Melanoma

Melanoma is a type of skin cancer that develops from abnormal moles, or the pigment skin present in the skin. Because of its nature to spread to other parts of the skin, melanoma is more serious that other forms of skin cancer. It can cause serious illness and death. Derived from Greek origin 'melas' which means 'dark', melanocytes are cells that produce dark pigment called melanin which is responsible for the color of the skin. Melanoma is a most common form of cancer and the risk can increase with age. However, melanoma affects people of all ages, races, and genders and ethnicity.

Signs and symptoms

As melanoma occurs in the skin and it can be seen, patients themselves are the first to detect many melanomas. If caught early, melanomas can be cured by relatively minor surgery. However, early diagnosis and detection are crucial as it may otherwise invade healthy tissues and spread to other parts of the body making it out of control. The ABCD of melanoma can be described as:

Asymmetry: that is the shape of one half does not match with the other half.
Border: the edges are blurred, irregular.
Color is uneven and includes shades of black, brown and tan.
Diameter: there is a change in size as it increases.

Causes of Melanoma

Researchers opine that a gene known as BRAF plays a lead role in causing melanoma. As BRAF is a switch gene, it allows other cells to divide and grow. Mutations in this gene can cause explosive growth and the resultant melanoma skin cancer.

• Sunburns, especially slow daily sun exposure, even without burning.
  
• White ancestry (Caucasian)
  
• Fair skin, light hair and light colored eyes
  
• Intense exposure to sun especially during childhood
  
• Many moles in the body, to the tune of more than hundred
  
• Large irregular funny looking moles
  
• History of close relatives especially parents, siblings or children with melanoma- presence of close family melanoma is a high risk factor; although only 10% of cases run in families.
  

Melanoma can occur on any skin surface – it is common on the area between a man's shoulders and hips. For women, melanoma generally develops on the lower legs. People with darker skin develop melanoma on their palms and soles as well as under toe and fingernails.

Diagnosis of melanoma

Get the dermatologist to examine your body fully and find out whether the moles are odd. The medical term for such moles is 'atypical'. The dermatologist will perform a skin biopsy to evaluate if the mole is cancerous or not. The doctor will remove all or part of the skin under local anesthesia and send the specimen to a pathologist for analysis. The biopsy report will reveal:

• A totally benign condition that requires no further treatment, as in the case of a regular mole.
  
• An atypical mole which depends on the judgment of the pathologist to treat – either conservative removal by taking off a bit of the normal skin all around to make sure that the spot is completely out or
  
• A melanoma requiring surgery
  
• Some doctors may perform epiluminescence or dermatoscopy.
  

Melanoma treatment

Once melanoma is diagnosed as cancer and staged, then the doctor will discuss the treatment options with the patient. Treatment is based on the stage of cancer and other related factors. In case of normal moles, which are small brown spots or growths of skin that appear in the first few decades of life in almost everyone, no treatment is necessary.

People with classic atypical mole syndrome have more than 100 moles, with many moles over 8 mm diameter and one or more moles are atypical. Treatment options include Surgery, chemotherapy, and immunotherapy and radiation therapy. Sometime a combination of treatment is used. In general melanoma is treated by surgery alone. But surgery need not be extensive, as was some years ago. During early stages of melanoma, surgeons will remove only a centimeter or even less of normal tissue around the melanoma. Whereas, deeper and more advanced cancers would require extensive surgery. The removal of nearby lymph glands depend upon factors that include tumor thickness, body location, age etc. If the stage is pretty advanced, immunotherapy treatments are adopted.

Prevent melanoma

Reduce sun exposure. Perhaps avoidance of sun exposure is the best means to prevent melanoma. Wear hats and tightly woven clothing and apply sunscreens liberally when going out. Although there is a controversy among dermatologists about sunscreen protecting against melanoma, it is certainly preferred to unprotected sun exposure.

Early detection is the key to prevention. Get your skin checked at least once every few years. In the US, the American Academy of Dermatology sponsors free skin cancer screening clinics every year all over the country. Special pigmented lesion clinics have also been established in many medical centers to allow close clinical and photographic follow ups of patient with high risk. But a reference from a concerned dermatologist is essential to undergo the screening.

Any person with high risk and having a close relative who has/had melanoma should be screened by a doctor for cancer of the skin. As with any other cancer, early diagnosis and proper evaluation and treatment is the essence.

Lentigo Maligna

Melanoma, a type of skin cancer is categorized into four types, three are 'in situ' and the fourth type is invasive. In situ is a very early stage of melanoma and does not invade enough to be considered invasive. Lentigo Maligna is 'in situ'. The cancer cells are in the top layer of the skin (epidermis) and are contained in the area in which the cells started to develop. If left untreated, 'in situ' lentigo maligna can become invasive.

• Lentigo maligna is more common in males.
  
• Working outdoors (exposure to UV rays) increases risk.
  
• Early childhood exposure to sunburn blisters increases chance of developing at later stage of life.
  
• Family history increases chance of developing lentigo maligna.
  
• Begins as a patch.
  
• Occurs around hair follicles on the sun-damaged skin of the head and neck or even face.
  
• Grows very slowly over many years.
  
• Diagnosed usually during middle age and the elderly.

