Melanoma
- Lungs –70 to 85%
- Other skin areas – 55 to 75%
- Lymph nodes – 60 to 75%
- Liver – 56 to 78%
- Brain – 35 to 55%
- Abdominal organs – 25 to 59%
- Bones – 25 to 47%
Prognosis, survival rates and melanoma recurrence
5 year survival rate is commonly used for melanoma prognosis. It estimates the number of people out of 100 who will survive for the next 5 years after diagnosis. Estimates do not provide actual prediction of what will happen. Your doctor will be in a better position to provide more accurate information.- Stage 0 – over 95%
- Stage 1 – around 91%
- Stage 2 – 52% to 83%
- Stage 3 – 40% to 80%
- Stage 4 – 15% to 20%
Causes and symptoms of spitzoid melanoma
Causes UV radiation is thought to be the main cause of Spitzoid melanoma. Fair skinned people and those with blue or green eyes are more prone to the disease. Other risk factors may include weakened immune system, family history of melanomas and a condition which makes cells unable to recover from sun damage. [RELATED] Symptoms Most Spitz nevi do not develop into melanoma. This is especially if they grew before adulthood. The problem is that the ABCDEs cannot effectively be used to identify early warning signs. In early stages, a Spitzoid melanoma is regularly shaped and appears as a normal nevus. Slowly, signs of lost symmetry set in. Some tumors may have the normal brown, black or blue coloration. If the malignancy has started in an amelanotic lesion, the tumor will be skin-colored, red or pink. With time, more cells will be produced. This will in turn make the original nevus larger. Ulceration may also occur, after which crusting will occur. Spitzoid melanomas are usually very firm. Neck and head areas, especially the face, are the mostly affected areas. Signs may also show up in the limbs or any other part of the skin. For example, an amelanotic nodular lesion can develop on the skin surrounding the nail plate. See acral lentiginous melanoma pictures for illustrations.Spitzoid melanoma in children
Spitzoid melanoma in children is rare. But since cutaneous melanoma is also particularly rare in children, the disease has a high incidence rate in children.
Misdiagnosing Spitzoid melanoma can be of fatal consequences. The problem is that even doctors have trouble differentiating a Spitzoid melanoma from a Spitz nevus.
One way an early Spitzoid melanoma can be identified is by looking for recent changes in an amelanotic lesion. Sometimes, there will be signs of ulceration, but mostly loss of symmetry and emerging irregularities at borders.
Spitzoid melanomas often appear singly. Though firmly attached to the skin, they tend to bleed easily upon touch. It is best that medical attention be sought once such signs show up in children. A doctor will take a biopsy and examine it under a microscope.
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An effective prevention approach is to get a Spitz nevus or amelanotic nodular lesion removed even without metastatic melanoma symptoms. You find that malignancy may not develop in the early ages but accumulative sun exposure may trigger it later in life.
Spitzoid melanoma in adults
Spitzoid melanoma in adults can be mistaken for the following:- Hemangioma – a hemangioma appears as red or purple patch of skin discoloration. It mostly appears in infants but can also occur in adults. The condition is harmless and painless. Resulting lumps don’t keep growing in size.
- Mole – moles are usually dark brown in color. They result from clustered melanocytes which are not malignant. Most moles do not enlarge beyond 5mm.
- Spitz nevus – this is a rare type of mole. It can grow as large as 2cm although some are much smaller. Spitz nevi that develop in adulthood are more likely to be malignant.
- Basal cell carcinoma – this is another type of skin cancer. It more treatable and less aggressive compared to melanoma. Common signs include ulceration and continued tumor enlargement.
- Pyogenic granuloma – this is a benign but possibly discomforting condition caused by abnormal growth of blood capillaries. It commonly occurs in areas that have recently sustained injury or trauma such as from an infection.
Spitzoid melanoma in adults diagnosis
A doctor will first rule out other possible conditions such as hemangioma. To confirm diagnosis, biopsy of skin will be taken.- Punch biopsy – here, a circular blade is used to extract a round tissue from the suspicious tumor. This is done under a local anesthetic. Large tumors are best candidates for this type of biopsy. It is therefore common in spitzoid melanoma diagnosis.
- Excisional biopsy – this involves cutting out the entire tumor and some surrounding tissue. These are then taken to the lab for examination under a microscope.
- Incisional biopsy – a small tissue from the part of the tumor showing most signs of malignancy is extracted. More than one biopsy may need to be taken for better results.
- Sentinel lymph node biopsy – this is only necessary when a tumor has been confirmed to be a melanoma. A dye will be injected in place where the melanoma was removed. A biopsy of the lymph node the dye will first reach is then taken. This tests checks for signs of malignancy in local lymph nodes.
Treatment for spitzoid melanoma
Spitzoid melanoma treatment depends on several factors, mostly how far it has spread. See how fast does melanoma grow for more details on melanoma metastasis.- Stage 1 – excision surgery is primarily used to remove melanoma in this stage. The tumor will be removed, after which a wide excision will also be performed. A wide excision usually sees 5mm thick tissue removed from all the surrounding areas. This is to avoid melanoma recurrence.
- Stage 2 – since tumors in this stage have reached the dermis and probably the subcutaneous layer, surgery will be done to remove the tumor, the subcutaneous tissue beneath and a bit of surrounding tissue.
- Stage 3 – at this stage, local lymph nodes have been invaded. Early in the stage, only about 1-3 nodes are involved. These are removed with surgery. The tumor plus some surrounding tissue and subcutaneous tissue beneath are also removed. Additional treatments such as radiotherapy and chemotherapy are also commonly used.
- Stage 4 – tumors at this stage are most advanced. Before it comes to this, many noticeable signs such as gradual size enlargement and ulceration in primary tumor will have occurred. Stage 4 tumors require several treatment approaches. First, tumors that can be surgically removed are cut out. Radiotherapy is used to stop spread and growth in metastasized tumors. Chemotherapy is also used for the same purpose. Since most stage 4 melanomas are hard to completely get rid of, other treatments such as targeted therapy and immunotherapy will be used to suppress tumors and in the process prolong life. Some cases such as melanoma in the brain are far harder to treat with surgery and drugs.
Red melanoma
Red melanoma is of the amelanotic melanoma type. It occurs when affected melanocytes fail to produce melanin. About 70% of amelanotic melanomas are red in color and account for about 4% of all melanomas. Melanomas of this type are often misdiagnosed or caught in later stages. Since the ABCDEs may not be very effective in identifying melanomas of this form, the 3 Rs can be used instead. [RELATED] The 3 Rs stand for red, recent changes and raised. Red describes the common coloration that is present in melanoma tumors of this from. Ulcerated melanomas may also appear red. Recent changes describe any change in the physical state of the tumor. Such changes may include shape, size, texture and coloration. Raised describes the tendency of malignant moles to be dome-shaped or elevated. Red melanoma may also be a nodular melanoma. This is an aggressive type with very poor prognosis. Its main characteristic is the appearance of a red lesion that rapidly gains mass. It is very important that a mole, lesion or spot displaying suspicious signs of malignancy be checked by a doctor. A biopsy will be needed to confirm diagnosis and rule out other conditions such as eczema and basal cell carcinoma. After diagnosis, treatment can begin immediately.Internal melanoma
Internal melanoma is often of the mucosal melanoma type. It can also be a complication of advanced cutaneous melanoma.
Mucosal melanoma is rare. It develops on mucosal body surfaces and cavities. Commonly affected body parts include the oral cavity, nasal passages, anus and vagina.
Mucosal membranes contain small numbers of melanocytes. This means that melanoma can develop in these membranes too. The exact reason as to why the disease develops in these areas is still not known.
Internal melanoma can be hard to catch in its early stages. Signs and symptoms depend on the affected region. They may include:
- Oral cavity – white spot inside mouth, dentures falling out of place, presence of a lump
- Nasal passages – nasal blocks, lump inside nose, blood in mucus
- Vagina – vaginal discharge, pain during/after sex, bleeding, presence of a lump
- Anus – bleeding, presence of a lump, changes in bowel habits
- Lungs – difficulty breathing, chronic cough, blood in cough
- Liver – reduced liver function, loss of weight, vomiting, nausea, lump in upper abdomen
- Brain – seizures, headaches, numbness in extremities
- Bones – frequent fractures, loss of bone density, pain in bones
- Lymph nodes – swelling of lymph nodes
White melanoma
White melanoma is very rare. It can be caused by mucosal melanoma in the oral cavity. Melanoma in the mouth mostly shows up in the gums and inside cheeks. Ill-fitting dentures are thought to be a major risk factor.
Most melanomas in the mouth appear as spots rather than tumors. For this reason it may be hard to spot them. A common characteristic that may help with identification is the tendency to ulcerate. If you notice a sore that doesn’t heal in the mouth, it is best that it gets checked by a doctor.
White melanoma can also be a result of a differently colored melanoma. It is common for melanomas to have more than one color. Black and brown are usually the primary colors. Secondary colors may include blue, orange, pink, grey and white.
Brown and Black melanoma
Most cutaneous melanomas are brown or black. As more melanocytes accumulate on affected skin areas, more pigment is present hence the brown or black appearance. The ABCDEs can be used to identify early signs of malignancy in black melanoma. The following types can pose as black melanoma: Superficial spreading melanoma It accounts for most cases of melanomas. This type is most common in middle aged adults. It tends to spread across the skin before becoming invasive. In most cases, it will start with an elevated growth with no regular borders.
Lentigo melanoma
Accumulative sun exposure is the main cause of this melanoma. For this reason, it appears in later years of life. In most cases, it will start as a flat spot or slightly raised growth that is black or brown in color. The symptoms will show up in areas that are usually exposed to the sun.
Acral lentiginous melanoma
This type affects hands and feet. Most cases of this melanoma are reported in colored people. It for this reason is not associated with UV radiation. Black or brown spots or patches of skin discoloration are usually the first signs. Most people tend to ignore such signs, mistaking them for blood blisters or skin lesions. The main unique feature is that blood blisters and other blemishes usually fade away and disappear before long.
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A subtype of this melanoma that develops under nails is known as subungual melanoma. It mostly occurs in the big toe and thumb although any nail can be affected. A vertical streak that runs from the cuticle to the tip of the nail is the main early sign. With time, discoloration will spread to the nail bed. On subungual melanoma pictures, the streak may appear on the nail matrix or in the nail bed. Melanoma under toenail sometimes requires that part of the affected toe be amputated.
Pink melanoma
Pink melanoma is another variation of amelanotic melanoma. It is very hard to detect and thus has poor prognosis. The variation accounts for about 5% of all melanomas.
The same trick mentioned as potentially helpful in identifying red melanoma can also help in this case. First, be on the lookout for changes in a spot, lesion or skin growth that has recently showed up. From there, start looking for signs of malignancy such as elevation, ulceration and itchiness.
Stage 2 melanoma is the last of the safest melanoma stages. Once tumors are past this stage, they reach lymphatic vessels and blood vessels. It will be only a matter of time before several malignant cells break free and spread. The good thing is that most melanomas will have exhibited a number of noticeable signs before advancing beyond this stage.
Note that some melanomas can take a while before exhibiting noticeable melanoma signs. It is therefore very important to closely monitor lesions or spots that weren’t there until recently.
Small melanoma
Small melanoma may also be what is commonly referred to in situ melanoma. In simple terms, these are tumors that are confined to the epidermis. The epidermis is the upper layer of the skin. Melanocytes are contained in this layer. Tumors confined to the epidermis are the easiest to treat. The only way to know if a melanoma is small or not is by going for medical diagnosis. Melanomas are measured in thickness. Breslow thickness and Clark level are commonly used to describe the thickness of a melanoma.- Breslow thickness – it describes the measurement of a melanoma from the granular layer to the bottommost part of the tumor. The measurement is given in mm. Small melanomas or stage 0 tumors are less than 1mm in thickness. Large ones are larger than 6mm.
- Clark level – this method uses 5 levels to describe the anatomical invasion of a tumor. Small tumors are yet to leave the epidermis while large ones have reached the subcutaneous layer.
