may lead to the development of melanoma [11]. This includes looking out for areas on the body where any of the following occurs: Asymmetry (half of a mole/birthmark does not match the other), Border (irregular, ragged, notched, or blurred edges), Color (color is not the same all over, may include different shades of brown, black, pink, red, white, or blue), Diameter (The spot is larger than ~6 millimeters across), Evolving ( mole is changing in size, shape, or color), and Funny-looking (stand out from other moles) [2,11]. Physician skin examinations, on the other hand, involve more formal tests, including a dermoscopy used to see skin spots clearly [12]. Other tests can be used to identify the spread of the melanoma including the Positron Emission Tomography (PET) for lymph nodes, Computed Tomography (CT) scan for internal organs, and the Magnetic Resonance Imaging (MRI) for the brain or spinal cord [1]. While it is common for physicians to examine any irregular spots at standard check-ups, self-examination is still critical to early detection and successful treatment. As soon as a patient detects any abnormalities, contacting a physician is a vital next step [13]. 

Stages of Development

There are five stages of melanoma cancer development: Stage 0-Stage IV. While there are many different systems in order to place the melanoma into a stage, the TNM system is identified as the most commonly used [14]. It takes into account the tumor thickness and skin coverage, if lymph nodes near the tumor have acquired the cancer, and if the cancer has spread. The following provides descriptions of the stages of Melanoma Cancer: Stage 0 is when the melanoma is only in the top layer of the skin (epidermis), Stage I is when the cancer is no more than two millimeters thick and hasn’t spread to any lymph nodes, Stage II is a bit similar, however, the size of the cancer has grown and may have grown to four millimeters thick, Stage III is where the melanoma has not yet spread to other parts of the body (this stage is divided into three substages of increasingly mature cancer), and Stage IV is when the cancer has spread to other lymph nodes or organs in the body [14]. In its early stages, melanoma cancer can be successfully treated with just surgery, but once the cancer reaches metastasis (when the cancer spreads to other parts of the body), success rates of treatment drops significantly. The most common methods of melanoma treatment are surgical removal of the tumor or biopsy, which is the removal of a certain part of the tumor or lymph node [15]. For metastatic skin disease, chemotherapy (drug therapy) is used after surgery to limit the spreading of the cancer. A recent breakthrough in the treatment of melanoma cancer used after later stages of detection is immune checkpoint inhibitors, these are a form of immunotherapy that results in T-cells being able to kill cancerous cells. While it has not been fully applicable for all patients, these inhibitors have revolutionized metastatic melanoma treatment [15].

Impact of Ethnicity

The most common and at-risk patients of melanoma cancer are caucasian people, what is surprising, however, is that minority patients suffer a higher fatality rate; an effect of increase in racial disparity in regards to melanoma cancer treatment [16]. This is greatly associated with a lack of immunotherapy and proper information regarding treatment. Racial and ethnic minorities tend to receive diagnosis at later stages of the cancer, contributing to the low success of treatment. A result of biologic, socioeconomic, and cultural factors, minorities may not have equal access to specific treatments [16]. Eliminating this apparent gap between treatments of melanoma cancer and different races is vital to the advancement of successful treatment and early detection for all. 

Global Scenario

            While melanoma is prevalent throughout the world, specific regions including Australia, New Zealand, and Western Europe have consistently shown higher incidence rates compared to the rest of the world [17]. This is the result of the copious amount of light-skinned populations present in these regions, and how low melanin is a common cause of the cancer. Concurringly, the regions with the lowest incidence rates include Africa and Asia [17]. Populations with high melanin tend to express melanoma on rare, less sun-exposed areas of the body; populations with low melanin, however, tend to express the disease on common sites [2]. Melanoma cancer continues to be one of the most preventable yet common disease and the global burden of melanoma is only predicted to rise from 2020 to 2040 [17]. This emphasizes the importance of awareness and prevention of melanoma cancer.

Conclusion

While melanoma cancer can be a difficult disease to combat, there exists a wide variety of treatment and prevention options available for the cancer that can dramatically increase the chance of overcoming it. Paying close attention to any changes on the surface of the body, through use of the “ABCDEF” rule, and notifying your doctor if any abnormalities are found, including moles or blemishes, is a vital step in prevention procedures [11] . While gender, ethnicity, and some risk factors do have an impact on the likelihood of attaining the disease, there are many factors, such as maintaining a healthy lifestyle, regular use of SPF-15, and limiting exposure to tanning beds, that are in our control [9].

References

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