Category: Skin Cancer

Overview

Malignant melanoma is often cited as one of the most common types of cancer of the skin affecting populations of Caucasian origin (Haydu et al., 2010), with available statistics demonstrating that it is the 5^th most commonly diagnosed cancer in the United States (Zhihong et al., 2011). Melanoma can be described as cancer that begins in the melanocytes (colored cells which lie in the epidermis) and can occur anywhere on the skin, though extant literature demonstrates it is more likely to start in specific locations such as the trunk (chest and back), legs, neck or face (American Cancer Society, n.d.).

Official figures released in 2008 by the American Academy of Dermatology cited in Vickers (2009) demonstrate that “…melanoma is the most common form of cancer for young adults 25 to 29 years old and the second most common form of cancer for young adults 15 to 29 years of age” (p. 15). It is reported in the literature that the risk of malignant melanoma is high in light-skinned individuals of European origin with both phenotypic vulnerability and sustained history of sun exposure (Bastuji-Garin & Diepgen, 2002).

Pathophysiology

It is important to underscore the fact that as with other forms of cancer, a sequence of genetic shifts takes place in melanoma cells that leads to mounting aptitude for growth of the affected cells as they become increasingly malignant. As acknowledged by Ralph (2007), “…a key issue emerging more recently in understanding the progression of malignant melanoma is the role played by the tumor microenvironment and the impact of the relationship between the immune system and inflammatory processes in promoting tumor cell development” (p. 125). At the cellular level, the ultra-violent (UV) mediated damage to skin keratinocytes and melanocytes is known to trigger DNA mutational shifts in the expression of growth regulatory genes in already predisposed individuals, resulting in uninhibited cell proliferation. The surrounding tissue damage and drying cells alert the individual’s immune system to the destruction being occasioned (Barnhill et al., 2007), with available literature demonstrating that this alert stimulates transient immune cell infiltrates, which in turn trigger the release of inflammatory signals into the surrounding microenvironment (Ralph, 2007).

But when the above process is taking place, the pro-inflammatory signals engaged in skin healing and repair produce the twin effect of not only arousing the cells of the immune system but also enhancing “…the growth and emergence of selected clones of tumor cells responsive to the very same signals used by the immune surveillance system, thereby helping the tumor cells to establish, escape, and evade immune detection” (Ralph, 2007, p. 125). Thus, during this materialization stage, immune cytokine signaling aspects such as interferon (IFN)-y or granulocyte-macrophage colony-stimulating aspect can and do advance tumor cell growth, survival, and even metastasis when present in small quantities, while at big quantities these aspects would stimulate immune responses to repress tumor progression (Ralph, 2007). This author further suggests that local immune cell activation may also be repressed by the operations “…of the a-melanocyte stimulating hormone, a factor released by dermal fibroblasts that promote the production of pigmented melanocytes to help protect the skin from further damage by continued UV exposure” (p. 125). At this juncture, melanocyte clones appear that prolong to advance in response to the continuing immune cytokine signals, ultimately occasioning the individual to develop nevi that may or may not become dysplastic.

Diagnosis

Krausz et al (2002) note that “…melanoma can present in a variety of histological forms and frequently appears camouflaged as a morphologically similar but a biologically completely different pathologic condition” (p. 120). Although the histologic mimics of malignant melanoma differ according to the anatomic site, pathologic level, tumor phenotype, and presence or absence of the colored cells in the epidermis (Krausz et al., 2002), histopathologic diagnosis typically entails several criteria which include “…asymmetry, diameter <5-6 mm, organizational aberrations including pagetoid melanocytosis, prominent confluence and high cellular density of melanocytes, diminished or absent maturation, effacement or ulceration of epidermis, significant cytologic atypia, and mitoses in the dermal component” (Barnhill et al., 2007, p. 140). Overall, it is important to note that early discovery and diagnosis of the disease are the most essential factors for survival rates (Vickers, 2009).

Treatment/Management

The 2009 evidence-based American Joint Commission on Cancer/International Union against Cancer (AJCC/UICC) melanoma staging and classification system should be used to treat and manage the disease according to the stage of progression. Although surgical excision is the principal treatment for malignant melanoma because recent guidelines demonstrate that a wide local excision should be done with margins correlating to Breslow thickness (Giudici & McPhee, 2011), other treatment methodologies such as isolated limb infusion, intralesional injections with Interleukin-2, and radiation are also used (Hallock et al., 2011).

According to Giudici & McPhee (2011), the sentinel lymph node biopsy (SNLB) should be performed using two tracer substances, blue dye, and radioactively labeled sulfur colloid, to determine the treatment protocol to be adopted. Complete resection, high doses of IFNa-2b treatment, and adjuvant chemotherapy with or without radiation are often used to treat stage I-III malignant melanoma, whereas patients presenting with stage IV are often exposed to systematic treatment using chemotherapy and/or targeted therapy (Zhihong et al., 2011).

Localized treatments such as surgery or radiotherapy are capable of achieving tumor control in stages I-III of the disease, thereby prolonging the survival of patients. Individualized treatments with Interleukin-2, IFNa-2b and other adjuvant chemotherapies not only kill the cancerous cells, but also stimulate the production of the needed immune system cells, assist to improve the effectiveness of the immune system cells, and ultimately cause the cells to produce more cytokines to boost the body’s immune system (Barnhill et al., 2007; Hallock et al., 2011).

Reference List

American Cancer Society. (n.d.). Melanoma skin cancer. Web.

Barnhill, R.L., Mihm, M.C., & Elgart, G. (2007). Malignant melanoma. In K. Nouri (Eds.), Skin cancer (pp. 140-167). New York City, NY: McGraw-Hill.

Bastuji-Garin, S., & Diepgen, T.L. (2002). Cutaneous malignant melanoma, sun exposure, and sunscreen use. British Journal of Dermatology, 146(61), 24-30.

Giudici, N., & McPhee, M. (2011). Diagnosis and treatment of malignant melanoma in pregnancy. Journal of Gynecologic Surgery, 27(3), 171-174.

Hallock, A., Vujovic, O., & Yu, E. (2011). Is radiotherapy an effective option for malignant melanoma? A case report of short course, long-fraction radiation and a literature review. Canadian Journal of Plastic Surgery, 19(4), 153-155.