Melanoma spots
While most melanomas form lesions, moles or start in existing moles, some begin as spots on skin. Such can be particularly dangerous. A good example is the melanoma that develops in feet and hands. But whether a melanoma begins as a spot or a growth, it will keep spreading across the skin or gaining mass in a short timeline. [post_title] => Different Forms of Melanoma: Red, Small, Black, Internal, White, Pink, Spots [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => different-forms-of-melanoma-red-small-black-internal-white-pink-spots [to_ping] => [pinged] => [post_modified] => 2018-05-05 21:55:58 [post_modified_gmt] => 2018-05-05 21:55:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://skinanswer.com/?p=4340 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 5260 [post_author] => 1 [post_date] => 2018-03-14 09:20:05 [post_date_gmt] => 2018-03-14 09:20:05 [post_content] => The term melanoma translates to "black tumor." It is one of the three types of cancer that begins in skin cells. Of the three types, melanoma is rarest but most dangerous. Specifically, the disease begins in cells located in the bottom layer of the epidermis. These cells are known as melanocytes and are responsible for making melanin. More melanocytes in one place result in spots or skin growths with more pigment, hence the term black tumor or melanoma. Some forms of melanoma, however, lack pigment and appear as pink, red or skin colored.Melanoma facts
Causes It is not known exactly what causes the disease. But like other cancers, changes in DNA are largely responsible. Risk factors may include:- Having blue or green eyes
- Being fair skinned
- Weakened immunity
- History of sunburns
- Atypical nevi syndrome
- Family history of the disease
- Using tanning beds
Melanoma can develop in anyone. People with a history of sunburns especially during early ages are particularly at risk.
About 75% of all melanomas begin in normal skin. The rest arise on existing moles. It is for this reason that a lot of emphasis is put on using the ABCDEs for physical examination at home.
UV radiation has been identified to be the most common risk factor. It is in fact identified as one of the possible choroidal melanoma causes. While sun is the greatest source of UV radiation, artificial devices such as tanning beds also emit this radiation. It is estimated that 15 minutes of tanning bed use is equivalent to a whole day of sunbathing.
Prognosis
Prognosis is best when melanoma is still confined to the epidermis. Survival rate is more than 90% then. This drops to 50% and below 20% for stage 3 and stage 4 respectively. See "What is metastatic melanoma?" to understand how the disease goes from one stage to another.
Melanoma statistics
While most skin cancer cases are not caused by melanoma, most deaths are. This is very worrying, considering that cancer of the skin is the most common.
Of all skin cancer cases, melanoma is only responsible for about 4%. Interestingly, the 4% results in 80% of all skin cancer-related deaths.
Children rarely develop melanoma. UV radiation exposure during childhood years makes it more likely that the disease will show up some time after adolescence.
In the last century, melanoma has become very commonly diagnosed. It is estimated to have an increase rate of about 2000%. This is higher than all the other types of cancer put together.
More cases are being reported in young people, between ages of 15 and 30 years. Melanoma is set to become the second or most common form of cancer in this age group.
In men the disease mostly shows up in the neck and head areas as well as the trunk. Melanoma on the back accounts for about 30% of all cases in men while the head and neck areas account for about 60%. It is below age 50 that men are most likely to develop melanoma. Between 15 and 40 years, twice as many men as women will succumb to the disease.
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In women, the disease mostly shows up on the legs. It is the leading cause of cancer-related deaths in women between ages of 25 and 30. Above 30 years of age, melanoma is second to breast cancer in terms of cancer-related diagnoses.
Fair skinned people are more likely to develop the disease. They also are more likely to catch the disease in its earliest stages.
African Americans have more melanin on their skins. This protects them from UV radiation. The problem is that black people are more likely to be diagnosed with advanced melanoma. It is made worse by the misguided belief that black people don’t develop melanoma.
Melanoma biopsy
Doctors rely on a number of tests to confirm melanoma diagnosis. Melanoma biopsy is the most accurate. There are three types of biopsies that may be taken:- Punch biopsy – here, a round skin tissue from a mole with signs of malignancy is removed. The tissue is taken to the lab and examined under a microscope.
- Excisional biopsy – this is the most commonly used type. The entire mole and some surrounding tissue are cut out.
- Incisional biopsy – the part of the mole showing most signs of malignancy is removed and taken to the lab for investigation.
Melanoma surgery
Melanoma surgery is usually the primary treatment method. First, imaging tests will be taken to show the thickness and location of the tumor. The doctor will then draw an excision margin. The tumor along some surrounding tissue and the underneath cutaneous tissue will be removed.
For melanoma in situ, wide excision will be necessary to ensure that all malignant tissues have been removed. 5mm melanoma in situ margins are traditionally used for wide excision. Large tumors may require margins as large as 2cm. Skin grafting may be considered for cases such as melanoma on face or finger.
Surgery may also be done to completely remove entire tissues or organs. A good example is removal of lymph nodes after stage 2.
Melanoma immunotherapy
In simple terms, melanoma immunotherapy is use of substances, mainly medicines, to boost a patient’s immune system so that it can recognize and kill cancer cells. It is one of the most recent melanoma treatment options to be introduced. In most cases, this option is used to shrink tumors and stop their spread rather than completely removing them. Immunotherapy is of the following types:
Checkpoint proteins inhibitors
Immune cells recognize healthy cells by presence of proteins known as checkpoint proteins. Since melanoma cells are almost normal, they usually have many of these proteins and therefore cannot be attacked. Substances that inhibit these proteins make cancer cells more recognizable to immune cells.
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PD-1 inhibitors
PD-1 is a protein that helps immune cells recognize normal cells. Once the protein is inhibited, immune cells can attack the apparently normal melanoma cells.
CTLA-4 inhibitor
CTLA-4 is yet another protein. It works by controlling the activities of immune cells known as T-cells. Once the protein is blocked, T-cells work much actively than they normally would have.
Cytokines
These are proteins used to generally boost the immune system. Boosting means production of more immune cells.
Imiquimod cream
As the name suggests, this drug comes in the form of a cream. It works by stimulating immune cells in a local area of the body.
BCG vaccine
Vaccines are mild forms of disease-causing organisms. Once administered, they stimulate the immune system to fight against any invading germs or abnormal cells such as melanoma cells.
Oncolytic virus therapy
Viruses are only active once inside host cells. The problem is that they usually destroy the host cells some time after invasion. Some viruses are altered in the laboratory and used to destroy cancer cells in the same way.
Melanoma histology
Melanoma histology is very important especially when dealing with amelanotic melanoma, where tumors lack the normal brown or dark pigmentation. Melanomas are usually found to be without symmetry, lacking in regular architectural design, with random concentrations of melanocytes and exhibiting signs of normal cell maturation and division. [RELATED] Nodular melanoma, which is the most invasive form, is seen to have large cells or epithelioid cells. For clinical purposes, Breslow’s thickness is used to describe how thick the tumor is. It is the measure of a tumor from the granular layer to its deepest tip. Clark level can also be used to describe the anatomical invasion level of a tumor in simpler terms. It tells whether a tumor has reached the dermis and the subcutaneous layer. See how fast does melanoma spread for more details. [post_title] => Melanoma Statistics, Facts, Biopsy, Immunotherapy, History, Surgery [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => melanoma-statistics-facts-biopsy-immunotherapy-histology-surgery [to_ping] => [pinged] => [post_modified] => 2018-05-05 21:47:28 [post_modified_gmt] => 2018-05-05 21:47:28 [post_content_filtered] => [post_parent] => 0 [guid] => https://skinanswer.com/?p=4338 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 5259 [post_author] => 1 [post_date] => 2018-03-14 09:19:51 [post_date_gmt] => 2018-03-14 09:19:51 [post_content] => Melanoma in situ is a very commonly used phrase when discussing melanoma. "In situ" translates to "in place." Basically, the phrase is used to describe melanoma skin cancer that has not left the epidermis. There are 3 different types of skin cancer. The deadliest but rarest of them is known as melanoma. This type develops in melanocytes, the cells that make melanin, the substance that gives color to the skin. Melanocytes are located in the bottom-most layer of the upper skin layer. Without treatment, cancer cells have a tendency of spreading to the lymphatic system and later to other body parts. Melanoma tumors begin in the skin then penetrate into the dermis and later reach lymphatic and blood vessels. It is through the vessels that malignant cells travel to other body parts. Melanomas that have spread are most dangerous, not only in terms of treatment but also in terms of tracing them with imaging tests.What causes melanoma in situ?
Almost any melanoma definition will include facts such as that the disease originates in melanocytes and has something to do with sun exposure. Melanoma is thought to be more common in middle-aged people, especially women. The disease mostly shows up in areas such as the neck, face, legs, arms and scalp. It can also occur in mucosal membranes and in the eyes. [RELATED] Apart from melanoma that develops on the hands and feet, other types appear to be encouraged by prolonged exposure to UV radiation. People who have histories of sunburns especially in their childhood years are at a higher risk. Other risk factors include having many moles, family history of the disease, being fair skinned, having blue or green eyes, and a weakened immune system.Melanoma in situ margin and symptoms
Since melanoma in situ is confined to the epidermis, most signs that may occur will be noticeable on the skin. The ABCDEs can be used to identify suspicious early signs.- Asymmetry – melanomas are usually asymmetrical. This means that a line to divide the tumor or spot into identical halves cannot be drawn.
- Borders – borders are also referred to as edges. These are points at which discoloration ends. In normal moles, the borders are regular and well defined. The opposite is true for melanomas.
- Colors – when melanocytes clump together, they form benign tumors known as moles. Many melanocytes in one place result in dark or brown coloration. While this coloration is also likely to be present in melanomas, other colors such as blue, pink or orange may also be present. Sometimes, some areas of the mole will be more heavily pigmented than others.
- Diameter – melanoma in situ may be even less than 1mm in diameter. However, its thickness will keep increasing indefinitely. Some melanoma in situ tumors are as large as a pencil eraser.
- Evolution – evolution describes frequent changes that keep occurring in melanomas. The changes can be in terms of color, texture, size and shape. See what does melanoma skin cancer look like for more details. As it happens, there are some types of melanoma where affected cells don’t make melanin. This results in pink, red or skin-colored tumors which can easily be taken for normal skin growths.
Melanoma in situ margins rarely depend on the patient’s gender, location of the tumor or its thickness. Basically, margins refer to the thickness of tissue that will require surgical excision. This includes the tumor itself. Surrounding tissues are usually removed sometime after tumor removal to avoid recurrence.
Melanoma in situ margins often range from 5mm to 15mm. 6mm margins have a success rate of about 85% while 9mm margins have a success rate of more than 95%. Large margins of up to 15mm have a success rate of near or equal to 100%.
Lentigo maligna melanoma usually requires wider excision margins than other types. This is because the type tends to spread across the skin before becoming invasive. People who suffer from severe sunburns or with skins prone to sun poisoning are particularly at risk of developing melanoma of lentigo maligna type. Most cases occur after the 50th birthday.
9mm excision margins are now preferred to 5mm margins. This is mostly to reduce the rate of recurrence. Your doctor will, however, make the final decision depending on diagnostic reports.
Melanoma in situ treatment
Melanoma treatment guidelines are usually developed by a team of professionals depending on a couple of factors. Melanoma in situ treatment is usually done with surgery. Pictures and images from imaging tests will assist the doctor to make an excision margin around the tumor. After that, the tumor will be cut out. Healthy skin surrounding the excision margin and the subcutaneous tissue underneath the tumor will also be removed. This ensures that no melanoma cells have been left behind. [RELATED] Normally, doctors follow-up the surgery with a wide excision. This involves removal of 5mm surrounding tissue in all directions. The procedure is aimed at ensuring that recurrent melanomas are avoided. Large tumors may require larger wide excisions. There are times that wide excision may depend on the location of the tumor. This is for example when dealing with uveal melanoma symptoms. Uveal melanoma begins in the uvea tract. This is the back part of eye which contains most of the blood vessels that nourish the eye.Melanoma in situ recurrence
Melanoma in situ recurrence is most likely in the first 2 years after the disease has been diagnosed. About 3% to 6% of in situ melanomas often recur after excision surgery. Recurring melanomas respond effectively to extensive surgery.
