A B C D E F G H I J K L M N O P R S T U V W

MELANOMA

What is a Melanoma ?

Melanoma is a malignant (cancerous) growth of the pigment cells of the skin. The malignant change may occur either in a pre-existing mole or in previously normal skin. Any mole may develop cancerous changes and it is therefore important to examine your moles regularly. Changes which need to be reported to your doctor include: · change in the size of the mole, either in diameter (i.e. outward growth) or in lumpiness (i.e. upward growth); · change in the colour of the mole (moles tend to be uniform in their individual colour, although different moles on the body can be different shades of brown or black, any patchy loss or increase in colour are worrying); · change in surface shape of the mole (most moles are round or oval irregularity of the shape of the mole is a worrying change); · itching, bleeding or ulceration of the mole. Always remember to look at the soles of the feet, palms of the hands, and the genital area for moles. Some melanomas may develop under the nails, giving rise to a band of pigment in the nail or a painful spot on the nail. The sudden appearance of a pigmented brown or black lump on the skin should be reported to the doctor. Melanomas are less common in dark skin. In Afro-Carribean populations, the commonest form of melanoma is one affecting the fingers and toes, particularly around the fingernails or toenails. Melanomas can affect any age group and any part of the body. They are commonest in the 40 to 60 age range. They are aggressive tumours and have the ability to spread to other organs of the body.

How does a Melanoma occur ?

The major cause of melanoma is sun exposure. This accounts for the high rate of melanoma in white populations who live near the equator (such as in Australia), compared to similar populations living in cooler climates. There seems to be a link between severe sunburn in childhood and the development of melanoma in later life. The site of the melanoma is not related directly to the sun-exposed skin and may occur even on covered sites. In melanomas occurring around the fingers and under the nails, injury to those places is thought to be a possible cause.

Why does a Melanoma occur ?

Melanoma is generally much more common in pale populations. This is because pigment in the skin is important in protecting against malignant skin change due to sun exposure. Although sun exposure is the main cause of melanoma, there is an inherited condition in which affected members of the family develop unusual moles. These have a high rate of malignant change. In some children who are born with large, hairy moles, there is also a high risk of malignant change.

Treatment Involved for a Melanoma

Melanoma can be cured as long as it is diagnosed early enough. If you notice any change in the appearance of an existing mole or sudden appearance of a pigmented spot, you should immediately tell your doctor. People may develop new moles up to the mid-40s and new moles are not of themselves a worrying event. If it is "suspicious" it will be surgically removed, together with a surrounding cuff of normal skin. This is then sent for microscopic examination. If the diagnosis of melanoma is confirmed, the doctor will assess how deeply the melanoma has penetrated into the skin. If penetration is deep, the doctor may recommend that further surgery is performed. You may then require a skin graft which will usually be taken from the thigh or buttock. A slightly tender area will be left which will then heal, to leave a small scar. In the initial examination the doctor will also examine to feel for any enlarged lymph glands (glands that fight infection). These may be removed, requiring a general anaesthetic and a short stay in hospital. Following removal of the melanoma, regular review by a specialist is needed to identify any recurrence or spread of the tumour. If the melanoma has spread, treatment with radiotherapy or chemotherapy may reduce the size of the tumour at the new sites. In patients in whom the melanoma has spread, the outlook is generally not good. It can become fatal.

After Treatment for a Melanoma

The rate of recurrence and spread of melanoma depends on the depth to which the tumour has penetrated. Recurrences may occur at the site of removal, or in the surrounding skin. Spread to lymph glands may produce swellings in the neck, armpits, or groins, depending on the site of the initial growth. Any dark spots that develop either at or near the site of removal of the melanoma or any lumps noted in the neck, armpits or groins should be immediately reported to the doctor.

If a Melanoma is Left Untreated

Melanoma is an aggressive malignant tumour which, once it penetrates deeply to the skin, spreads to involve the lymph glands and other organs of the body. Once spread has occurred, the outlook for life is poor.

Effects on Family of a Melanoma

If you have a melanoma, then brothers and sisters should be screened for the presence of abnormal moles, which may be part of the "familial melanoma syndrome" . Patients with melanoma need considerable support, particularly if the diagnosis is not made until a late stage.