Haydu, L.E., Holt, P.E., Karim, R.Z., Madronio, C.M., Thompson, J.F., Armstrong, B.K., & Scolyer, R.A. (2010). Quality of histopathological reporting on melanoma and influence of use of a synoptic template. Histopathology, 56(6), 768-774.

Krausz, T., McKee, P.H., Milim, M.C., Spatz, A., Mooi, W.J., Pepper, D.S…Muijen, G.N.P. (2002). Symposium 8: Pathology and pathophysiology of melanocystic disorder. Histopathology, 41(2), 120-146.

Ralph, S.J. (2007). An update on malignant melanoma vaccine research. American Journal of Clinical Dermatology, 8(3), 123-141.

Vickers, A. (2009). Evidence-based practice guidelines for skin cancer screening. Dermatology Nursing, 21(1), 15-18.

Zhihong, C., Siming, L., Xinan, S., Lu, S., Chuanliang, C., Mei, N., & Jun, G. (2011). Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: A study of 552 consecutive cases. BMC Cancer, 11(1), 85-94.

Introduction

Argument construction is a systematic and dynamic process. The main objective, sub objective, and environment influence its process of dissemination. This analytical treatise reviews Sarah Longwell’s dispute on indoor tanning as the cause of melanoma. Besides, the treatise presents a personal opinion on the cause of melanoma and provides a rationale.

Sarah Longwell’s Claim

Sarah Longwell’s claim that there is no scientific evidence to confirm that indoor tanning is one of the leading causes of melanoma is invalid. Sarah argues from a business perspective with her major premise of reasoning lying in protecting the business. She is apparently ignoring the empirical findings of well established organizations such as the National Cancer Institute and other bodies who have established a clear difference in the skin cancer prevalence among the males and females over a decade. It is apparent that women who practice indoor tanning showed higher levels of risk of skin cancer (Stein, 2008).

Thus, concluding that indoor tanning is not a possible cause of melanoma makes her claim invalid since the researchers suggested a possible cause through comparative analysis of the users of indoor skin tonners and those who don’t use them. Apparently, the evidence suggests that the users of indoor skin tanning, especially the females, had higher cases of skin cancer than their male counterparts who do not use the indoor skin tanners.

Personal opinion

Having a well prepared argument logic plan will ensure that a person is adequately prepared with all the materials that are needed to deliver a properly constructed and easy to interpret argument. I don’t agree with Sarah’s claim that indoor skin tanner is not a possible cause of melanoma since the empirical research seems to suggest so. Besides, it is common knowledge that continuous indoor tanning render users skins to the harmful UV-B and UV-A rays which are known to have a damaging effect on skin pigments. Since a prolonged use of indoor tanning changes the texture of skin, its effects cannot be ignored, especially with the rising cases of melanoma being reported among the female population who are the users of skin tanning products.

Despite her full knowledge of the indoor tanning policies in the United States, especially on minors, Sarah argument is only meant to protect the interests of her organization and does not put into consideration the other cancer contributing factors that indoor skin tanning has on the skin. In fact, most of the indoor tanning products have side effects include burning, itching, and mild infection when applied through occlusive dressing to sensitive skins. In cases of prolonged exposure, the side effects may lead to serious skin damages, even to normal skin (Stein, 2008).

The researchers from the National Cancer Institute have proven that “unprotected outdoor ultraviolet exposure is dangerous. Ultraviolet radiation is a carcinogen. If you bathe your skin in the ultraviolet light carcinogen long enough, skin cancer is going to develop” (Stein, 2008, par. 8). There is no major difference between outdoor and indoor tanning since the same products are used in different environments. Although the effects of unprotected outdoor tanning are easy to detect after a short period, it is illogical to assume that practicing indoor tanning with the same products would not expose the skin to the harmful UV rays responsible for melanoma.

Conclusion

Conclusively, Sarah’s argument that there is no scientific evidence to support the claim that indoor tanning is invalid. Research on the effects of outdoor tanning reveals that prolonged exposure to skin tanning chemicals exposes the skins to UV rays. Indoor tanning also exposes the skin to these rays which are associated with melanoma.

Reference

Stein, R. (2008). Melanoma rates increase among young women. Web.

Further Questions for the patient

Seborrheic keratosis

• When did the mole appear? Or when was it first noticed on the body?
• Are the examinations of your body organized by your wife systematic or occasional? If systematic, what are the reasons for them?
• How much time do you spend under the sun?
• Does the mole itch from time to time?
• Are there any other unusual moles on your body?

Malignant melanoma of the skin

• Does your family have a cancer history?
• Have you ever been treated for cancer? What were the results?
• What is the period of mole growth?
• Do you observe other changes in your health or mood?
• Do you have some skin burns or other changes that are caused by the sun?
• Could it happen that your immune system has been weakened recently?

Melanocytic nevi

• Have you ever noticed the appearance of new moles?
• Do you feel pain or discomfort with the growth of the mole?
• Has the color of the mole been changed during the last several days?

Differential Diagnoses

Other seborrheic keratoses (L82.1): is one of the common skin benign tumors that usually affect older males more than 50 years of age (Hiraishi et al., 2013, p. 93). Though chest, face, and shoulders are the most frequent places where this kind of mole could be observed, they could also be found on backs and legs (Longo et al., 2014, p. 121). It is a tan to dark brown neoplasm with a number of clinical appearances that could be caused because of sun exposure (Chang, Wang, Kisner, & Federman, 2012, p. 603). The patient admits that his wife observed a new mole that was different in comparison to all other moles on his back. Besides, it is evident that Jimmy’s skin color is deeply tanned. Sun exposure should be taken into consideration as one of the possible factors that contribute to the development of seborrheic keratosis.

Malignant melanoma of the skin, unspecified (C43.9): is a type of lesion that could be developed in melanocytes (the cells that produce melanin) and introduced as a new pigment that could be different in color (Flaherty, Hodi, & Fisher, 2012, p. 349). In this disease, age turns out to play an important role because a number of unfavorable prognostic variables could be predetermined in older people with the diminished immune system, poor abilities to repair DNA after sun damage, and inabilities to cope with changes in host immune biology (Bartos & Kullova, 2015, p. 143). Jimmy’s main complaint is the inability to understand the nature of a new mole that continues growing and neither looks like other moles on his body nor itches. Such factors as a serious smoking stage and occasional alcoholic drinks could be additional factors to cancer.