Melanoma can be in situ, locally invasive or distantly invasive. In situ tumors only affect the upper part of the skin. They have not even reached the subcutaneous layer of the skin. Local invasive tumors migrate to nearby lymph nodes that contain melanocytes. This occurs when several malignant cells break free from the original tumor, enter lymphatic vessels and get emptied into local lymph nodes. Distant invasive melanomas migrate to organs such as the lungs, liver, brain, abdominal organs and bones. The spread is facilitated by blood vessels. Distant invasive tumors have the highest recurrence rate, followed by in situ tumors. The margin between recurrence rates is not wide however.
Recurrence occurs at the same site that a primary tumor was removed. Signs will still involve skin discoloration or presence of an abnormal mole. Patients are advised to report recurring cases as soon as possible. This is partly following the fact that statistics show cases of melanomas being on the rise, especially in younger people.
Learning more on how to identify early metastatic melanoma symptoms may help. Once malignancy has spread from a local tumor, it becomes much harder to trace and treat.
Melanoma in situ prognosis
Melanoma in situ prognosis is considered the best. This is mostly because melanoma prognosis largely depends on the stage the disease is in. In situ tumors are in stage 0. In fact, some staging systems often combine stage 0 with stage 1. This is common in acral lentiginous melanoma prognosis.
For clinical purposes, prognosis is given in terms of survival rate. 5 year and 10 year survival rates are commonly used for melanoma prognosis. 5 year survival rate, for example, indicates the probability that a patient will survive for the next 5 years after diagnosis.
For in situ melanoma, survival rates are higher than 95%. The remaining 5% allows for the possibility of recurrence and missed spreading. Most doctors find it necessary to carry out tests such as sentinel lymph node biopsy. This test checks for signs of malignant cells in local lymph nodes. It is very important especially if the local tumor is ulcerated or when treating pink melanoma.
Prevention and outlook
It has been observed that cases of melanoma in situ in 20-30 year old age group are on the rise. Most have something to do with over-exposure to sunlight and use of devices such as tanning beds which emit UV radiation. Prevention against this disease can be done by avoiding direct sunlight and other sources of UV radiation. [RELATED] Measures such as applying sunscreen (SPF 15 or higher), wearing hats and seeking shade might help. Another very effective prevention measure is going for routine skin checkups. In fact, melanomas of the scalp and back are often caught accidentally. Check with your doctor in the advent of an abnormal mole, spot and patch on skin or streak under nails. It is important to remember that melanoma also begins in parts of the skin rarely exposed to sunlight. Vaginal melanoma is a good example. If you are to notice early warning signs even in such areas, check with your doctor immediately. Melanoma in situ is confined to melanocytes located in the upper layer of the skin. As a result, it can be easily removed with wide excision. While some types of melanoma first spread across the skin before becoming invasive, other types such as nodular melanoma spread very quickly. This means that it may be only a matter of weeks or months before an in situ melanoma enters its most dangerous stages. [post_title] => Melanoma in Situ: Prognosis, Recurrence, Margins, Treatments [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => melanoma-in-situ-prognosis-recurrence-margins-treatments [to_ping] => [pinged] => [post_modified] => 2018-05-05 21:39:07 [post_modified_gmt] => 2018-05-05 21:39:07 [post_content_filtered] => [post_parent] => 0 [guid] => https://skinanswer.com/?p=4336 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 4119 [post_author] => 1 [post_date] => 2018-03-13 07:10:52 [post_date_gmt] => 2018-03-13 07:10:52 [post_content] => Most people think of skin cancer when melanoma is mentioned, and it is no wonder with the phrase melanoma skin cancer. Well, it is a type of skin cancer, the rarest but most deadly. The disease gets its name from the fact that it develops in melanocytes. These are cells located in the bottom layer of the epidermis. The cells make melanin. Melanin is the substance that makes the skin, eyes and hair look the way they do. Without melanin, the skin would be uncolored. Cancer develops in a very peculiar manner. There are no disease causing organisms such as viruses or bacteria involved. The disease develops when normal cells get out of control in regards to controlled cell division and cell death. This means that affected cells will still be able to carry out cellular functions, such as the production of melanin in the case of melanoma. This is why most melanomas are dark or brown. Sometimes, affected melanocytes may not be able to make melanin. This results in amelanotic melanoma (AM). The disease is often misdiagnosed or caught late due to this characteristic. Amelanotic melanoma pictures may help.Causes and symptoms of amelanotic melanoma
Of all melanomas, about 7% are amelanotic in nature. Most cases are reported in individuals with a history of sun poisoning. You may have heard of the ABCDE rule. It is commonly used to identify suspicious signs in moles. The problem is that AMs are a bit harder to identify with the rule. Below are ways that may help identify early signs of the disease: [RELATED] Pigmentation If melanin is absent, it means that the resulting spots or bumps will take the color of the skin, be pink and sometimes red. This can be seen in most amelanotic melanoma pictures. Red melanoma may however indicate nodular melanoma, a very aggressive and dangerous type.
Gradual changes
Regardless of the type of cancer or melanoma, cells will keep dividing rapidly. This means that changes will be occurring from time to time. Common changes include enlargement of the tumor and loss of symmetry.
Dome-shaped
Normal moles are oval or round in shape. Melanomas tend to be elevated and dome-shaped. This is with the exception of melanoma on hand or the sole of the foot. Melanoma on finger will also not be elevated if it occurs on the side.
Note that any type of melanoma can develop into the amelanotic type. For example, acral lentiginous melanoma pictures may show a pinkish broken nail or a red lesion on the skin near nail plate. This means that the melanoma is of both acral lentiginous and amelanotic types.
Amelanotic melanoma diagnosis
Doctors usually require details on the symptoms of a suspicious lesion and the patient’s medical history. The details will be very important in confirming diagnosis. You find that AM doesn’t only mimic normal skin growths but also other types of skin cancers.
Dermoscopy is usually performed as part of diagnosis. The doctor will evaluate the consistency of pigmentation. This is only possible if the lesions are pigmented in the first place. Outline of blood vessels in the lesion will also be evaluated. Malignant tumors usually develop their own rich network of blood vessels for nourishment.
After dermoscopy, excision melanoma biopsy will be taken. This is very important in amelanotic melanoma cytology. The problem of lacking pigmentation still persists even with biopsies. But when examined under powerful microscopes, some pigment residuals can be identified in AM tumors. Presence of pigment confirms the cells to be melanocytes.
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Late diagnosis is the chief problematic issue affecting amelanotic melanomas. Even on easily seen body parts such as the arms or legs, the disease may still go unnoticed. It is for this reason that doctors urge people to get any changing, red or elevated lesions checked. This also goes for lumps and spots in body regions that may not allow for physical examination. Topics such as what does vulvar melanoma look like, mucosal melanoma symptoms and eye melanoma can be of some help in this regard.
Amelanotic melanoma staging
Staging is done with the help of a report from diagnosis tests. A number of systems can be used for staging: 4 stage system This is the most common staging system for melanomas.- Stage 0 – it indicates that tumors are still confined to melanomas in the epidermis. Cells with the ability to divide quickly are still in small numbers. Survival rate is best at this stage. Unfortunately, most AMs are caught after this stage.
- Stage 1 – typical signs of melanomas such as incremental growth in size and thickness has set in. Some tumors may be ulcerated but most are not. In this stage, tumors are less that 2mm in thickness.
- Stage 2 – rapid division of cells has pushed tumors into the dermis. This increases both the level of penetration and thickness of the tumor. Signs of enlargement are more pronounced.
- Stage 3 – tumors have reached far enough into the skin to reach lymphatic vessels. Once several malignant cells break free from the primary tumor into the vessels, it is emptied in local lymph nodes. Nodes that contain melanocytes become invaded. Signs may include ulceration and swelling of lymph nodes.
- Stage 4 – malignancy has spread to organs much further from the primary tumor.
- T – It describes the location and thickness of the tumor. The information determines how the tumor will be removed.
- N – It stands for nodes and describes how much lymph nodes have been involved. In the best case scenario, only 1-3 lymph nodes will have been affected. These are removed with surgery. Advanced stage 3 involves more than 4 local or distant lymph nodes.
- M – It stands for metastasis and explains the involvement of distant organs such as lungs, liver and brain.
Amelanotic melanoma treatment
Amelanotic melanoma treatment doesn’t much differ from that of other types of melanoma. It mostly depends on the stage the tumor is in. Stage 1 Since tumors in this stage are wholly in the epidermis, an excision surgery will effectively get rid of the same. Tests may be performed to ensure that malignancy has not spread to lymph nodes. Stage 2 Surgery is still the primary treatment of choice. With the help of images from imaging tests, an excision margin will first be set before the tumor is cut out. Some surrounding tissue will also be cut out. Radiotherapy and chemotherapy may also be used to completely kill AM cells. Tests are very important to check for malignancy in local lymph nodes. Stage 3
Surgery is done to both remove the primary tumor and remove lymph nodes that have been affected. After the surgery, chemotherapy and radiotherapy are often given. Drugs that block checkpoint proteins may also be administered to prevent recurrence. Checkpoint proteins are substances that keep cancer cells from being attacked by immune cells. Sometimes, substances that increase production of immune cells may also be given.
Stage 4
At stage 4, amelanotic melanoma will have to be fought on several fronts. Surgery may be done to remove the primary tumor and other accessible ones. If necessary, entire organs will be removed.
Many patients require radiotherapy as a means of improving quality of life. This is especially in regards to reducing pain caused by spreading tumors. Radiotherapy can be done eternally or have radioactive substances injected directly.
Chemotherapy is also a common treatment option for stage 4 AMs. It involves use of drugs to shrink tumors or destroy them.
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Other options include targeted therapy and immunotherapy. Targeted therapy uses drugs to inhibit some molecular functions of amelanotic melanoma cells. Drugs that break down the tumors may also be used. As for immunotherapy, the body’s natural defense mechanism is boosted. This increases its ability to recognize and destroy cancer cells. The common way of achieving this is by inhibiting checkpoint proteins or stimulating more production of immune cells.
Prevention
UV radiation is thought to trigger most of the changes that ultimately lead to melanoma. It is therefore thought that avoiding both natural and artificial sources of the radiation may help prevent melanoma.
Regardless, some melanomas seem to have come out of nowhere. The only way to prevent such is by getting medical screening as soon as first warning signs occur. As you may already know, the survival rate for early stage melanoma is very high.
[post_title] => Amelanotic Melanoma Cytology, Treatments, Diagnosis, Pictures
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[post_content] => When cancer develops in the lungs, it is known as lung cancer. When it develops on melanocytes, it is referred to as melanoma. Melanocytes are certain cells that make the skin, eyes and hair look like they do. They produce a substance known as melanin, which basically is skin pigment.
There are several types of melanoma. The types are discussed in this article. See pictures of melanoma for illustrations.
What is melanoma; definition, types and statistics
Definition Melanoma is a cancer that develops on the skin, in the melanocytes to be specific. Other than melanoma, there are two other types of skin cancers. Melanoma is of the three most aggressive, deadliest but rarest. Although only about 15% of all skin cancers are caused by melanoma, it accounts for about 65% of all deaths due to skin cancer. Types of melanoma For clinical purposes, four types of the disease are described: Superficial spreading melanoma Mostly appears as a spot or blemish on skin which tends to spread across the skin before penetrating into the dermis. [RELATED] Nodular melanoma The type gets its name from its tendency to form red nodules. The nodules spread into deeper skin layers very rapidly. This type is considered the most invasive. Acral lentiginous melanoma This type occurs on soles of feet and palms. It is characterized by a flat discolored spot or patch. The patch may linger for a long while before spreading. Lentigo maligna melanoma This is the most common type in older people but perhaps the rarest of all types. It begins on the skin in the form of a discolored slow-growing patch or mole. Other subtypes may include:- Malignant melanoma – here, melanoma cells often break free from a primary tumor, enter blood or lymphatic vessels, migrate and invade other organs. This type can also be referred to as metastatic melanoma.
