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Levels of Malignant Melanoma

Melanoma, according to the American Cancer Society, is the fifth most common cancer. Unfortunately, both the incidence and the mortality rate of this disease are increasing. As of 2008, an individual in the United States has a 1 in 65 lifetime risk of being diagnosed with melanoma. It is more common in Whites than in African-Americans.

  1. Definition

    • Melanoma is a cancer of the melanocytes, which are cells that produce pigment. Many different factors (including unknown ones), including genetic factors, are involved in a melanocyte's evolution into a melanoma.

    Evaluation

    • When a skin lesion is found, like a mole that has changed, the ABCDE criteria can be helpful in examining it, although a physician will do a more thorough exam and testing.

      A---asymmetry: one part of the lesion is not identical to the other
      B---border irregularity: the border is not clear, it has ragged or blurry edges
      C---color: pigmentation is usually a mixture of tan, brown, or black. Any red, white, or blue coloration is concerning
      D---diameter: an increase in size or a lesion larger than 6 mm is concerning
      E---evolving: changes in a lesion over time

    Types

    • The are four subtypes of melanoma. The difference between the subtypes does not influence prognosis by itself.

      Superficial spreading melanoma (SSM) comprises about 70 percent of melanoma diagnoses, making it the most common subtype of melanoma. In men, it is often found on the trunk, in women, on their legs. On presentation, it is usually a flat or raised lesion with an undefined border.

      Nodular melanoma (NM) is the next most common subtype, making up 15 to 30 percent of melanomas. It appears most on the legs and trunk as a black lesion. It tends to be fast-growing, and does not always follow the ABCDEs of melanoma, so they may not be diagnosed initially.

      Lentigo maligna melanoma (LMM) is representative of 5 to 15 percent of melanomas. It has a precancerous lesion, lentigo maligna (LM), and is often found on elderly patients, usually on sun-exposed areas like the neck and upper extremities. The evolution from LM to LMM is found by changes in color and formation.

      Acral lentiginous melanoma (ALM) makes up 5 to 10 percent of melanomas. It is often found on a patient's palms, soles of the feet, and around the nail beds. In those with darker skin, it is the most common type of melanoma found.

    Metastatic Melanoma

    • Metastatic melanoma occurs when the cancer has spread to other sites in the body. The most common sites of spread for melanoma include regional and distant lymph nodes, lung, liver and brain. The median survival time for metastatic melanoma is 9 months.

    Treatment

    • For non-metastatic melanoma, surgical excision and early diagnosis are usually curative for early stage melanomas. For advanced disease, Interferon can be given. Chemotherapy has not been proven to have any benefit to these patients.

    Famous Ties

    • Senator John McCain, former President Ronald Reagan, talk show host Regis Philbin and reggae singer Bob Marley have all had melanoma.

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