Melanocytic nevi, unspecified (D22.9): is a benign growth on the skin that looks like a mole. It is not cancer but a brown or flesh-colored spot on the skin that could grow because of supportive tissue that surrounds the benign (Gulia, Brunasso, & Massone, 2012, p. 443). This change on the skin could be classified into three categories and divided into a number of types with each of them having its own impact on the work of a human body and the development of other diseases such as cancer. Jimmy does not have enough information about the history of the mole or the peculiarities of its development. He wants to clarify the nature of the new mole on his back because he is not so young that some new moles could appear on his body without any reason.

Body Systems to Examine

Seborrheic keratosis, melanoma, and melanocytic nevi are the problems of the skin. Therefore, it is possible to gather the body systems and explain the effects of the differential diagnoses on different systems.

The integumentary system – skin problems and the necessity of surgeries to remove unpleasant moles.

The immune system – stress and poor protection.

The endocrine system – metabolism changes could be observed.

The nervous system – paranoia and the inability to understand the nature of the mole could influence the mental health of a person.

The blood and circulatory system could be affected by cancer because its spread is possible through the bloodstream.

The lymphatic system – cancer cells could approach lymph nodes and begin growing there.

Specific Lab/Testing To Offer

Three differential diagnoses are skin problems. Therefore, the diagnostic steps should be similar to all of them because the nature of the mole could help to clarify the diagnosis and start the required portion of treatment.

Reflectance confocal microscopy (RCM) helps to organize the assessment of skin neoplasms at the cellular level in a short period of time (Ahlgrimm-Siess et al., 2013, p. 120).

A biopsy helps to examine the tissue that could be taken from the body in case it is abnormal to check if cancer is the reason for the mole or not (Chang et al., 2012, p. 603).

Dermoscopy aims at examining the skin with the help of special skin surface microscopy and defining the nature of skin lesions (Gulia, Brunasso, & Massone, 2012, p. 450).

References

Ahlgrimm-Siess, V., Cao, T., Oliviero, M., Laimer, M., Hofmann-Wellenhof, R., Rabinovitz, H. S., & Scope, A. (2013). Seborrheic keratosis: reflectance confocal microscopy features and correlation with dermoscopy. Journal of the American Academy of Dermatology, 69(1), 120-126

Bartos, V. & Kullova, M. (2015). Age-related differences in the incidence and clinicopathological findings of malignant melanoma of the skin. Our Dermatologist Online, 6(2), 140-144.

Chang, C.R., Wang, S., Kisner, R., & Federman, D.G. (2012). Elderly adults and skin disorders. Southern Medical Journal, 105(11), 600-606.

Flaherty, K. T., Hodi, F. S., & Fisher, D. E. (2012). From genes to drugs: Targeted strategies for melanoma. Nature Reviews Cancer, 12(5), 349-361.

Gulia, A., Brunasso, A.M.G., & Massone, C. (2012). Dermoscopy: Distinguishing malignant tumors from bening. Expert Review of Dermotology, 7(5), 439-458.

Hiraishi, Y., Hirobe, S., Iioka, H., Quan, Y. S., Kamiyama, F., Asada, H.,… & Nakagawa, S. (2013). Development of a novel therapeutic approach using a retinoic acid-loaded microneedle patch for seborrheic keratosis treatment and safety study in humans. Journal of Controlled Release, 171(2), 93-103.

Longo, C., Moscarella, E., Piana, S., Lallas, A., Carrera, C., Pellacani, G.,… & Argenziano, G. (2014). Not all lesions with a verrucous surface are seborrheic keratoses. Journal of the American Academy of Dermatology, 70(6), e121-e123.

Introduction

Breakthroughs in medicine are common occurrences in the modern age. The success in the medical field is the result of the better use of technology and information available on a global scale. The collaboration of doctors and other specialists made it easier to come up with solutions to medical problems that bothered many people in the past. Nevertheless, there are still many illnesses and medical issues that remain a mystery to many physicians. One of the most problematic is melanoma – it is a cancer of the skin. Doctors must find a way to know more about this disease to find a cure. Melanoma is a preventable disease but ignorance of the problem is the reason why this medical condition has claimed the lives of many people.

This study attempts to learn more about Melanoma. It is important to know more about risk factors so that at-risk patients can improve their chances of beating the disease. It is also important to improve the information dissemination campaign within countries that show high incidence rates of this type of cancer. Just like other forms of cancer, melanoma significantly reduces the productivity of a person affected by it. The cost of treatment is an added burden that affected families must not be forced to carry.

Melanoma

This medical condition is a form of cancer that affects the skin, the largest organ of the human body. Although melanoma is a type of cancer that exhibits the usual problems associated with cancer and tumor, melanoma distinguishes itself as being “…the most serious type of skin cancer” (Merck, 2011). The root cause of the problem is exposure to ultraviolet radiation. During the summertime people love to put on their swimming attire and other types of clothes that expose a great degree of their skin. These types of clothing do not offer much protection from sunlight. Ultraviolet radiation coming from sunlight is a potent force that has to be blocked by appropriate clothing. Many have adapted to the scorching heat of the sun by developing natural barriers that can be found in their skin. But Caucasians and people with fair skin do not possess much of the natural blocking mechanisms that are present in dark-skinned individuals, thus they are prone to acquire melanoma.

In the Western world many people suffer from this medical condition. The reason is simple. It is a fun activity to frolic under the sun. In addition, many are willing to spend hours baking under the intense glare of the sun because of the effect this activity has on their looks. The aesthetic aspect of sunbathing is the reason why it is difficult to put a stop to this practice. Therefore, for many decades Americans, Europeans, and Australians love craved for that bronze look and so they either go to tanning booths with its extreme use of ultraviolet radiation or they spend so much time under the scorching heat of the sun’s rays. Thus, melanoma is on the rise especially in the United States.

In America, melanoma is now considered one of the fastest-growing types of cancer and it has claimed the lives of many. Health experts are alarmed because this type of cancer is very aggressive and once diagnosed many succumbed to its effects in a short span of time. The high number of patients recorded in the last few years coupled with the mortality rate is enough to prompt the government and concerned parties regarding the importance of improving the fight against melanoma. Consider the fact that “the median survival of patients is generally limited to 6 to 10 months, and it has not been significantly improved since the 1970s” (University of Michigan Health System, 2007, p.1). Many cancer survivors can attest to a higher survival rate but not those afflicted with melanoma.