- Ocular melanoma – this type develops in the eyes, mostly in the uvea. A common subtype is choroidal melanoma which develops in the choroid.
- Subungual melanoma – develops in the nail matrix, nail plate or skin areas surrounding the nail matrix.
What causes melanoma?
Like other cancers, melanoma develops when certain changes occur in DNA, in melanocytes in this case. The changes results in fast cell division and lack of cell death. Functionless cells then accumulate to form a lump. It is not clear what causes melanoma. Risk factors include: UV radiation Sun is the largest source of UV rays. People with a history of sunburns and related conditions are more prone to developing melanoma. Some artificial devices such as tanning beds also emit UV radiation. Age It is quite rare to find melanoma in children, especially in the head and neck areas. More cases are reported in people above 60 years of age. Regardless, the disease can affect anyone.
Genetic predisposition
Australia is one of the countries in which many cases of melanoma are reported. This attributed to the country’s hot climate and the fact that people there are fair skinned. Additionally, there is about 10% higher risk of developing the disease if you have a close relative diagnosed with the same.
Fair skin and blue eyes
Melanin protects the skin from UV poisoning. Fair skinned people have less melanin and therefore at higher risk of developing melanoma. This is also true for people with blue eyes.
Atypical nevi syndrome
Although atypical moles are benign, some tend to develop into melanoma.
Melanoma signs and symptoms
Most melanomas appear on skin and resemble moles or skin blemishes. The ABCDEs are popularly used to identify what may be early melanoma signs. Asymmetry (A) A line of symmetry divides something into two equal halves. This is possible in normal moles. Malignant ones are often irregular in shape, such that no symmetry can be obtained. Borders (B) Moles are usually round or oval in shape. The shape is marked by clearly defined edges. For malignant ones, they can take any irregular shape. The borders do not follow any consistency. [RELATED] Colors (C) Dark-brown or red is the usual color of moles and most normal skin blemishes. When some blue, orange, green or white (for oral blemishes) occurs, it is a possible indication of malignancy. Diameter (D) Some people have moles as large as a pencil eraser. More than 20 of them can develop, mostly before adulthood. Any mole that gets bigger than 5 mm or gradually spreads across the skin should be checked. Evolution (E) Changes in physical features of a mole or spot on skin are not good indications. Rarely will major changes occur in how a normal mole measures, looks like, feels like or is shaped like. Such changes are common indications of malignancy. Other signs and symptoms that often indicate melanoma include:- Itchiness
- Bleeding or ulceration
- Inflammation or dome-shaped
- Crusting
Melanoma diagnosis and treatment
Diagnosis Quite a number of tests are available to check for melanoma cells. They include:
Physical examination
A doctor checks for signs of malignancy using the ABCDEs. For ocular melanoma, a magnifying lens or a bright light will be used for better view.
Biopsy
Biopsy is the most accurate test with which to confirm melanoma diagnosis. Here, a small tissue is extracted from the affected organ and checked for melanoma cells under a microscope. Most doctors prefer excisional biopsy for more accuracy.
Imaging tests
Imaging tests such as MRIs and CT scans produce images and pictures of the organ on which a melanoma tumor has developed. This helps set melanoma stage and also identify the extent to which the tumor may have spread.
Other tests such as angiogram and sentinel node biopsy depend on the type or stage of melanoma in question. Doctors usually discuss them with patients.
Treatment
Most cancers require a combination of treatments to completely get rid of. Small in situ melanomas can be easily removed by cutting the tumors out. Once malignancy has spread to lymph nodes and distant organs, major challenges in locating and treating them arise. Below are the available treatment options:
Surgery
This is usually the primary treatment of choice. In most cases, surgical excision is used. Here, an excisional margin which depends on the thickness of the tumor is first made with help of imaging tests. An excision is then made, through which the tumor is cut out. It is a very effective melanoma in situ treatment. After the operation, radiation doses may be administered to ensure complete removal of malignant cells.
Surgery can also involve amputation or complete removal of an organ or tissue. For example, ocular melanoma treatment may involve removing the entire eye.
Radiotherapy
During radiotherapy, X-rays are focused on malignant tumors. The high-powered rays work by damaging the DNA structure of melanoma cells. Once DNA of a cell is damaged, the cell cannot function properly and mostly ends up dying. Radiotherapy is commonly used to shrink tumors and stop them from spreading rather than for completely removing them.
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Chemotherapy
Drugs used in chemotherapy work by destroying cells with a characteristic of rapid cell division. Most cancer cells divide very rapidly. The main problem associated with this treatment is that it also ends up destroying some healthy cells too. Once tumors have been treated with chemo drugs, they sometimes develop resistance to the drugs.
Targeted therapy
To address the issue of drugs also destroying healthy cells, targeted therapy was developed. In this case, drugs are used to target specific functions of cancer cells. This interferes with the way the cells bind to specific enzymes, inhibiting their normal functions in the process. It is a very powerful form of treatment which works even for tumors too small to be mapped by imaging tests.
Immunotherapy
The immune system is able to identify and destroy abnormal cells in the body. One way this is achieved is by triggering a process that sees cells ‘commit suicide’ when something goes wrong in their DNA. Conditions or diseases that weaken the immune system make it hard for the body to protect itself from cancer cells’ invasion. To address this issue, immunotherapy has been developed. Here, drugs are used to boost the immune system’s ability to fight melanoma cells. Introduction of immunotherapy is one of the reasons why survival rate for melanoma has risen in the recent past.
Melanoma staging, survival rate and prognosis
Prognosis Melanoma prognosis is very dependent of its stage and several other factors. Generally, it is best for melanoma tumors that have not migrated from primary locations. Factors that determine prognosis include: Location of tumor Melanoma in lungs or brain for example has poor prognosis than melanoma on leg. For one thing, it will be challenging to access the tumor for surgical excision. Apart from that, it is not always guaranteed that the tumor will not be in a delicate location which may not allow for a surgical operation or use of radiation. Thickness of the tumor The much a tumor is determines how big the excision margin will be. Thicker tumors call for bigger margins. Unless the tumor is in body parts such as the leg which can allow for big excisional margins, it will be very hard to remove the same. Large tumors are common choroidal melanoma prognosis complications. Health status Drugs used in chemotherapy, targeted therapy and immunotherapy produce a number of side effects. Not every patient’s health status will be in a position to handle such side effects. Moreover, some people respond very well to such drugs while others show a form of intolerance. Age Most melanomas occur after the age of 50. It is common for aged people to not respond well or be able to tolerate some drugs. Staging Generally, melanomas are grouped in 4 stages:- Stage 1 – this represents tumors still in their primary location. Most are small and have just started showing early signs of malignancy.
- Stage 2 – here, tumors have penetrated below the epidermis and entered the dermis. Ulceration may be present, which makes tumors in this stage quite dangerous.
- Stage 3 – melanoma cells have by this time broken free from the original tumor, entered lymphatic vessels and invaded local lymph nodes. Early signs of swelling in lymph nodes closest to the tumor may be present.
- Stage 4 – this is the final and most dangerous stage. It represents tumors that have migrated and invaded distant organs. For example, stage 4 melanoma on scalp may invade the brain while choroidal melanoma will often spread to liver.
Early melanoma warning signs
A sign is something that can be seen by another person. For example, a lump on the skin is a sign, while pain is a symptom. Early melanoma warning signs often appear on the skin in form of an abnormal mole, spot or blemish. So how does a normal mole look like? [RELATED] Most people have moles. Small spots or patches of discoloration may also occur throughout the skin. Moles usually are brown or black in color. They have defined borders which mostly result in oval or round shape. Most of them are smaller than a pencil eraser and will be present by the age of 20. Normally, moles don’t undergo regular or noticeable changes. Some do, however, disappear after several years.
All moles are classified as benign skin tumors. However, melanomas have a tendency of mimicking these harmless growths or originating in them. This makes it very important to keep an eye on your moles and any regions of discoloration on the skin.
Melanoma is a result of melanocytes that have gone out of control in terms or regulated division as well as normal cell death. However, these cells are still able to make melanin or skin pigment. This means that areas in which melanoma early signs are present will be heavily pigmented than surrounding areas. Early signs can therefore be caught by paying extra, advisably medical attention to skin regions that rapidly change in coloration. This includes streaks that appear under nails but not related to recent cases of injury. You can browse through acral lentiginous melanoma pictures for illustrated details.
Using ABCDEs to identify melanoma signs
When learning more about melanoma signs, you will come about the ABCDEs. They are commonly used to identify first signs of melanoma especially on areas such as on face, on chest and on scalp. Asymmetry A rectangle can be divided into two halves that mirror each other. The same cannot be said about a trapezium. The latter is said to be asymmetrical. This property is shared by malignant moles or spots on skin. Borders Borders are the points at which discoloration ends. For normal moles, a line tracing these points will make a regular shape such as a circle. If the same experiment is repeated on a malignant mole, the resulting shape will be irregular. Colors
As mentioned earlier, most people develop brown, black or tan moles. Whichever the color, it will be consistent throughout the mole. Most malignant moles will not show such consistency. While most may be brown or black, they will also have several other colors such as blue, yellow or orange.
Diameter
A mole as thick as 6mm is normal. This is as long as it has been that size since you can last recall. If most of the mass has been gained in a short timeline however, it is no good sign. In fact, if a skin growth jumps from 1mm to 2mm thickness, have it checked immediately.
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Evolution
You probably know this term from biology class or some theory by Darwin. The basics of evolution are that plants and animals keep changing with time. This is same with melanomas. Today, a melanoma may be less than 1mm, brown in color and regularly shaped. Some days or months after, a 2mm thick, multiple colored, irregular tumor may have developed.
The ABCDEs can only be used for diagnosis on areas of the body that allow for physical examination. Tumors on back, on scalp and such areas may require some help.
Other melanoma warning signs
Ulceration It is common for melanomas to become ulcerated. The main difference between this type of ulceration and the type we are used to is that the former doesn’t heal. This increases the risk of some malignant cells finding a way into blood vessels. Itchiness Some melanomas tend to constantly itch. If this is accompanied by a couple of other signs we have identified, it is best that medical attention be sought as soon as possible.
Pain or tenderness
There are many cellular activities that go on in melanoma cells. This leads to constant changes in how the tumor is textured or feels to the touch. Pain occurs when tumors press against a nerve or a blood vessel.
Rapid changes
Melanomas that begin in already existing moles are harder to catch early. Spitzoid melanoma in adults is a good example. The unique characteristic is that malignant tumors are never dormant. Soon enough, you will see changes such as a new bump growing on the side of the original mole or discoloration spreading to surrounding skin.
Signs and symptoms of melanoma based on stages
The stage a melanoma is in greatly influences the treatment option to be used. Although diagnosis reports are the only ones that can confirm the stage, symptoms may help predict the same. Stage 0 It is at this stage that first signs appear. Here, malignancy is confined to melanocytes found in the epidermis. Discoloration in a small skin region will most likely be the first sign. [RELATED] Stage 1 More melanoma cells have been made. This means that they require more space to occupy. The previously small discolored area will spread across the skin. Stage 2 Here, malignancy is no longer confined to the epidermis. Tumors have reached the dermis and will soon reach lymphatic and blood vessels. A dome-shaped lump may develop. Tumors in this stage are usually more than 2mm in thickness. Ulceration may also be present. Stage 3 Lymph nodes that contain melanin and located closest to the primary tumor have been invaded. At first, there will be no signs of enlargement in the nodes. By as more melanoma cells are made, affected lymph nodes will swell. The primary tumor may be ulcerated, larger than 4mm or still spreading across the skin. It also may be painful. Stage 4 Malignancy has spread to distant organs such as the brain and lungs. In fact, the primary tumor is no longer the main cause for concern. Widespread signs and symptoms will occur. Most will largely depend on the affected organ:- Brain – seizures, headaches and numbness in extremities
- Liver – reduced liver function, loss of weight, nausea, vomiting, lump in abdomen
- Bones – loss of bone density resulting in frequent fractures
- Lungs – chronic cough, blood in cough and chest pain
- Subcutaneous skin layer – other lumps elsewhere in the skin
Melanoma signs on different body parts
Any organ in the body where melanocytes are produced can develop or be invaded by melanoma. It may be interesting to know that even internal organs and body cavities contain these cells. [RELATED] Regardless, largest numbers are found on the skin, hair and eyes. Melanoma signs on the following body parts may include:- In mucosal membranes - mucosal melanoma symptoms depend on where the tumors have developed. They may include nasal blocks, anal bleeding, pain before/after sex and a white spot in the mouth.
