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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.


Skin Cancer Pill

The choice of treatment for basal cell carcinoma includes surgical removal of the affected area by excision, cryosurgery or radiation therapy. The contemporary method of treatment introduced is through the administration of skin cancer pills called as Erivedge approved by United States food and drug administration society. Erivedge pills are designed to treat advanced levels of basal cell carcinoma. This drug was designed to prevent surgical or radiation associated intervention in sensitive areas such as the nose regions of the face where the carcinoma predominantly occurs.

Erivedge

Erivedge the revolutionary pill for the treatment of advanced basal carcinoma is chemically known as vismodegib. This oral medicine is associated with the prevention of overactive signaling of the Hedgehog pathway by binding to a trans membrane protein occurring in basal cell carcinoma. The continuum of the Hedgehog pathway may result in the metastases of the carcinoma.

Vismodegib (erivedge) is highly permeable and has low aqueous solubility. The plasma protein binding in patients is very high. It binds to albumin and alpha- 1acid glycoprotein. The metabolic pathways associated are oxidation, glucouronidation and also pyridine ring cleavage. The excretion of the drug predominantly happens through the hepatic route. The absorption and retention of the drug occurs in feces and urine.

Dosage and administration

The recommended dosage of erivedge is 150mg taken orally once a day. The duration of medication has to continue until the complete prophylaxis of the disease. Discontinuation of erivedge is only advisable under the incidence of drug toxicity. Additional doses of erivedge are not recommended in case of missing a dose; the next dose has to be resumed. Erivedge intake does not depend upon food intake.


Contraindications and adverse effects

Erivedge is considered as teratogenic, embryo toxic and fetotoxic drug and hence it is not recommended for pregnant women. If administered, the effects include severe birth defects such as craniofacial anomalies, absent or fused digits and also open perineum. Erivedge is also not advisable for nursing mothers as it may be excreted in the milk.

Erivedge consuming patients are advised not to donate blood for a period of seven months. Many adverse effects were reported in the clinical trials conducted on erivedge some of which are muscle spasms, arthralgia, fatigue, diarrhea, weight loss, alopecia, constipation and also decreased appetite. Erivedge intervenes with other drugs such as clarithromycin etc. in leading to adverse reactions. Erivedge usage is not recommended in children as it intervenes in the epiphyseal growth plate affecting the bones; causing damage to the teeth by necrosis, cysts in the dental pulp and also ossification of the root canal.

Geriatric use of erivedge is also not recommended. The other conditions under which the use of erivedge is not recommended is in patients having hepatic and renal impairments.


Plastic Surgeon

A surgeon, who can correct deformity, scars and disfigurement caused by accidents, birth defects and treat diseases like skin cancer (melanoma), is called a plastic surgeon. A plastic surgeon also performs surgeries purely based on cosmetic purposes, e.g. rhinoplasty. The first plastic surgeon of the U.S. was Dr. John Peter Mettauer who performed his first surgery of cleft palate in the year 1827. Plastic surgeons perform various levels of surgeries on human body to beautify and restructure it. The main surgeries performed by plastic surgeons:


Reconstructive surgeries: The most common surgeries in the reconstructive section are breast reconstruction, palate surgery, cleft lip, surgery for patients suffering from burns called contracture surgery. Another technique called microsurgery is performed where tissue is transferred from one place to another where tissue is damaged and needs replacement.


Cosmetic surgery: The most famous and common surgery in the area of plastic surgery is cosmetic surgery and is performed purely from beautification point of view. Cosmetic surgery also known as aesthetic surgery is done just to enhance the beauty of any part and may possibly be a reconstructive surgery. The surgery improves the beauty or looks of any part of the body and is usually referred with the name of that particular part of the body. For e.g. Abdominoplasty (tummy tuck - reconstruction of the abdomen), Blepharoplasty (eyelid surgery) - application of permanent eyeliner or reshaping the eyelids.


Cosmesis: Another common procedure called as cosmesis is a blend of reconstructive plastic surgery and cosmetic plastic surgery. In the process of reconstructive surgery, cosmetic surgery techniques are utilized thus improving cosmesis.


In addition to these branches of plastic surgery, there are also surgeries such as craniofacial surgery - mainly dealing with pediatric deformities, maxillofacial surgery - improvement of the jaw and the face.


The risk of handing over your beauty lies with the plastic surgeon. Ensure your surgeon is


  • Certified by a board, e.g. American Board of Plastic surgery.
  • The surgeon is rightly qualified, cross check his qualifications with the right body. He should have completed medical school and then specialized for five years in the field of general surgery and then plastic surgery. After this should have cleared oral and written examinations held by the board.
  • Has the right infrastructure and facilities to handle surgeries. They should be well-equipped with the latest gadgets and facilities thereby making the procedure easy.
  • Has enough experience in the field of plastic surgery.

Latest trends in plastic surgery


  • Use of lasers and fiber optic telescopes to in the field has led to better results and satisfying customers. The outcome of the surgery is more enduring than earlier times.
  • This method has made plastic surgery more economical and trouble-free as a result reduced side effects.
  • An endoscopic method for facelifts and forehead corrections.
  • Modern techniques mean smaller incisions and practically no scars left behind after the surgery.
  • Also modern sedation techniques like the intravenous sedation save a lot of trouble and risk for the patients.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 11, 2019