Another problematic characteristic of melanoma is that it is not only limited to the skin. According to the National Cancer Institute melanoma can also develop in the human eye and it is labeled as intraocular or ocular melanoma (National Cancer Institute, 2007, p.1). However, the most common area affected is the skin. The most logical explanation is that the human skin is the largest organ of the human body that is directly exposed to ultraviolet rays. A more technical explanation is that the cancerous growth which is called melanoma commonly occurs within the skin cell called melanocytes.

Before going any further it is important to note that melanocytes are skin cells and that their primary purpose is the production of melanin (Barnhill & Trotter, 2004). The primary purpose of melanin on the other hand is to give a person’s skin a particular color and the reason why groups of people are classified by the color of their skin. Melanin also explains how various ethnic groups had adapted to the harmful effects of ultraviolet radiation, thus people living near the equator developed dark skin as compared to those who lived in temperate zones.

Melanin is important not only for the external beauty and color of the skin but also because it is the body’s primary defense against UV rays. Its main function is actually to protect the lower layers of the skin from the sun’s harmful radiation. Melanin acts as a barrier. Those who are constantly exposed to the sun have developed a natural blocking mechanism which is the presence of a high amount of melanin in their skin and also explains the darker complexion of these ethnic groups. But for Caucasians there is little need for melanin because traditionally they live in colder climates where the sun can be hidden many months of the year. The following information supports this view:

Over the past several decades, there has been a significant increase in the incidence of and mortality from coetaneous melanoma among white populations worldwide. From the 1960s through the mid-1980s the incidence of melanoma among white populations has consistently risen, with increases averaging between 3 and 7% per annum. The highest incidence rates worldwide have been observed in Queensland, Australia (Barnhill & Trotter, p.1).

Now, when a person spends a considerable amount of time under the sun, melanocytes are forced to work overtime. There is no extra pressure for the melanocytes to produce more melanin (Buchanan & Roberts, 2000). The added workload is believed to be the reason why melanocytes are known to behave abnormally (Buchanan & Roberts, 2000). The abnormal behavior of the melanocytes is the signal to health experts that cancer has occurred at Stage 1 (Medical News Today, 2007). Nevertheless, it is still a puzzle as to how melanocytes begin their transformation from healthy cells to cancerous cells (Soengas, 2007). In fact, the dermatology research team at the University of Michigan remarked that “The identification of the molecular basis of melanoma progression […] is largely unknown” (Soengas, 2007). There is a need for more research in this field.

Risk Factors

There is both good news and bad news regarding this ailment. The good news is that if melanoma is diagnosed at an earlier stage then there is a greater chance of effective treatment and recovery. The bad news however concerns those that did not take firm action when it comes to the symptoms of melanoma and only sought medical help when the disease has already progressed into the latter stages. If diagnosed at an earlier stage, doctors assert that melanoma is highly treatable (Medical News Today, 2007). It is therefore important to learn more about the symptoms in order to seek medical help at the earliest possible time.

Before learning more about the symptoms it is imperative to know more about the risk factors because it is the first step to mitigate the impact of melanoma. It is also important to take note that “one theory that has been successfully applied to a number of health-related issues views change as a gradual process involving several stages” (Buchanan & Roberts, year, p.48). Therefore, it is imperative to deal with melanoma when it is still in the early stages of development so that it will not be given the chance to progress to higher levels.

Risk factors in the development of this type of cancer include “endogenous and environmental factors and their complex interactions” Barnhill & Trotter, 2004, p.2). A more detailed description of risk factors is as follows:

The most significant factors are numbers of nevi (both typical and atypical), coetaneous and pigmentary phenotypic characteristics (such as eye color, hair color, skin color, and freckling), skin phototype (propensity to tan and burn), family and personal history of melanoma and non-melanoma skin cancer, significant sun exposure, and probably nonsolar UV radiation exposure (Barnhill & Trotter, 2004, p.2).

According to one report, “The most stunning statistic is the increase in risk for persons with atypical moles, prior personal history of melanoma, and a family history of melanoma. These individuals’ likelihood of developing another melanoma is 500 times higher than that of the general public” (Wang, 2011, p.52). Individuals with these risk factors must have close follow-up. An example of a close follow-up is the insistence that they should conduct a full-body skin exam at least once a year (Wang, 2011, p.52). But there are at-risk individuals who find it unnecessary to be extra-vigilant when it comes to melanoma. Consider the following commentary:

Many patients when they first present to a doctor with a change in a pigmented lesion do not seriously believe that they have a type of skin cancer as there is still perception that all cancers are painful and, in particular with melanoma, that all malignant lesions itch or bleed” (Buchan & Roberts, 2000, p.39).

The high mortality rate is linked to the late diagnosis of melanoma. By that time cancer has already created complications that can lead to the sudden demise of the person. But there is also another reason why melanoma at later stages is more problematic, according to researchers at the University of Michigan: “A main contributor to this poor prognosis is an extreme resistance to standard modalities of anticancer treatment, ranging fro immunotherapy, to radiotherapy or chemotherapy” (Soengas, 2007). It is therefore important to determine the risk factors to treat this medical condition as soon as possible.

Treatment Modalities for Melanoma

As mentioned earlier there are is still no clear understanding regarding the progression of the disorder at the molecular level. Health experts can determine who among the population has a greater risk to develop melanoma but the disease is still a mystery when it comes to issues that cannot be seen by the naked eye. As a result medical practitioners in the field of cancer treatment have acknowledged the difficulty of managing melanoma.

The high mortality rate and the speed at which conditions can go from bad to worse suggests a better way detect symptoms. At the same time these new findings place much importance on prevention rather than the cure. Thus, the medical community has disseminated information regarding the need to decrease the amount of time spent sunbathing or using UV rays in tanning saloons. At the same time, those who are at a greater risk of developing melanoma must take a proactive stance when it comes to prevention. The best way to mitigate the effect of UV rays is to use sunscreen lotions, hats, and appropriate clothing to block the rays of the sun. It would be better for them to work under a shade.