- On face – facial skin has the highest number of melanocytes. Signs will mostly revolve around sudden new moles or moles that gradually change. The same can be said of other cutaneous melanomas such as on the chest, on arm, on leg or on back.
- On nails – the big toe and thumb are the most common areas that melanoma on nails appears. Early signs revolve around a dark streak in the nail matrix or nail plate. A fleshly, red or pink nodule may also appear on the skin near the nail plate. See subungual melanoma pictures for illustrations. Melanoma on toe or finger is sometimes removed by amputating the affected toe or finger.
- In eyes – common signs of eye melanomas include blurred vision, changes in size or position of pupil, seeing shadows and flashes, eye pain and presence of a lump in the conjunctiva.
- On scalp – most melanomas on the scalp are discovered by accident, such as during routine skin checkups or by a hair stylist. Signs resemble those of other cutaneous melanomas.
- On hands and feet – the melanoma that develops on hands and feet is a very slow growing. This is both a good and a bad characteristic. Slow growth means that a patient will likely dismiss it for a normal blemish. Fast growth will however result in quicker metastasis. In most cases, a spot or patch of discolored skin will be among the first signs.
- On genitals – melanoma on vagina or vulva may be indicated by signs such as vaginal discharge, presence of a lump, bleeding and pain before/after sex. Melanoma on penis may be indicated by color changes in a localized region or presence of a bump with no apparent cause.
Factors that affect treatment for melanoma
Several factors are considered when the best treatment for melanoma is being decided. They include: [RELATED] Stage Generally, a 4 stage system is used to categorize melanoma:- Stage 1 – here, tumors are small and confined to melanocytes in the epidermis. Cells with the ability to rapidly divide are present in small numbers. On acral lentiginous melanoma pictures, this stage can be easily mistaken with a blood blister or a blemish under the skin.
- Stage 2 – tumors have grown past the epidermis and have reached the dermis. There may be signs of ulceration.
- Stage 3 – some malignant cells have broken free from the primary tumor into the lymphatic system. More than 1 lymph node that contains melanocytes and located close to the primary tumor has been invaded. There may be signs of swelling in the lymph nodes.
- Stage 4 – malignancy has spread to distant organs such as the brain, liver and lungs. Learn more about what is malignant melanoma for further details on how the disease spreads.
Thick tumors require bigger excisional margins. Also, more than one treatment option has to be used if malignancy is to be fully gotten rid of.
Location
A melanoma on hand is, for example, easier to cut out compared to another in the uvea or brain. This is one of the reasons as to why subungual melanoma stages are much more general. When dealing with delicate body parts or organs, consequences of every inch that may be removed during surgery must be considered.
Age
Drugs play an important role in treatment of melanoma. The problem is that the drugs come with a number of side effects. Older people are sometimes not in the best conditions to handle the side effects.
Health status
General health status of a patient affects the type of treatment to be used in many different ways. This is especially when dealing options such as immunotherapy.
Melanoma treatment options
There are 5 main melanoma treatment options. They include: Surgery Surgery is by far the most common option. It is often done to remove a melanoma. Before the operation, the doctor marks excision margins with the help of imaging tests. The tumor plus some surrounding tissue are then removed. [RELATED] Surgery may also be done to amputate an entire organ or part of the body. This is common when treating melanomas on fingers, toes and eyes. When lymph nodes are invaded, they are usually too removed with surgery. Radiotherapy Also referred to as radiation therapy, it uses X-rays to destroy tumors or shrink them. The option includes two types:- External radiotherapy – here, radiation is focused on the tumor to be removed using a machine outside the body. This option is mostly used for melanomas that have spread and also as an alternative to increase survival rate or reduce pain associated with spreading tumors.
- Internal radiotherapy – a tool such as a needle is used to deliver radioactive substances into the tumor to be removed.
- Direct injection – here, drugs are injected directly into affected organs, cavities or cerebrospinal fluid. This option is mostly considered for primary tumors that have not spread to multiple organs.
- Systematic chemo – drugs are taken orally or injected into the blood. From there, the drugs can reach any part of the body which may be invaded by melanoma cells. Common side effects of chemo are loss of hair and destruction of some healthy cells.
In general, immunotherapy aims at restoring or improving the body’s ability to fight cancer cells. This can be achieved in several ways. The most common form of immunotherapy is use of substances that block checkpoint proteins in cancer cells. These are proteins that keep cells from being attacked by immune cells. Another strategy is to increase the rate at which immune cells are made in the body. In this way, more cancer cells will be identified and destroyed. Immunotherapy is often used for melanomas that have spread and when surgery is not the best option or a considerable one.
Targeted therapy
Chemo and radiotherapy are known to destroy healthy cells. This is avoided with targeted therapy. Here, drugs that target certain functions of cancer cells such as molecular communication are used.
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Some drugs used in this therapy digest cancer cells, killing them in the process. New treatments in this field are being developed to stop development of blood vessels in malignant tumors.
Other treatments
- Vaccines – it is hoped that vaccines will soon be developed to fight stage 3 cancer. Basically, vaccines provide the immune system with structural details of a disease causing organism.
- Support therapy – this is a very important part of cancer treatment. It prevents from demoralization caused by cancer.
- Clinical trials – it is with clinical trials that new treatments for melanoma and other diseases are tried. Patients are always free to take part in the trials.
Melanoma treatment guidelines based on stages
Actual melanoma treatment guidelines will be developed for an individual after diagnosis. Below is some general information: Stage 0 Earlier, this stage was skipped. This is because stage 0 is commonly combined with stage 1, especially when dealing with rare cases such as vaginal melanoma. Clinical reasons however require more precision. Melanomas in this stage are usually removed with surgery. The tumor plus some surrounding tissues are removed. Stage 1 Tumors in this stage are also removed with surgery. If the doctor finds it necessary, he will test for signs of malignancy in local lymph nodes. Stage 2 Tumors are removed with surgery. Some surrounding tissue is also removed to ensure complete removal of malignant cells. Tests will be done to check for malignancy in local lymph nodes. After tumor removal radiation therapy or chemo may be used. Drugs that inhibit cancer cells division are nowadays often used to keep the melanoma from coming back. Stage 3 Surgery is done on two fronts: to remove the primary tumors and affected lymph nodes. Before the latter, a form of biopsy will be taken to determine the nodes that have been invaded. It is also likely that chemo drugs and radiation therapy will be used to destroy or keep any tumor that may not have been completely removed from growing back. Immunotherapy and targeted therapy help keep the melanoma from recurring. Stage 4 Surgery is done in multiple areas. This may involve cutting out tumors, removing entire organs or amputating some body parts. Melanoma on hand for example can be removed by amputating a finger. Other treatments will be used to shrink the tumors, reduce pain, inhibit spread and keep tumors from recurring.Side effects of treatment for melanoma
Even top treatments used to fight melanoma come with a list of side effects. It is very important that the side effects be discussed by the doctor with the patient. While in most cases the best decision will be to receive the treatment despite its side effects, prior knowledge keeps a patient psychologically prepared. This is very important during recovery. Common side effects include hair loss, loss of some organs, scarring and many others. They will mostly depend on the stage of the tumor, the type of treatment and personal factors. [RELATED] The good thing is that side effects are usually tolerable, however distressing. Most improve with time and may completely disappear once treatment is over. Prevention One of the things that make melanoma so deadly is misdiagnosis or late diagnosis. This is commonly seen in nodular melanoma prognosis. Survival rate for early stage melanoma is more than 90%. This means that most small tumors yet to leave primary locations can be easily removed. While keeping away from excess UV radiation or applying sunscreens may help prevent melanoma, it is not enough. You find that experts are not yet sure what exactly causes the disease. The best prevention measure is to learn how to identify early signs of the disease. From there, a doctor can be approached for diagnosis and treatment. [post_title] => Best Options and Guidelines for Melanoma Treatments [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => best-options-and-guidelines-for-melanoma-treatments [to_ping] => [pinged] => [post_modified] => 2018-04-28 21:21:11 [post_modified_gmt] => 2018-04-28 21:21:11 [post_content_filtered] => [post_parent] => 0 [guid] => https://skinanswer.com/?p=4113 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [9] => WP_Post Object ( [ID] => 4111 [post_author] => 1 [post_date] => 2018-03-13 07:10:09 [post_date_gmt] => 2018-03-13 07:10:09 [post_content] => Melanoma can be deadly, but not always. When the disease is caught early, a plastic surgeon can remove it with a not too complicated excision surgery. This changes for the worse as the disease advances. Mostly for clinical purposes, melanoma stages are used to denote how advanced the disease has become. Early stages describe what are known as local tumors. These are tumors from which malignant cells have not broken free to migrate and invade other body parts. Latter stages describe tumors that have released malignant cells into local lymph nodes or distant organs.What are melanoma stages and what are they used for?
Melanoma staging is a means with which doctors describe how a tumor has spread and how much it has grown. Staging is also used as a tool to describe where a tumor is located and parts of the body it has spread to. [RELATED] Different types of tests are done for diagnosis depending on the type of melanoma in question. Staging depends on reports from the tests. It therefore cannot be effectively done before the tests have been done. The commonly used ways for staging are:- 0-4 scale – here, melanomas are put in 5 stages. This mostly depends on extent of metastasis. It is the most commonly used staging system. The system works effectively for melanoma on leg or for rare melanoma types.
- TNM staging – T stands for thickness, N for nodes and M for metastasis. This method describes a melanoma tumor’s thickness, whether it has invaded lymph nodes and if it has reached distant organs. There are subdivisions in this staging system. The subdivisions are very important for precision especially when dealing with melanoma in mouth, eye and mucosal membranes.
- Clark and Breslow staging – this mostly deals with how deep a melanoma has grown into the skin. Breslow’s scale uses millimeters to measure the distance from the tip of a melanoma to the bottommost part.
Stage 0 melanoma definition, signs, treatments and prognosis
Definition In some melanoma definition platforms, this stage is sometimes skipped or merged with stage 1. It describes in situ melanomas. In other terms, tumors at this stage are still in the epidermis. The epidermis is the upper layer of the skin. Signs and symptoms
Signs largely depend on which type of melanoma in question. Since cutaneous melanoma is most common, early signs may include an irregular mole, blemish, spot, patch or streak in case of the fingers and toes. The ABCDEs are commonly used to check for suspicious signs. It is often hard to catch a melanoma on toe or finger at this stage. Acral lentiginous melanoma pictures may help.
Treatments
Stage 0 tumors are easy to remove. A qualified surgeon performs an excision surgery after marking excision margins with the help of images from MRIs or CT scans.
Prognosis
Most patients receive effective treatment for melanomas in this stage. Chances of surviving for the next 10 years or more are above 90%. Factors that may lead to poor prognosis include lack of treatment or follow-up appointments.
Stage 1 melanoma subdivisions, signs, treatments and prognosis
Subdivisions
Stage 1 melanoma is still in the early stages. As hinted earlier, this stage is often combined with stage 0. This is because tumors in this stage are still in the epidermis. It can be subdivided into 2 other stages:
- Stage 1A – here, tumors have not reached 1mm in thickness. There are no signs of ulceration and cells with ability to rapidly divide are still in small numbers.
- Stage 1B – features that define stage 1B melanomas include ulceration, tumor thickness of 1-2mm and increase in number of fast dividing cells. Ulceration may or may not be present.
