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Melanoma

© David Olle

How important is melanoma?

The number of cases of melanoma is increasing faster than any other cancer so that currently, a person living in the U.S. will have a one in 75 lifetime risk of developing the disease. Worldwide, the incidence of melanoma has increased 5% a year. May was National Melanoma-Skin Cancer Detection and Prevention Month, and as it comes just before the summer season, calls attention to the fact that the primary cause of melanoma is exposure to sunlight, in particular ultraviolet radiation.

What is melanoma?

Melanomas are malignant transformations of cells called melanocytes, which are located in the epidermis or upper layer of the skin. Melanocytes are rather unusual in that they arrive in the skin by migration from the brain and adrenal gland tissue during fetal development. They perform the specialized function of converting the amino acid tyrosine into melanin when exposed to sunlight. This pigment darkens the skin, resulting in a tan that protects the skin. There are three main types of skin cancer: basal cell cancer, squamous cell cancer and melanoma. Of the three, melanoma is by far the least common, but causes the most cancer deaths.

The importance of early detection

Melanoma can be one of the easiest or one of the most difficult of cancers to cure. Fortunately, since melanomas originate in the outer layer of skin, detection can be easy, providing the patient and physician follow the guidelines regarding monitoring any changes in appearances in moles or sores on the skin. 3

The importance of early detection is reflected in the staging system developed by the American Joint Commission on Cancer. The first two stages (extent of the cancer) depend on the thickness of the tumor while it is still confined to the skin. Stage 3 is defined as cancer that has spread to the lymph nodes, while Stage 4 refers to spread to the internal organs. Stage 4 is grave indeed, since the aggressiveness of melanoma can lead to death within months.

Surgery, the most effective treatment

Surgery remains the most effective means of curing cases of melanoma, particularly when the cancer is still confined to the skin (Stages 1 and 2). Recently, a study has shown that the thickness of the tumor when it is removed has a greater bearing on the possibility of recurrence of the cancer than the amount of healthy tissue removed around the tumor. The lymph nodes are always examined in patients, since the lymph nodes are the first site for spread of melanoma. If only a small number of nodes are affected, surgical excision alone can cure 25-50% of the patients. Surgery is no longer effective for Stage 4 patients.

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