For those who are already battling this aggressive form of cancer there is no other course of action but to avail of a suitable treatment method. There are at least four (4) major types of treatment:

• Surgery – This includes removing the melanoma or removing cancer cells and some of the normal tissue around it; lymphadenectomy is also an option wherein the lymph nodes are removed. Skin grafting is also part of this type of treatment;
• Chemotherapy – Cancer drugs are taken orally or injected into a vein so that they can enter the bloodstream and kill cancer cells; but due to the fact that melanoma is in the skin, basically outside the internal organs of the body this common cancer treatment has to be modified; the technique is called “hyperthermic isolated limb perfusion” where the flow of blood from the limb is inhibited through the use of a tourniquet and thus anticancer drug can be put directly into the blood of the limb;
• Radiation Therapy – There are two types of radiation therapy – internal and external radiation therapy where the former uses high-energy x-rays while the latter uses radioactive substances sealed in catheters and then placed near the affected areas of the body;
• Biologic Therapy – This type of therapy finds ways to boost the body’s immune system so that it can fight the disease (National Cancer Institute, 2007, p.1).

It must be made clear that surgical removal of melanoma in different locations presents different challenges, taking into consideration the removal of the primary melanoma, the intervening lymphatic vessels, and the lymph nodes to which metastases may spread” (Brunner, Smeltzer, Bare, Hinkle, & Cheever, year, p.1711). The removal of tumor-containing lymph nodes can result in the following complications: “hematoma, wound infections, postoperative lymphedema, nerve damage, and lymphatic fistula formation” (MacFarlane, year, p.208).

Another popular form of treatment is Selective Sentinel Lymphadenectomy or SSL. The following are the standard steps when it comes to SSL: 1) preoperative lymphoscintigraphy; 2) injection of radioisotope; 3) identification of lymphatic basins; 4) determining the type of anesthesia; 5) intraoperative mapping technique; 6) injection of isosulfan blue dye; 7) intraoperative mapping with a handheld gamma probe; 8) identification of sentinel lymph nodes; and 9) pathological examination of sentinel lymph nodes by hematoxylin and cosin staining (Bland & Csendes, year, p.1600).

However, there are complications and these are listed as follows: a) seroma; b) wound infection; c) sensory loss; and d) lymphedema associated with SSL for melanoma in the axilla and the groin (Bland & Csendes, year, p.1603). The complications can further reduce the quality of life of the patients.

Patients and their loved ones must have access to pertinent information regarding the disease and the available forms of treatment. However, there are other issues to consider. Just like any other cancer, melanoma brings a certain level of pain and discomfort to the patient. The skin is a sensitive human organ designed to feel stimuli from the environment, imagine what happens if this organ is damaged or cancerous. It is also important to take care of the needs of the patient, “the major goals for the patient may include relief from pain and discomfort, reduced anxiety and depression, increased knowledge of early signs of melanoma, and absence of complications” (Brunner, Smeltzer, Bare, Hinkle, & Cheever, year, p.1711). These steps must be added to the overall treatment program.

The medical community continues to find ways to deal with melanoma. One of the cutting-edge developments can be seen in the laboratories of the Wistar Institute. This is an independent nonprofit biomedical research facility established to discover the causes of cancer and at the same time develop cures for major medical problems such as cancer. Researchers from the Wistar Institute discovered that a substance called peptide exists in approximately 70 percent of melanomas but not in normal cells (Medical News Today, 2007). Dorothee Herlyn one of the lead researchers in the project decided to use principles of a vaccine approach to deal with melanoma.

According to Herlyn, the peptide found in melanomas can be used to stimulate T cells in the body. As result T cells are then able to attack the melanoma cells. Herlyn also discovered that a great number of melanoma patients, about half of them, have killer T cells that respond well to the stimulation process. As result Herly is optimistic that this new-found strategy can be used to treat at least one-third of all melanoma patients (Medical News Today, 2007).

Conclusion

Melanoma is a serious medical condition. It claimed the lives of thousands of people in recent decades alone. However, it is a preventable disease. It is therefore important to know more about risk factors. Certain members of the population are prone to develop melanoma. Their knowledge of risk factors and symptoms should prompt them to invest in regular check-up and skin examinations. Prevention is better than cure because it is more cost-effective. But there is another reason why melanoma must be detected at the earlier stages. Medical experts said that it is highly treatable if the disease has been diagnosed in the earlier stages. Another reason why prevention and early diagnosis are crucial is based on the realization that melanoma is still a challenge for the medical community to understand the true nature of the disease. It is difficult to find an effective cure if the disease has already progressed into the latter stages.

References

Barnhill, R., & Trotter, M. (2004). Pathology of malignant melanoma. New York: Springer.

Brunner, L., Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Brunner and Suddarth’s textbook of medical-surgical nursing. PA: Wolters Kluwer Health.

Buchanan, J., & Roberts, D. (2000). Pocket guide to malignant melanoma. MA: Blackwell Science.

MacFarlane, D. (2010). Skin cancer management: a practical approach. New York: Springer.

Medical News Today. (2006). Melanoma research progress suggests optimism for future cures. Web.

Merck. (2011). What is melanoma? Web.

National Cancer Institute. (2011). General information about melanoma. Web.

Soengas, M. (2005). Molecular basis of melanoma progression and drug resistance.

Wang, S. (2011). Beating melanoma: a five-step survival guide. MD: the Johns Hopkins University Press.

Introduction

Melanoma is one of the most dangerous forms of skin cancer and has been on the rise over the past 30 years. More than 90% of persons who have had the illness for five years are still alive (Chiaravalloti et al., 2018). According to the American Cancer Society Journal, melanoma is a condition that affects more than a million people in the U.S (Chiaravalloti et al., 2018). The illness is also well-known for its virulence and for its ability to elude the treatments available.

On the other hand, melanoma has the ability to spread during its early phases. Its aggressiveness and resistance to therapy are two of its most concerning characteristics, and the disease will take 10 to 25 years of a person’s life on average (Tibubos et al., 2018). Researchers need to understand the long-term implications of melanoma diagnosis to assist them in devising appropriate melanoma care practices that can enhance the quality of life. The term “quality of life” encompasses a person’s physical, social, and mental well-being (Vogel et al., 2017). There is insufficient research on the effects of melanoma treatment on people’s life. The findings of this research will help to alleviate some of the anxieties that survivors of melanoma have. There are many issues related to the quality of life for those battling cancer, and the purpose of this study is to have a concentrated group discussion to identify them all. To advance the life of the melanoma survivors, researchers will need to better know the challenges that survivors face even after their treatment has ended.