Stage 2 melanoma subdivisions, signs, treatments and prognosis
Stage 2 melanoma can be subdivided into 3 other stages. In this stage, tumors have penetrated into the dermis but are still yet to reach the lymphatic and blood systems.- Stage 2A – tumors are between 1mm and 4mm thick. Ulceration is common but not always present.
- Stage 2B – here, tumors are usually thicker than 2mm. most show signs of ulceration. If not, the tumors reach 4mm in thickness.
- Stage 2C – in this stage, tumors are quite large and show signs of ulceration.
Stage 3 melanoma subdivisions, causes, treatments and prognosis
Stage 3 melanoma marks the end of early stages. The main unique feature is spread of malignancy to local lymph nodes. Once melanomas have penetrated deeper from the dermis, they may encounter lymphatic vessels. Several cells may break free into the vessels and be emptied in local lymph nodes.
Subdivisions
- Stage 3A – some melanomas in this stage may not have yet reached the lymph nodes. If so, the invaded nodes are not swollen.
- Stage 3B – less than 3 lymph nodes located the closest to the primary tumor have been invaded. There are no signs of swelling but melanoma cells can be identified with a microscope.
- Stage 3C – this stage comes early in melanomas located close to lymph nodes that contain melanocytes. In this stage, more than 4 nodes have been invaded. Signs of ulceration on the tumors are common but not always there. Affected nodes are enlarged.
Stage 4 melanoma definition, treatments and prognosis
Definition Stage 4 melanoma represents the most advanced stage. This is when melanoma is most deadly. Often, treatment doesn’t succeed in completely removing melanoma cells. The difficulty in treatment arises from the fact that malignancy has spread to distant organs such as the lungs, liver, brain, other lymph nodes, abdominal organs or bones. [RELATED] Treatments Surgery – usually done to remove the primary and accessible secondary tumors. Some forms of surgery may also involve amputation, removal of lymph nodes or entire removal of organs or tissues.- Chemotherapy – drugs are used to kill cells with the characteristic of rapid division. It succeeds in shrinking most tumors.
- Radiotherapy – done to shrink tumors and prevent their growth rather than for complete removal. It is also commonly used to stop pain associated with spreading tumors.
- Immunotherapy – use of drugs to boost the body’s ability to fight cancer cells. It is quite effective even for small tumors that don’t show in imaging tests.
- Targeted therapy – use of drugs to inhibit certain functions essential for growth of melanoma cells.
Melanoma under toenail symptoms, causes and treatments
Melanoma under the toenail often develops in the big toe. It can arise in the nail matrix, under the nail plate or in the skin that borders the nail plate. The disease may begin with a streak or a fleshly nodule. The latter is more dangerous and requires immediate nodular melanoma treatment. Symptoms In most cases, symptoms will revolve around changes in a streak that develops vertically from nail bed to the tip. With time, the streak will widen at the base, spread to the nail fold and develop multiple colors. In some cases, there will be ulceration and cracking of the affected nail. [RELATED] Some melanomas under the toenail largely lack pigmentation. For this reason they appear fleshy or reddish. While a streak that resembles a blemish under the toenail is the most common early sign, some people will develop a flesh-colored or red nodule in the skin bordering the toenail. This can be mistaken for a blood blister or a hematoma. The main difference is that the nodule will not be painful at first and will persist indefinitely. Causes Exact causes of melanoma under toenail are not clearly understood. This is especially due to the fact that this type of melanoma is not associated with UV radiation. Risk factors may include:- Dark skin
- Age
- Toe injuries
- Weakened immunity
Diagnosis is very essential to rule out other possible causes of blemishes and spots under toenail such as fungal infections. During diagnosis, a doctor will carry out a physical examination. The patient will be required to provide brief details of their symptoms and medical history. Biopsy will finally be taken to confirm diagnosis.
Treatment is primarily done with excision melanoma surgery. This involves cutting out the tumor and some of the surrounding tissue. Depending on the stage the tumor is in, more treatment options such as chemotherapy and radiotherapy may also be used. See full malignant melanoma definition to understand how tumors spread.
Melanoma on toe symptoms, causes and treatments
Melanoma on the toe can begin on the upper part or the bottom. While the disease is rare, most people tend to ignore its early signs. Another problematic issue is the notion that melanomas will always be brown or black. It is a common factor that worsens spitzoid melanoma prognosis. Symptoms When it occurs on the upper side of the toe, the melanoma will most likely resemble a mole, a discolored spot or a wart. If it develops on the bottom side, it may resemble a blood blister or a dark-brown patch or spot. [RELATED] The best way to identify early warning signs is using the ABCDEs. Start by checking whether the spot can be divided in two equal halves. After that, see if the points at which discoloration ends follows a consistent pattern, such as to make a round or oval shape. Proceed by determining the primary color of the spot. Lastly, compare the current status of the spot with how it appeared some time before. Generally, normal moles or spots should not change, especially over a short timeline. They also should not have multiple colors. Causes Melanoma on the upper side of the toe is thought to be encouraged by exposure to direct sunlight or other sources of UV radiation. There also are reasons to associate it with injuries and forms of trauma. People with fair skin or have many atypical moles are also at a higher risk. Melanomas that occur on the bottom side of the toe are also thought to be encouraged by the above mentioned factors. Diagnosis and treatments The ABCDEs alone cannot be used to confirm diagnosis. Doctors usually use dermoscopy to check the behavior of cells in areas with melanoma signs. For more accurate results, a biopsy will be taken. Treatment depends on how advanced the melanoma on toe is. It is also much the same with other melanoma types, a reason as to why uveal melanoma staging is quite complex. A skilled plastic surgeon can remove an in situ in a not too complicated surgery. If malignancy has spread to lymph nodes, surgery will also be needed to remove the affected nodes. This also goes for tumors that have spread to organs such as the lungs. Advanced melanomas also require treatment alternatives such as chemotherapy and radiotherapy. See malignant melanoma definition to understand how the disease spreads.Melanoma under fingernail symptoms, causes and symptoms
Melanoma under the fingernail falls in the subtype referred to as subungual melanoma. It is not common but unfortunately is often misdiagnosed.
The common early sign is appearance of a dark line under the fingernail. The problem is that many other causes can be responsible for such a line. So how do you tell the difference between normal lines and malignant ones under fingernail?
First, you can use the Hutchinson’s sign. This is where the line or streak widens at the nail cuticle and spreads or causes color changes to the nail bed. Lines caused by melanoma also tend to widen, forming bands or streaks rather than lines.
Another way to tell if a streak is malignant or not is by associating it with recent cases of injury or trauma. For example, when a finger is trapped under a heavy object, one or several blood vessels may become damaged. As a result, blood will leak and collect under the fingernail. Other forms of trauma such as psoriasis may have similar results. The main difference between blemishes formed in this manner and malignant ones is that the former improve and disappear with time. Sometimes, the affected fingernail may come off during the healing process.
Diagnosis and treatment
A doctor will physically examine the affected finger for any signs of malignancy. For accuracy, a biopsy will be taken.
Treatment depends how invasive the melanoma has become, thickness of the tumor, its location among other factors. For example, large mucosal melanoma treatment may not be very successful with surgery unless the entire affected organ is removed.
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Regardless, surgery will be the treatment option of choice. Small tumors respond very well to excisional surgery. For large tumors, amputation may be done at the joint closest to the fingernail.
Since early signs of melanomas under the fingernails are often ignored or misdiagnosed, the possibility of malignancy having spread to other body parts is always there. This calls for other treatment options such as chemotherapy, radiotherapy and targeted therapy.
Melanoma on finger symptoms, causes and treatments
Several types of melanoma can develop on the finger. The type will depend on which part of the finger it is appearing on. See acral lentiginous melanoma pictures for illustrations.
Superficial spreading melanoma often begins as a freckle which spreads across the skin. If not treated, it may penetrate deeper into the skin and spread. Nodular melanoma is another common type and most invasive. It often appears as a red nodule on the skin that rapidly gains mass. In people who have a history of sunburns or long periods of sun exposure especially during childhood, lentigo maligna melanoma may occur. Early signs of this melanoma resemble sun spots and may easily be ignored. The common sign is appearance of shades of black and brown.
Most melanomas on fingers develop on sun-damaged areas. People with fair skin or who have a history of sunburns are usually at a higher risk.
Diagnosis and treatments
Melanoma signs can help a lot with diagnosis. This can be achieved with the help of the ABCDEs and dermoscopy. Doctors however usually confirm diagnosis with a biopsy.
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The mode of treatment to be adopted depends on factors such as location of the tumor, thickness of the tumor, age and health status. The much tumors have spread or basically subungual melanoma stages will also largely determine treatment procedures.
- Stage 1 –stage 1 tumors have not left the finger. These ones can be removed by a plastic surgeon with excision surgery.
- Stage 2 – stage 2 finger melanomas have still not spread but have penetrated into the dermis. Further, the tumors will reach blood and lymphatic vessels. It is common for stage 2 melanomas to bleed, a factor that increases the chances of spreading. Surgery is still the main method of treatment. If necessary, a part of or the entire finger may be amputated. Radiotherapy and chemotherapy may also be used.
- Stage 3 – some malignant cells have left the primary tumor on finger and entered the lymphatic system. It is likely that local lymph nodes in armpit have swollen. Surgery is done to remove the primary tumor and invaded lymph nodes. To ensure complete removal of all malignant cells, other treatments such as chemotherapy, targeted therapy and immunotherapy may be used.
- Stage 4 – tumors are so advanced that they may have spread to the brain, lungs, nodes and other organs. It is usually not possible to cure melanoma at this stage. However, drugs and surgical tumor removal can be used to prolong lifetime. These same treatment procedures are applicable for melanoma on back.
Melanoma on hand symptoms, causes and treatments
The two most common types of melanoma on the hand are acral lentiginous and subungual melanoma. Acral lentiginous melanoma This type begins as a discolored flat spot or patch on sole of foot or palms. It is often slow-growing and can in fact take months or years before becoming invasive. The EBCDEs can be used to differentiate normal blemishes from malignant ones. Acral lentiginous melanoma pictures may also be of some help. [RELATED] Subungual melanoma This subtype develops in nail matrix, nail plate or skin surrounding the nail matrix. It is often characterized by a longitudinal streak perpendicular to the nail bed. Early signs of subungual melanoma can easily be mistaken for a blood blister. The main difference is that blood blisters develop after an injury or a form of trauma. The cancer often shows up in the thumb or big toe. Causes
It is not clear what exactly causes melanoma on the hand. It however seems to be associated with UV radiation and sun poisoning. Subungual melanoma doesn’t share this characteristic.
Treatments
Excision surgery is the usual treatment of choice. For subungual melanoma, surgery may also be done to amputate the affected finger. Nowadays, amputation is usually done at the joint closest to the fingernail.
Melanoma on leg types, symptoms and treatments
The types of melanoma that may develop on the leg include nodular melanoma, superficial spreading melanoma, amelanotic melanoma and lentigo maligna melanoma. Nodular melanoma
This is the most invasive type of all. It often appears as a red nodule on the skin. Once the nodule has developed, it rapidly spreads into the dermis and much deeper into the skin. Once it reaches lymphatic or blood vessels, it spreads to other body organs. This happens in a very short timeline. Prompt nodular melanoma treatment is usually very essential.
Superficial spreading melanoma
This type is not very invasive. It tends to spread across the skin before invading other parts. The ABCDEs can be used to identify suspicious patches or blemishes on skin.
Amelanotic melanoma
This is a commonly misdiagnosed type. Affected melanocytes make less melanin, making amelanotic melanomas almost colorless or fleshy. This is one of the factors that worsen spitzoid melanoma prognosis.
Lentigo maligna melanoma
Of all the types, this is the least invasive. It grows slowly and is more common in older people. Early signs revolve around a mole or blemish that grows in size, has multiple colors and with irregular shape.
