Melanoma Diagnosis & Treatment

Malignant melanoma is one of the fastest growing cancers in the United States. It is also one of the most aggressive. The rate of survival when detected early is excellent. When melanoma is advanced it is not only difficult to treat but the treatments used are not very effective. Being aware of your body and watching for early signs of trouble is by far the best prevention for this insidious disease.

Characteristics

• Malignant melanoma is a cancer that begins in the epidermis so unlike tumors hidden away in the body we have the ability to see it. Melanoma is detected by changes in a mole, some are obvious and some are very subtle. Moles are made up of melanin that comes from a group of cells that cause the dark pigment color we see in moles. Melanin also is responsible for freckles and the darkening of the skin from ultraviolet rays. Anyone having a high number of moles on their body or sunburns easily runs a higher risk of developing melanoma. A mole is suspicious when there are sudden changes such as redness, irregular shape, ulceration, rapid growth or itching. New moles that appear later in life are usually watched closer.

Staging Methods

• When a suspicious mole is found it is removed and sent to the pathologist. If cancer cells are found, the mole is measured and examined for staging. Although there are several staging methods, the five-step system is the simplest. These stages determine how advanced the cancer is likely to be. The earliest and easiest to treat is stage 0, which means it is in the upper layer of the skin and has not yet spread. Stage I means the mole is thicker than 1.0 mm but still within the skin layer. Stage II is smaller than 2 centimeters and deeper but thought to still be isolated to the skin. Stage III is when the cancer is found in a lymph node, muscle or bone but still within the same area. In Stage IV the cancer has spread beyond the localized area and calls for aggressive systemic treatment.

Determining Treatment

• After the pathologist determines the mole is malignant, a second surgery is performed to remove surrounding tissue for testing. The width and depth of the tissue depends on how thick or advanced the mole is. When it is beyond 1.0 mm the lymph nodes are examined and may be biopsied since this is usually the second place melanoma is found. Any suspicious nodes will be removed and tested. Once the cancer has reached more than one node the cancer cells are more likely to be in the bloodstream. The circulating cancer cells can then metastasize anywhere in the body so must be attacked aggressively.

Treatments

• When all possible surgical treatments have been exhausted a systemic approach is needed to attack circulating cells. It is important to note that there are no perfect treatments for advanced melanoma. There are different forms of chemotherapy being used to help irradicate remaining cancer cells. Immunotherapy is another method being applied in order to boost the body's own defenses to fight the cancer. Radiation is used in late stage melanoma as a last ditch effort but the results are not promising. There is currently a vaccine being tested that could boost the body's immune system to target melanoma cells. It is not known why melanoma cells are less likely to respond to conventional treatments than other forms of cancer. Some patients have responded to treatment but the results are random so there is not one proven method to use against melanoma.

Misconceptions

• One myth that needs dispelling is that this cancer is only skin deep and cannot kill. No one is completely immune and everyone should perform self examinations for unusual moles. The best diagnostic tool to date is catching melanoma early, and many times it is the patient who first sees the changes. Getting the mole removed at the first possible sign of trouble yields a 99 percent success rate.