Study Partakers

Patients who had been treated by a dermatologist and an oncologist were included in the research. Patients who agreed to participate in the study were asked to provide a suitable sample that would aid in achieving the targeted outcomes. To participate in the study, participants had to have been diagnosed with cutaneous melanoma after 2010. The research was open to everyone between the ages of 18 and 65. It was required to set boundaries in order to guarantee that the study’s appropriateness criteria matched those of the prior investigations.

Intensive Group Conversation

Individuals diagnosed with stage 1-3 melanoma were divided into small groups and asked to share their fears and anxieties about the condition in the research. However, the groupings were arranged in accordance with the severity of the illness. There were two groups of patients: those who had early-stage melanoma and those who had more advanced stages (stage 3). Due to the aforementioned observations of differences in emotional adjustment upon diagnosis, the gender of the patient was also considered an essential factor.

The research required two-hour focus group conversions to point out the survival concerns among them. Participant signatures on written informed agreements were obtained ahead of time and presented to them before the conversation began. Audio recordings of the meetings were made, and the subjects were given a token of gratitude for their participation. Moderators were utilized in the facilitation of the discussion, and each group’s moderator followed a set of guidelines for leading a productive conversation in a small group setting. The discussions were facilitated by questions that had been iteratively formulated. First, a literature review was conducted on the prominence of life in melanoma fighters.

The examiners went over all of the concerns raised and narrowed them down to a manageable number of questions for the focus group discussion. Finally, a question on melanoma’s physical, social, emotional, and expressive effects after diagnosis was asked. In analysis of records given by recruited groups, standard qualitative research procedures were used. Due diligence, homogeneity, and consensus on the most essential subtopics were taken into consideration while comparing the findings.

Findings

The study utilized 110 people with melanoma who were willing to participate in the trial. Of the willing 110 participants, only 73 of them participated in the study. The rest of the participants who expressed interest but never participated gave scheduling conflicts as the significant reason for their lack of participation. Despite the failure among some targeted number of participants, extensive discussion was carried out among the available number, and excellent results were revealed. Physical, emotional, social concerns amongst the melanoma survivors, as well as their experience at diagnosing, were studied, and the rest of this chapter gives the findings.

Physical uncertainties

The study looked at the individuals’ physical well-being from the moment of diagnosis all the way through their post-survivorship years. Many of the subjects in the research reported recurring physical anxieties, such as pain, shock, and edema (Brown et al., 2020). According to one participant, her melanoma started on the side of her face and spread to the neck itself. She had to wear compression stockings to prevent fluids from leaking out since it was so deep. Other individuals experienced minor recovery-period limits, mostly on their range of motion, although these subsided with time because of the treatments they received. Additional adverse effects were reported by those who received adjuvant treatment, with weariness being the most common. Melanoma patients with stage 1 tumors who had modest procedures reported no physical changes.

Emotional Concerns

Majority of participants reported feeling anxious about their emotional well-being. Fearing additional malignancies, several people were concerned about the test and follow-up appointments following melanoma diagnosis (Krajewski et al., 2018). Pressure decreased with time for some subjects, while tension persisted for years after their diagnosis for others. Most of those surveyed said they depended on their religious leaders for emotional support, while some relied on family members. The spiritual support from families and religious authorities were noted to ease the emotional concerns among the participants

Social Apprehensions

Some of the participants’ social concerns included avoiding excessive sun exposure by switching up their usual social activities. Even though some said they did not want to allow their melanoma diagnosis to hinder their social life, others took extra precautions to avoid being in the sun, so they could do their favorite things. In addition, additional participants shared their thoughts on the necessity of spreading the word about melanoma and its preventative techniques. Most people were frustrated because others misunderstood how bad their situation was. Due to the lack of health insurance and an expensive deductible plan, several participants had difficulty getting the best possible therapy for their skin cancer.

Changes in Behavior

The study also looked at how people’s health habits changed as a result of melanoma diagnosis. According to a number of individuals, they minimize their exposure to the sun. Some also avoided exposure to the sun altogether, and therefore they never engaged in any outdoor activity. Those who had the condition for a more extended period required more protective clothing from sunscreen (Fu et al., 2020). Some other participants said that they had become used to their condition and accepted themselves and so never altered any of their life style. A study has revealed some remained indoors because they feared other people.

Discussion and conclusion

The primary purpose of this research was to examine the experiences of people diagnosed with melanoma. Survivors of melanoma reported certain quality-of-life concerns as a result of their experiences (Baruch et al., 2021). Research on cancer survivors’ quality of life is ongoing, and this research will add to the findings from previous studies on the subject. Most of the individuals in this study were astonished and heartbroken when they learned they had the disease. The findings are also in line with earlier studies showing that people who have survived melanoma often have side effects related to their therapy. After adjuvant treatment, individuals reported experiencing symptoms including nausea and exhaustion. Persistent pain and changed feelings were also experienced by several of the patients at the surgical site. Some of the individuals had lymphedema, which added to the problems. Some volunteers, on the other hand, did not express any physical discomfort.

Emotional distress also is a major concern for melanoma survivors, as research has shown. According to some participants, the most common concern was anxiousness. Some patients expressed anxiety about recurrence or the emergence of an entirely new type of cancer, while others expressed concern about the disease spreading to other members of their family. During the diagnosis, fear was at its highest, but it decreased with time. Participants in this study, like those in previous studies, expressed anxiety over surgical scars that were left behind following their procedures (Baruch et al., 2021). Some folks were worried about what others would think of them since they believed they were deformed.

Some individuals who were diagnosed with melanoma had a positive influence on their families since it strengthened their familial ties, according to prior research. Some people, on the other hand, feared social isolation and hence avoided any outdoor activities. Research has found that despite the support of the individual family, loneliness and isolation remained high (Davis et al., 2019). The general public’s lack of knowledge regarding the danger of melanoma was cited as a contributing factor throughout the discussion. Compared to breast cancer survivors, melanoma survivors also have to meet and support one other on a more regular basis (Greco et al., 2019). Public awareness of the condition will also be raised as a result of the group effort.