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Treatment
Treatment depends on diagnosis reports and stage of the tumor. For small or tumors that haven’t left the local position, surgical excision and several doses of radiation will do. Chemotherapy may also be used to ensure complete remove of malignant cells. The latter options are also considered when surgery may not be the best option such as in ocular melanoma treatment.
Tumors that have migrated to other body parts are much harder to treat. They require combined efforts of several treatment options for complete removal. Doctors usually discuss the treatment approach to be used with the patient.
Melanoma on arm symptoms, causes and treatments
The arm is one of the body parts often exposed to sun. This makes it a common site for melanomas to develop.
Symptoms
Most melanomas on the arm will be noticed in their early stages. Since affected melanocytes will still be able to produce melanin, the affected area will appear heavily pigmented than surrounding areas. Early signs can start in an existing mole or in a healthy part of the skin. The ABCDEs are commonly used for diagnosis. They stand for:
- Asymmetry – this describes the general orientation or shape of the mole or blemish. If you can’t draw a line that cuts the mole in two equal halves, medical attention should be sought.
- Borders – borders or edges are points that mark the extent to which discoloration has spread across the skin. Melanomas often have unclearly marked or what can be described as irregular edges. For normal moles, they may be round or oval.
- Colors – blue is the main color that often appears in mixed in the dark-brown of most melanomas. Multiple colors in a skin blemish or a mole is never a normal feature.
- Diameter – a mole can become as wide as a pencil eraser. This should not cause you much concern, as long as the mole has always been there and is not showing any sign of changing. The only thing to worry about is a mole that appears as if from nowhere and becomes fairly large in a short time.
- Evolution – by the age of 20, most moles will have developed. Mature moles stay in the same state for a long time. If any changes are to occur, they probably will not be noticeable or significant. Malignancy in moles is often indicated by gradual change in physical features such as texture, size, shape and color. For example, a melanoma can appear as a bumpy, freckled or ulcerated mole. These same features will likely also appear in a melanoma on back.
- UV radiation
- Weakened immune system
- Age
- Fair skin
- Stage 1 – stage 1 melanoma tumors are still in local positions. Treatment mostly involves surgical excision. Before the operation, imaging tests will be used to set an excisional margin. An excision will then be made to remove the tumor and some tissue surrounding the tumor.
- Stage 2 – surgery is still the main treatment method in this case. The main difference is that a larger excision margin will be set. This is because stage 2 melanomas usually have penetrated into the dermis. After the surgery, a sentinel lymph node biopsy may be performed. It is a test to check whether melanoma cells have reached local lymph nodes. Doses of radiation or chemotherapy drugs may be administered afterwards.
- Stage 3 – at this stage, some malignant cells have broken free from the primary tumor and entered lymphatic system. Surgery is therefore done on two fronts. One involves cutting out the primary tumor and some surrounding skin. The other one involves removing the lymph nodes that have been invaded. It is very likely that drugs which target some functions of cancer cells will be administered after surgery. This is to reduce the likelihood of melanoma recurring. Another prevention mechanism is to use radiotherapy.
- Stage 4 – here, surgery may require to be done in more than two fronts. This is because malignancy has spread not only to local lymph nodes but also distant organs such as the brain or lungs. Doctors first identify all tumors and determine whether they can be surgically removed. If not, chemotherapy, targeted therapy, radiotherapy and immunotherapy treatment options will be used. In most cases, treatment in this case will only be aimed at shrinking tumors but not get rid of them. This is why survival rate is very low at this stage.
Foot melanoma symptoms, risk factors and treatments
Foot melanoma can develop on sole or in the nail. For the former, early melanoma signs can be identified with the ABCDEs. Be on the lookout for new moles or ones that change how they look, are shaped or textured. [RELATED] For melanoma in the toenails, the common sign is appearance of a vertical streak which may be brown, purple or black. Unlike bruises, they will persist indefinitely. It is also common for the streaks to be wider near the nail bed. Affected nails may crack. Risk factors- Fair skin
- UV radiation
- Atypical moles syndrome
- History of melanomas
- Genetic predisposition
- Weakened immunity
- Surgery – done to either remove the tumor or amputate part of affected nail. It is very successful and widely used for in situ tumors. In the past, melanoma on toe was usually treated by amputating the entire toe. This has recently changed for the better.
- Chemotherapy – used to shrink tumors or ensure complete removal of malignant cells after surgery. Drugs are either injected directly or administered systematically.
- Radiotherapy – use of X-rays to damage the structure of melanoma cells. It is commonly used to shrink tumors as well reduce pain from spreading tumors.
- Immunotherapy – an advanced form of treatment where drugs are administered to boost the body’s capability to fight cancer cells. It is a common treatment of choice after advanced uveal melanoma staging.
- Targeted therapy – can be described as an advanced form of chemotherapy. In this case, drugs that specifically target cancer cells are used.
Melanoma in lungs symptoms, causes and treatments
Melanoma in the lungs can be primary or secondary. Primary lung melanomas originate in the lungs while secondary lung melanomas migrate from another body part, for example the conjunctiva. See what is uveal melanoma for more details. The former type is very rare.
Symptoms
Symptoms will most likely resemble those of lung cancer. They may include:
- Blood in cough
- Chronic cough
- Chest pain
- Difficulty breathing
Melanoma on breast symptoms, causes and treatments
Melanoma on the breast is more likely cutaneous than metastatic. Cutaneous melanomas on the breast are not common however. If metastatic, the melanoma will develop in the subcutaneous tissue (fat tissue) of the breast. Symptoms Cutaneous melanoma on the breast may resemble a changing blemish or mole on the breast skin. The following characteristics may also be present in the mole or blemish:- Irregular borders
- Multiple colors
- Increasing diameter or thickness
- Lack of symmetry
- Gradual changes in physical features such as texture, shape and size
Melanoma in lymph nodes symptoms, causes and treatments
Melanoma in the lymph nodes is always metastatic. This means that it will have migrated from a primary tumor, most likely located nearby. Melanomas begin by spreading across as well as penetrating the skin. Since melanocytes are located in the epidermis, it will take some time before the developing tumor reaches the lymphatic vessels. Nodular melanoma is considered most invasive because it spreads deeper into the skin more than it does across. Once a melanoma has reached the lymphatic vessels, several malignant cells may escape into the vessels and be emptied into a local sentinel lymph node. This marks stage 3 of a melanoma tumor.
Symptoms
Once invaded, lymph nodes will most likely swell. This can be felt as a lump under the skin in areas such as the groin, armpit and neck. More than one lymph node may swell. Some patients may also experience fever. Note that there will be a primary tumor before the lymph nodes are involved. You can consider learning more on how to identify melanomas on topics such as what does vulvar melanoma look like.
Causes
Lymph nodes produce lymph, the fluid that filters germs and waste materials from blood. Melanoma cells reach lymph nodes through the lymphatic system in the 3rd stage of primary melanomas.
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Diagnosis and treatment
A doctor will first perform a physical examination. This is to check for swollen lymph nodes. Patients may be required to provide details on symptoms and their medical histories. A sentinel lymph node biopsy is the most accurate diagnostic tool. During the test, a dye will be injected where a primary melanoma has been removed. It will then be traced as it circulates in local lymph nodes.
Affected lymph nodes are usually removed with surgery. To ensure that all or most malignant cells have been eradicated, chemotherapy drugs may be prescribed. Radiotherapy may also be used for further treatment.
Melanoma on back symptoms, causes and treatments
The back is one of the most common areas for melanoma on skin. This is especially for people who spend a lot of time outdoors or who have a history of exposure to sun during childhood.
Symptoms
Melanoma on the back is cutaneous. In most cases, cutaneous melanomas begin as changing moles or skin blemishes. Most can be caught early with the help of the ABCDEs.
- Asymmetry – this describes the overall shape of the mole or blemish. If a line to cut the mole in two equal halves cannot be drawn, medical diagnosis is necessary.
- Borders – this describes the outline of the mole’s edges. For normal moles, the borders should be clearly defined and regular. They can be round or oval.
- Colors – the common colors for moles are dark-brown and red. If one has multiple colors, especially with some blue, orange or green, it should be checked immediately.
- Diameter – some people have blemishes and benign skin growths as big as pencil erasers. Melanomas start as small spots less than 1 mm in diameter. Suspicion should arise when the spots gradually get bigger especially after a short timeline.
- Evolution – evolution describes changes that may occur in the physical features of a spot or mole. These include size, shape, texture and color.
- Having many atypical moles
- Exposure to UV radiation
- Sunburns
- Family history of melanomas
- Old age
- Fair skin
- Weak immune system
Melanoma on head symptoms, causes and treatments
Common sites for melanoma on head are face, neck, scalp and ear. More cases are reported in men compared to in women. Age seems to be a contributing factor since most incidences occur in older people. [RELATED] Symptoms Most people will notice early signs of a melanoma on the head. This is because they revolve around an evolving blemish or mole. The ABCDEs are used to identify suspicious moles. See more details here what does melanoma skin cancer look like.- Asymmetry (A) – for normal moles, its two halves will mirror each other. Malignant ones often don’t allow for a line of symmetry.
- Borders (B) – if carefully inspected a normal mole, you will realize that it has very well defined edges. Most are round but can also be oval. Melanomas lack this quality.
- Colors (C) – dark, red and brown are the common colors for normal moles. While melanomas will also likely have any of these colors, there will also be another additional color such as blue, orange or green.
- Diameter (D) – moles are usually small, less than 3 mm in diameter. When a skin blemish or growth continues to grow in size or reaches the size of a pencil eraser, it should be checked immediately.
- Evolution (E) – adults can have up to 20 or more moles. This doesn’t mean that the benign tumors will keep changing in size, texture or shape with time. If this happens, you may be dealing with a melanoma.
The full process by which melanocytes start dividing out of control and fail to die naturally is not fully understood. But since more aggressive types and more cases are reported in people with a history of excess exposure to sun, there are reasons to associate UV poisoning with the disease. Other risk factors may include:
- High number of moles or dysplastic nevi syndrome
- Age
- Fair complexion
- Family history of melanomas
- Older age
Melanoma on scalp symptoms, causes and treatments
One thing that makes melanoma on that scalp very deadly is that patients rarely catch it in time, as it is obscured by hair. Late diagnosis is also a factor that makes spitzoid melanoma prognosis often poor. Additionally, the scalp receives a lot of direct sunlight.
Symptoms
Changes in a new or existing blemish or mole on the scalp are the most common signs. The ABCDEs may prove quite helpful in this case. Since it is a bit hard to self-examine the scalp, you can consider help from a friend, a hair stylist or a dermatologist. It is also good to maintain routine skin checkups.
Causes
Just like melanomas on skin, it is not known how and what exactly causes melanocytes to divide aggressively and fail to die as they should. Genetic mutation is thought to play a big role. Risk factors include:
- Family history of melanomas
- Benign atypical moles
- UV radiation
- History of sunburns
- Excess sun exposure during childhood
- Use of devices such as tanning beds
Melanoma on lip symptoms, causes and treatments
Melanoma on the lip often is more invasive than other melanomas. Other than that, lip cancers are some of the most common types of oral cancer.
Symptoms
Lip melanomas often begin as a dark spot on the lower lip. They tend to appear from nowhere and with no noticeable cause. Other symptoms that may occur include:
- Increasing in size
- Bleeding or ulceration
- Irregular borders
- Several millimeters thick
- No equal halves
- Multicolored, especially blue or white
- Smoking
- Excess alcohol consumption
- UV radiation
- Fair complexion
- Older age
- Being male
- HPV
Melanoma in the brain symptoms, causes and treatments
Melanoma in the brain is also referred to as brain metastases. It is a complication of melanoma and one of the most challenging to treat. Symptoms Symptoms revolve around neurologic signs. They may include:- Headaches
- Numbness in hands and feet
- Loss of hearing
- Interfered vision
- Poor judgment
- Weakened muscle activities
- Seizures
- Difficulty walking
- Ulcerated melanoma
- Metastatic melanoma
- Head, neck, abdomen or trunk melanoma
Studies have shown that the brain provides a very conducive environment for melanoma cells to grow in. For this reason, it tends to be very aggressive and thus with poor prognosis. Until recently, life expectancy for multiple melanomas in the brain used to be 4-5 months. More advanced treatment procedures have improved this.
