Melanoma

Melanoma: Understanding the Most Serious Form of Skin Cancer

Melanoma is a serious type of skin cancer that originates in the pigment-producing cells known as melanocytes. Melanoma earns its reputation as the most serious form of skin cancer because it has the potential to spread to other parts of the body if not detected and treated early. Recognising the signs and symptoms of melanoma, understanding its various types, and exploring treatment options are crucial for effective management and improved outcomes.

Symptoms and Signs of Melanoma:

Melanoma often presents as an abnormal mole or lesion on the skin, characterised by the following features, which conveniently form the acronym ABCDE:

Asymmetry: One half of the mole or lesion does not match the other half in size, shape, or colour.

Border Irregularity: The edges of the mole are uneven, scalloped, or notched, rather than smooth and well-defined.

Colour: The mole exhibits multiple colours or shades, such as light brown, dark brown, black, blue, red, or white.

Diameter: The diameter of the mole is larger than the size of a pencil eraser (6 millimetres) or appears to be increasing in size.

Evolution: The mole undergoes changes in size, shape, colour, or elevation, or develops symptoms such as itching, tenderness, or bleeding.

Types of Melanoma:

Melanoma can manifest in various forms, each with distinct characteristics and behaviours:

Melanoma In situ: Melanoma in situ, also known as stage 0 melanoma, confines itself to the outermost layer of the skin (epidermis) and does not invade deeper tissues. It is highly curable with early detection and rarely requires extensive treatment beyond surgical excision.

Superficial Spreading Melanoma: This is the most common type of melanoma, characterised by horizontal growth along the surface of the skin before penetrating deeper layers. It typically appears as an irregularly shaped, multicoloured lesion with asymmetrical borders.

Nodular Melanoma: Rapid vertical growth characterises nodular melanoma into the deeper layers of the skin. Typically, it manifests as a raised, dome-shaped nodule that can either have a consistent colour or display areas of ulceration or bleeding.

Lentigo Maligna Melanoma: Lentigo maligna melanoma typically arises in sun-damaged skin, such as the face or neck, and develops from a pre-existing lentigo maligna lesion. It appears as a flat, tan or brown patch with irregular borders and may develop into a more invasive form.

Acral Lentiginous Melanoma: Acral lentiginous melanoma is a subtype that occurs on the palms of the hands, soles of the feet, or beneath the nails. It often presents as a dark-coloured lesion with irregular borders and may be mistaken for other non-cancerous skin conditions.

Invasive Melanoma: Invasive melanoma refers to melanoma that has penetrated beyond the epidermis into the deeper layers of the skin or spread to nearby lymph nodes or other organs. It poses a higher risk of metastasis and requires prompt intervention to prevent disease progression.

Treatment Options for Melanoma:

Treatment for melanoma depends on factors such as the stage of the disease, tumour characteristics, and the individual’s overall health. Common treatment modalities include:

Surgical Excision: Surgical removal of the melanoma along with a margin of healthy tissue is often the initial treatment for localised melanoma. The amount of normal skin ranges from 5mm to 20mm. 

Lymph Node Biopsy: Sentinel lymph node biopsy may be performed to assess whether melanoma has spread to nearby lymph nodes, guiding further treatment decisions. This is usually reserved for lesions with a depth of over 1mm. Interestingly, the guidelines for this differ from state to state and between public and private systems. 

Immunotherapy: Immunotherapy drugs such as checkpoint inhibitors (e.g., pembrolizumab, nivolumab) or targeted therapy (e.g., BRAF inhibitors) may be prescribed to boost the immune system’s ability to recognise and destroy cancer cells.

Targeted Therapy: Targeted therapy drugs, which inhibit specific molecular pathways involved in melanoma growth, may be recommended for individuals with certain genetic mutations, such as BRAF mutations.

Radiation Therapy: Radiation therapy may be used as adjuvant therapy following surgery to eliminate residual cancer cells or as a palliative treatment for advanced melanoma that cannot be surgically removed.

Prognosis and Outlook for Melanoma:

The prognosis for melanoma depends on factors such as the stage of the disease, tumour thickness, presence of ulceration, and lymph node involvement. Early detection and treatment significantly improve the chances of survival and reduce the risk of disease recurrence or metastasis.

Recurrence Risk: Individuals with melanoma have a risk of disease recurrence, particularly if the tumour is thick, has ulceration, or has spread to nearby lymph nodes. Regular follow-up appointments and surveillance are essential for monitoring for signs of recurrence and detecting new melanomas early.

Metastasis Likelihood: Melanoma has the potential to metastasize to other organs, such as the lungs, liver, brain, or bones, particularly in advanced stages of the disease. Metastatic melanoma is associated with a poorer prognosis and may require systemic treatment approaches, such as chemotherapy, targeted therapy, or immunotherapy.

Long-Term Prognosis: With timely intervention and treatment, most individuals diagnosed with melanoma can achieve favourable long-term outcomes. Adherence to sun protection measures, regular skin self-examinations, and ongoing surveillance are crucial for minimizing the risk of disease recurrence and promoting overall skin health.

In conclusion, melanoma is a serious form of skin cancer that requires early detection, prompt treatment, and vigilant surveillance for optimal outcomes. By recognizing the signs and symptoms, understanding melanoma subtypes, exploring treatment options, and adopting preventive measures, individuals can reduce their risk of developing melanoma and improve their chances of survival and long-term skin health. Regular consultation with a dermatologist or skin cancer specialist such as Dr Barney Gordon is essential for personalised evaluation, treatment planning, and ongoing management of melanoma.