Some survivors stayed indoors when the sun was out, avoiding activities that might expose themselves to the rays. Others used garments to protect themselves from the sun’s harmful rays. Even with a diagnosis, some people refuse to limit their sun exposure, putting their health in danger. The paper recommends that melanoma survivors be educated about sun exposure and sun protection activities in order to reduce their chance of developing future melanomas.

To conclude, melanoma has become more common in recent years. Considering the disease’s existence at young age, improved knowledge of the experience of its survivors is needed to create strategies to assist them in managing the illness. The ailment has such a devastating impact on the survivors’ quality of life. Understanding the illness in greater detail is vital to assist manage it and improve health and well-being as melanoma’s incidence continues to increase.

Disease survivors who took part in this study expressed a broad sense of psychological, social, and physical problems after their diagnosis. As a result of the high levels of loneliness and isolation experienced by melanoma survivors, it is critical that the general public learn more about them. In order to improve their social well-being, survivors should engage with one another and offer support to one another. Despite the fact that melanoma survivors have varying concerns, there are many similar experiences. It is clear from the results of this investigation that the illness affects only one person and is not communicable. As a result, melanoma sufferers’ shared experiences may be used to build interventions that improve their health and well-being.

References

Baruch, E. N., Youngster, I., Ben-Betzalel, G., Ortenberg, R., Lahat, A., Katz, L., & Boursi, B. (2021). Fecal microbiota transplant promotes response in immunotherapy-refractory melanoma patients. Science, 371(6529), 602-609.

Brown, S. L., Fisher, P. L., Hope‐Stone, L., Hussain, R. N., Heimann, H., Damato, B., & Cherry, M. G. (2020). Predictors of long-term anxiety and depression in uveal melanoma survivors: A cross-lagged five-year analysis. Psycho-Oncology, 29(11), 1864-1873. Web.

Chiaravalloti, A. J., Jinna, S., Kerr, P. E., Whalen, J., & Grant-Kels, J. M. (2018). A deep look into thin melanomas: what’s new for the clinician and the impact on the patient? International Journal of Women’s Dermatology, 4(3), 119-121.

Davis, L. E., Shalin, S. C., & Tackett, A. J. (2019). Current state of melanoma diagnosis and treatment. Cancer biology & therapy, 20(11), 1366-1379.

Fu, H., Teleni, L., Crichton, M., & Chan, R. J. (2020). Supportive care and unmet needs in patients with melanoma: A mixed-methods systematic review. Supportive Care in Cancer, 28(8), 3489-3501.

Greco, A., Safi, D., Swami, U., Ginader, T., Milhem, M., & Zakharia, Y. (2019). Efficacy and adverse events in metastatic melanoma patients treated with combination BRAF plus MEK inhibitors versus BRAF inhibitors: A systematic review. Cancers, 11(12), 1950.

Krajewski, C., Benson, S., Elsenbruch, S., Schadendorf, D., & Livingstone, E. (2018). Predictors of quality of life in melanoma patients 4 years after diagnosis: results of a nationwide cohort study in Germany. Journal of Psychosocial Oncology, 36(6), 734-753. Web.

Tibubos, A. N., Ernst, M., Brähler, E., Fischbeck, S., Hinz, A., Blettner, M., & Beutel, M. E. (2019). Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study. Supportive Care in Cancer, 27 (8), 2809-2818.

Vogel, R. I., Strayer, L. G., Engelman, L., Nelson, H. H., Blaes, A. H., Anderson, K. E., & Lazovich, D. (2017). Comparison of quality of life among long-term melanoma survivors and non-melanoma controls: A cross-sectional study. Quality of Life Research, 26 (7), 1761-1766.

Malignant melanoma is the deadliest type of skin cancer due to its ability to evade all treatment attempts. It accounts for 75% of mortalities associated with skin cancer though it only constitutes 4% of total dermatological cancer incidences (Davis et al. 1367). CDC research statistics show that melanoma’s annual incidences and mortality rates have considerably increased in the last few decades. As of 2019, in every 100,000 people in the US, 22.1 are diagnosed with malignant melanoma (Davis et al. 1367). This dramatic increase in incidences can be attributed to modern-culture behaviors of sun-seeking and the migration of fair-skinned populations to regions near the equator (Davis et al. 1366). Given the high prevalence and mortality rates of melanoma, information about the risk factors and effects of this neoplasm is valuable in improving understanding of the disease. This essay reviews the causes of melanoma, including the genetic aberrations involved, and discusses some of the effects of this cancer.

Melanoma arises from complex interactions between genetic and environmental factors. In the genetic aspect, the majority of the cases are due to inherited or acquired mutations in the MAP kinase pathway (Davis et al. 1368). MAPK contributes to carcinogenesis by disrupting the cell cycle and inhibiting apoptosis (Leonardi et al. 8). Epidemiological research implicates intense Ultraviolet radiation as the main cause of acquired mutations (Davis et al. 1368). This comes about due to intensive sun exposure and the acquisition of sunburns early in life (Liu and Sheikh 3). According to Davis et al., sunburns in childhood or early adolescence doubles the risk for melanoma in adult life (1367). Ultraviolet radiation increases the risk for skin cancers through DNA mutations, that is, by inducing the formation of pyrimidine dimers in DNA (Davis et al. 1367). Alternatively, UV rays facilitate tumorigenesis through the deamination of the cytosine base pair into thymidine. UV mutagenic effects are very potent to the point that the base pair alteration rate in malignant melanoma exceeds that of any other solid cancer.

Malignant melanoma can also occur due to hereditary or familial mutations. According to Davis et al., 8-12% of patients with melanoma have a family history of this neoplasm (1368). Patients in this category are highly sensitive to UV rays, which are present in childhood. Importantly, malignant melanomas emanate from moles, and individuals from families with a history of melanoma develop numerous moles. Genetic profiling also shows there are different mutations in hereditary melanoma compared to the non-hereditary type. Approximately 40 % of familial melanoma shows a somatic mutation in the CDKN2A gene (Davis et al. 1369). This genetic aberration causes defects in tumor suppressor protein (P53) that regulate the G1-S checkpoint, causing uncontrolled cell proliferation. Hereditary melanomas develop earlier (average age 65 years) and present as multiple cancer lesions.