Doctors are able to predict brain melanomas based on patient’s symptoms and medical history. To confirm the diagnosis, imaging tests will be done.
Treatments vary wildly depending on the location of the tumor, size, number and general health status of the patient. The problem is that the brain is protected by a mechanism known as blood-brain-barrier. While it is very important, it keeps medications from reaching the brain. Some drugs may also damage vital tissues of the brain.
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A team of doctors will come together to decide the best treatment approach. Available options include:
- Surgery – only small or few tumors in the brain can be surgically removed, unless they are in vital brain areas.
- Radiotherapy – radiotherapy has traditionally been used to prevent further growth of tumors. Recently, forms of radiotherapy have been introduced which can specifically target certain spots in brain.
- Chemotherapy – drugs are administered to destroy cancerous tumors in the brain. In most cases, tumors treated this way don’t go away for good. The treatment is all the same effective especially for multiple and melanoma in lymph nodes.
- Targeted therapy – this is a recent treatment option. It is very effective in reducing growth rate of cancer cells.
- Immunotherapy – there has been growing evidence that immunotherapy may succeed in shrinking brain tumors at a high rate. This is especially if the tumors are small and not visible in imaging tests.
Melanoma in mouth (oral) symptoms and treatments
Melanoma in the mouth is also commonly referred to as oral melanoma. It originates in the squamous mucosa basal layer. In this layer, melanocytes are significantly less than basal cells. The disease accounts for about 5% of all melanomas and about 1.5% of all tumors that develop in neck and head areas. [RELATED] Symptoms Most oral melanomas tend to be asymptomatic. Oral mucosal melanoma symptoms that may occur include a dark, brown, blue or white spot in the mouth. It is likely that the spot will be multicolored. Some melanomas begin in form of nodules or small lumps. Commonly affected areas are the gums and palate. 80% of oral melanomas occur in these areas. Ill-fitting dentures are reported to be possible causes or risk factors of oral melanoma. When signs show up in tongue, mandible or the linings of mouth and cheeks, they are very likely going to be metastatic. Melanoma oral lesions, lumps or spots are usually caught when they are 1 mm thick or larger. Sometimes, there will be ulceration but with little or no pain. Prognosis, diagnosis and treatment
Prognosis is always best for in situ tumors and depends on the stage of the tumor. Nodular melanoma prognosis is usually poor. Oral melanomas are grouped in three stages. Stage 1 is for tumors which have not spread. Stage 2 is for tumors which have spread to local lymph nodes. Stage 3 is for tumors that have spread to distant organs.
Physical examination and biopsy are commonly used to confirm diagnosis. During physical examination, the doctor will check for signs such as multicolored lesions and bleeding ones. Biopsy involves extracting a small sample and testing it in the lab.
Treatment usually involves surgery to remove the tumor. Afterwards, radiotherapy and chemotherapy may be used to ensure complete removal of malignant cells.
Melanoma in ear symptoms and treatments
Melanoma in the ear is not common. It only accounts for about 3% of all melanomas and about 15% of melanomas that develop in neck and head region. It has been recently found that more men are affected than women. Symptoms- Chronic ear pain
- Bleeding
- Loss of hearing
- Discharge of fluids from the ear
- A lump inside ear
Melanoma on nose symptoms and treatments
Melanoma on the nose can be on the skin outside the nasal cavity or in mucosal membrane of the nasal cavity. The former is more common. In fact, melanoma on mucosal nasal cavity only accounts for less than 1% of all melanomas.
Symptoms
Outside the nose, symptoms will resemble those of an atypical mole. Such indication sinclude irregularity at borders, multiple colors and gradual change in physical features. Some melanomas on the nose can be elevated or appear as flat spots on the skin.
When it occurs inside the nose, symptoms will include swelling, nose bleeds and nasal block. Patients may also notice a lump inside the nose that doesn’t go away.
Diagnosis and treatments
Only a melanoma biopsy can correctly diagnose a melanoma inside the nose. Physical examination may help in case the melanoma occurs on skin outside the nose. Even in that case, however, a biopsy will still be necessary.
Treatment depends on the location and thickness of the tumor. Small tumors only require surgical removal and maybe several doses of radiotherapy. Melanoma in situ margins are first marked before surgery. If the doctor finds it necessary, chemotherapy drugs will also be prescribed. Tumors that have spread or are harder to completely remove with above treatments will require immunotherapy or targeted therapy. The former uses drugs to boost immune system. Targeted therapy uses drugs which targeted specific functions of cancer cells.
Melanoma on face symptoms, causes and treatments
Facial skin contains most melanocytes per unit area. It is also often exposed to direct sunlight when outdoors. These are some of the facts that make melanoma on face fairly common. It accounts for about 80% of all melanomas that occur in head and neck areas with most incidences reported on the cheeks. [RELATED] Symptoms Most patients will notice an evolving mole or blemish. Other early signs may include bleeding, ulceration and itchiness. Some melanomas are painful but most are not at first. The ABCDE rule can be used to identify early warning signs.- Asymmetry – look for two halves of the blemish or mole that don’t mirror each other
- Borders – look for irregularly defined edges
- Color – look for multiple colors, mostly dark-brown with some blue
- Diameter – look for blemishes exceeding 2 mm in diameter and keeps increasing
- Evolving – look for moles that keep changing their physical features such as shape, size and texture
- Old age
- Genetic mutation
- Weakened immune system
- Dysplastic nevi syndrome
- Family history of melanomas
Melanoma of the eye
Melanoma of the eye can develop on the uvea or conjunctiva. The uvea consists of iris, choroid and ciliary body.
When melanomas develop on the uvea, the choroid is mostly affected. This is the part of the eye that contains 80% of all blood vessels that nourish the eye. Due to the huge network of blood vessels, melanomas in this region tend to often spread to the liver. See pictures, images and more details on what is uveal melanoma.
Symptoms
- Seeing shadows and flashes
- Loss of peripheral vision
- Blurred vision
- Loss of vision
- Changes in shape or position of the iris
- A lump or spot on the white part of eye or iris
- Eye exam – use of a bright light or magnifying lens to view the inside of eye. Eye drops are used to dilate the eye prior to this test.
- Biopsy – a small tissue removed from the affected area to check for cancer cells in the lab.
- Ultrasound – sound waves are used to produce images of inside eye on an ultrasound monitor.
- Angiogram – a fluorescent dye is injected in the arm and mapped as it circulates in eye.
- Imaging tests – taken to show size, location and metastatic status of eye melanomas.
- Surgery – excisional surgery to remove the tumor. For large or very painful tumors, surgery can be done to remove the entire eye, after which an artificial one is used for replacement.
- Chemotherapy – use of drugs to destroy fast dividing cells, mainly cancer cells.
- Radiotherapy – X-rays are used to destroy malignant tissues.
- Cryotherapy – use of a very cold substance to destroy unwanted cells.
- Immunotherapy – use of drugs to boost body’s capability to fight cancer cells.
How fast does melanoma grow?
There is no exact answer to the "how fast does melanoma grow?" question. It mostly depends of the type of melanoma in question. Let's first look at the stages of the disease: Stage 0 At stage 0, the melanoma is only confined to melanocytes in the upper layer of the skin known as the epidermis. Here, the disease grows very slowly since only a few cells are capable of rapid division. Symptoms only show up on the affected areas. [RELATED] Stage 1 More cells are taking part in rapid division. Signs of elevation or spreading across the skin may set in. Malignancy is, however, still confined to the epidermis. Stage 2
More cells have been made while only a few have naturally died like they should. As the functionless cells accumulate, the tumor gets thicker and penetrates the dermis. Later in this stage, the tumor will reach the subcutaneous layer of the skin and lymphatic or blood vessels. Enlargement also occurs on the skin as discoloration spreads and elevation increases. When melanoma exhibits these characteristics, it is said to be invasive.
Stage 3
Once the tumor has reached lymphatic vessels, several malignant cells may break free and enter the lymphatic system. The cells will then be emptied in local lymph nodes during filtration process of the lymphatic fluid. If the lymph nodes contain melanocytes, the malignant cells will invade them.
Stage 4
Here, melanoma reaches distant organs through blood vessels. It at this stage that the disease spreads the fastest. This is primarily because there are many more cells taking part in rapid cell division.
How fast does melanoma spread?
So how fast does melanoma spread? Again, it is not possible to provide an exact answer to this question. It mostly depends on the stage and type of melanoma. Since we have looked at the stages, let’s go through the various types of the disease that exist: Nodular melanoma This type grows and spreads faster than the rest. It usually begins as a red nodular lesion. Within weeks or months, the lesion will have reached the subcutaneous layer and possibly the lymphatic vessels. Superficial spreading melanoma
This type is responsible for most melanoma cases. It mostly shows up after the age of 40. In women, the legs are commonly affected while the trunk is a more common site for the disease in men. This type gets its name from the tendency to spread across the skin before becoming invasive. The ABCDEs can be used to identify this type in its early stages. However, some cases such as in the oral cavity can begin as white melanoma.
Lentigo melanoma
Older people are more commonly affected by this type. Accumulative sun exposure is thought to be a main contributing factor. It usually begins as a dark spot which may be slightly elevated. Of all types, it is the slowest in growth.
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Acral lentiginous melanoma
This is the melanoma that develops on hands and feet. A spot or patch of discoloration is the common warning sign. Sometimes, the spot can linger for months or years before becoming invasive. A subtype known as subungual melanoma that develops under nails is more invasive.
Factors that affect how fast melanoma grows
There are several factors that may affect how fast melanoma grows. They include: Stage For melanoma to jump from one stage to the next, it has to invade surrounding tissues and later migrate. This means that the tumor has to enlarge, which in turn translates to the presence of more malignant cells. So the more advanced the melanoma is, the faster it will grow and spread. Type Nodular melanomas are most aggressive. The lentigo and superficial spreading types are much slower growing. Other subtypes such as spitzoid melanoma in children and amelanotic melanoma are harder to catch early. While they may not necessarily be fast growing, diagnosis is often confirmed when tumors have advanced.
Location
An abnormal mole on the face or limbs is much easier to notice. The same cannot be said about a melanoma in the nasal passages. Additionally, mucosal membranes are much closer to vital organs such as the brain and lungs. This is not to mention the fact that mucosal melanoma symptoms can always mimic those of other more common conditions.
Ulceration
Ulcerated melanomas are more likely to spread. This is primarily because cells have the ability to easily break free and enter blood vessels.
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Genetic factors
It has been observed that some gene factors encourage cancers to develop much quickly than others. Unfortunately, this is highly dependent on the patient and cannot be universally described.
Health status
Immune cells naturally recognize abnormal cellular activities and stop them. Cancer cells have a way of becoming invisible to T-cells. They accumulate substances known as checkpoint proteins. As a result, T-cells see them as normal body cells. This is only one of the several ways with which cancer cells hide from immune cells. A weakened immune system is therefore less likely effective in fighting melanoma.
Where does melanoma spread to the most?
Cases such as melanoma in the brain and melanoma in lungs are complications of advanced stage melanoma. Below are estimations for the likelihood of melanoma spreading to different organs:- Lungs –70 to 85%
- Other skin areas – 55 to 75%
- Lymph nodes – 60 to 75%
- Liver – 56 to 78%
- Brain – 35 to 55%
- Abdominal organs – 25 to 59%
- Bones – 25 to 47%
Prognosis, survival rates and melanoma recurrence
5 year survival rate is commonly used for melanoma prognosis. It estimates the number of people out of 100 who will survive for the next 5 years after diagnosis. Estimates do not provide actual prediction of what will happen. Your doctor will be in a better position to provide more accurate information.- Stage 0 – over 95%
- Stage 1 – around 91%
- Stage 2 – 52% to 83%
- Stage 3 – 40% to 80%
- Stage 4 – 15% to 20%
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