Lentigo Maligna - ABCD rule

Initially, it appears as a mole in the sun exposed areas. Over time, it grows into an odd-looking, multi-colored structure that doesn't go away. The ABCD rule is useful to recognize lentigo maligna. Considering these as lentigo maligna symptoms, without any delay, it is best to seek medical attention.

A: Stands for asymmetry. The mole can be anywhere on the skin which is not symmetric in shape.

B: Stands for border. The border of the mole is ragged, notched, and irregular.

C: Stands for color. The mole is multi-colored, a mixture of brown, black, red, blue or white in varying shades and patterns.

D: Stands for diameter. The size of the mole is more than 6mm.

Lentigo maligna diagnosis

Post a visual examination of the affected areas, a skin biopsy is recommended by the doctor. A biopsy is required for diagnosis. The biopsy involves removing the growth and a small part of the surrounding skin to analyze it under a microscope. Confirming lentigo maligna diagnosis, the doctor determines the best course of treatment.

Lentigo maligna treatment

Early detection and medical attention restrains the lesions or mole from spreading across the skin's surface. If left untreated, it can spread deeper into the skin and can eventually pass to other parts of the body.

Slow Mohs is a preferred surgical technique for completely removing the melanoma. Along with it, about 5mm margin of normal tissue is also excised. Radiation or cryosurgery is resorted to when the lesion is difficult to access and excise. Under local anaesthesia, surgery is performed. Healthy tissues around the area are also removed as a precautionary step leaving no cancerous cells. If the mole or lesion is in an area where spare skin is not available, like the face or lower leg, skin graft to remove the lesions may be required. A plastic surgeon would remove skin and replace it from another area. A follow-up visit may or may not be required.

Lentigo maligna self care tips

Lentigo maligna is not hereditary but it is more likely to develop when a close relative has suffered a melanoma. Self care tips can prevent getting another lentigo maligna.

• Monthly self examination of the whole body applying ABCD lentigo maligna rule.
  
• Protect your skin from too much exposure to the sun. Use sun-care tips like sun protection cream, wearing a hat, cotton clothes, avoiding sun bathing, sunburn and tanning etc.
  
• Avoid sun beds and tanning lamps.
  
• Avoiding direct sunlight exposure can be substituted to an extent with Vitamin D supplements.
  
• Inform family members particularly the youngsters keeping in mind the genetic influence.

Benign nevi

Also known as a mole, nevi is a benign growth that could appear like hyperpigmentation of the skin, colored macules, plaques or papules. Nevi are mostly congenital. They are confined to a particular area of the skin. They are also commonly referred to as birthmarks or beauty marks. Benign nevi typically means that the specific pigmented skin portion has not shown any signs of abnormality that is typical of skin cancer.

How do nevi occur?

Development of nevi is influenced by age of the person, environmental factors like sun exposure, race and genetic factors. It can develop in any part of the body though it can be predominant in sun-exposed areas like arms, face or neck when compared to intermittently exposed areas like chest, back or legs. Though most nevi are benign, 25% of malignant melanoma arise from pre-existing nevi.

For males, nevi are concentrated on the face and neck while for females nevi are concentrated on thighs and upper arms. Dark skinned individuals have a low count of total body nevus when compared to light skinned individuals. However dark skinned individuals develop nevi on the palms and soles. Nevi count in males is higher than in females. Nevi count in children depends on the nevi count in their parents. Commonly acquired nevi follow the ABCDE rule:

Nevi can be classified into different types as listed below

Connective tissue nevus: This type is very rare to occur; they are fleshy deep nodules.

Epidermal nevus: They are present at birth (congenital), and appear on the upper torso of the body. They resemble the color of flesh and appear raised or like a wart.

Nevus sebaceous: A variant of epidermal nevus, it appears on the scalp. The affected scalp area becomes hairless and looks yellowish in color. Melanocytic nevus: Benign production of melanocytes i.e. the skin cells make the brown pigment melanin. Therefore most of the nevi are brown to black in color. They are the common type of nevi and are present in almost all adults. They could be congenital or may develop at a later stage in life. Different types under melanocytic nevus are:

Acquired melanocytic nevus: Acquired at a later stage in life; will not be present in birth or near birth period.

Congenital nevus: Present from birth or near birth.

Dysplastic nevus: Acquired type of melanocytic nevus and difficult to differentiate from melanoma. It could be an indicator for the risk of developing melanoma.

Nevi are grouped based on their location. The different categories are:

Compound: They are hyper pigmented macules located in the epidermis and dermis.

Junctional: They are hyper pigmented macules located in the epidermis.

Intradermal: They are brown/skin colored papules located in the dermis layer.

Diagnosis and treatment of nevi

Diagnosis of nevi is generally done through visual examination; a dermatoscope may also be used. While diagnosing nevi, the main concern lies in identifying a benign nevus from a dysplastic nevus and melanoma. If physical examination doesn't suffice, a skin biopsy may help in identification.

Treatment for benign nevi

In general, benign nevi need not be treated. However a few may want it to be treated for cosmetic reasons. You can opt for laser treatment with a qualified skin specialist.

Protecting skin with nevi

• Wear a sunscreen that is waterproof with a SPF that suits your skin type and climatic conditions.
  
  
• Use a sunscreen with UVA and UVB protection.
  
  
• Minimize outdoor exposure under direct sunlight.
  
  
• Wear a hat to shade your face
  
  
• Wear sun glasses
  
  
• Wear protective clothing.