Melanocytic nevi (benign lesions) predisposes patients to malignant melanoma. Nevi, colloquially known as birthmark or mole, are dark pigmentations on the skin composed of aggregates of melanocytes (Davis et al. 1370). When the quantity of nevi increases, more often than not, it signifies an increased predisposition to melanoma. Similarly, if a mole changes color, shape, or texture, it is pathognomonic for the onset of melanoma (Leonardi et al. 8). Epidemiological studies show that nearly 81% of patients with melanoma noticed nevi changes at the site of the malignant lesion (Davis et al., 1370). Moles prove valuable in the early diagnosis and prevention of skin cancer. However, not all changing nevi indicate (or progress to) melanoma.

The effects of melanoma are somewhat similar to those of other forms of cancer. For instance, melanoma patients present with cachexia and lymphadenitis (Davis et al. 1371). Cancer cachexia is more common in metastatic melanomas, and it impairs the patient’s work capacity. Lymphadenitis is commonly due to cancer dissemination to sentinel and distant lymph nodes and is an indicator of poor prognosis. Another effect of melanoma is increased susceptibility to other types of skin cancer. Research evidence reveals that poor management of melanoma increases the risk of another melanoma different from the first one (Davis et al. 1372). There is also a substantial risk of developing other malignancies such as salivary gland cancer and small intestine tumors. Organ failure is also a potential consequence of malignant melanoma. Neoplastic cells metastasize to distant organs like the liver, brain, heart, and spinal cord via the lymphatic and hematogenous routes, and by invading these organs, they disrupt their physiological functions (Davis et al. 1372). Metastasis in melanoma is very common and causes physiological derangements in other organs more often than not.

Dermatological disfigurement and scarring are potential consequences of malignant melanoma. Neoplastic growth may present as cutaneous lesions which damage skin appearance (Davis et al. 1374). Similarly, 64-71% of melanoma patients develop skin rashes or proliferative lesions following treatment (Davis et al. 1374). Other potential effects of melanoma include verrucous keratosis, photosensitivity, and hyperkeratosis, most of which are exacerbated by treatment. Malignant melanoma also increases the global burden of the disease since many resources are directed toward its treatment and management (Davis et al. 1376). Melanoma is aggressive cancer; therefore, more research on preventive and curative measures is needed to reduce its incidences.

Works Cited

Davis, Lauren, et al. “Current State of Melanoma Diagnosis and Treatment.” Cancer Biology & Therapy, 2019, Web.

Leonardi, Giulia, et al. “Cutaneous Melanoma: From Pathogenesis to Therapy (Review).” International Journal of Oncology, vol. 52, no. 4, 2018, Web.

Yuxin Liu and M Saeed Sheikh. “Melanoma: Molecular Pathogenesis and Therapeutic Management.” Molecular and cellular pharmacology vol. 6, no. 3 (2014): 228. Web.

Primary Diagnosis

Malignant melanoma of skin (C43)

Malignant melanoma is one of the most aggressive forms of cancer people could suffer from (Flaherty, Hodi, & Fisher, 2012, p. 349). It could appear on different parts of the body that are usually exposed to the sun (Stanganelli, 2013, p. 351). Recent research proves that red-haired people are at high risk of having melanomas because the skin of such people lacks natural protection against ultraviolet radiation (Printz, 2013, p. 1118; Rodwell, 2012, p. 795). Elderly adults are also a group of people, who are at a high risk of having melanomas or other types of cancer because their immune system is weak and cannot resist all-natural dangers (Chang, Wang, Kisner, & Federman, 2012, p. 600).

The rationale for such a primary diagnosis can be explained using the fact obtained from the assessment done. A patient is a 58-year-old man with red hair, who prefers to work without shirts on the roof to promote his personal comfort. Besides, he does not use sun-protective creams or sprays, and his skin is tanned. There is also another lesion on his shoulder with a black-to-purple color. Such signs could prove that the patient has skin cancer on different parts of his body because of his careless attitude to his skin.

Treatment Plan

Diagnostics

A biopsy is one of the frequently used methods to check the nature of moles on a human body and make a further decision in regards to the patient’s treatment (Change et al., 2012, p. 603).

Medication

Melanoma is usually treated with the help of special therapies such as radiation therapy, chemotherapy, and surgeries with the help of which the lesion could be removed. Still, the following drug could be offered to the patient:

Rx: Opdivo, 3mg/kg, Sig.: a 60-minute infusion once every two weeks. Disp # 30. Refill: not required (Scott, 2015, p. 1413).

Conservative Measures

Surgeries are usually the best and most effective answers to the patients, who have melanoma. A doctor removes it and prescribes the required portion of therapies that could help to stabilize the organism (Change et al., 2012, p. 603). Besides, it is required to ask the patient’s family to decrease his presence under the sun.

Education

One of the most important issues for consideration is the promotion of sun-protective behaviors (Guy et al., 2015, p. 591). The patient should learn how to protect his body from the sun regarding a number of risks of having other cases of melanoma or other types of skin cancer. It is also important to understand that his smoking history is another risk factor for cancer. It is better to quit smoking and choose a healthy diet with the help of which he could improve his immune system.

Referrals

An oncologist is a person whom Jimmy should address as soon as a biopsy proves the case of skin cancer. The help of a dermatologist could also be appropriate with time to get the required portion of the information on how to protect his skin.

Follow-Ups

In case a surgery occurs, the patient should address a doctor in two weeks and check his condition. If no surgery is required, the next visit to a doctor should be in one month to check the nature of the mole, its size, and its effects on a human body.

References

Chang, C.R., Wang, S., Kisner, R., & Federman, D.G. (2012). Elderly adults and skin disorders. Southern Medical Journal, 105(11), 600-606.

Flaherty, K. T., Hodi, F. S., & Fisher, D. E. (2012). From genes to drugs: Targeted strategies for melanoma. Nature Reviews Cancer, 12(5), 349-361.

Guy Jr, G. P., Thomas, C. C., Thompson, T., Watson, M., Massetti, G. M., & Richardson, L. C. (2015). Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. Morbidity and Mortality Weekly Report, 64(21), 591-596.

Printz, C. (2013). New research on melanoma risk in red‐haired people. Cancer, 119(6), 1118.

Rodwell, C. (2012). Melanoma: Seeing red. Nature Reviews Cancer, 12(12), 795.

Scott, L.J. (2015). Nivolumab: A review in advanced melanoma. Drugs, 75, 1413-1424.

Stanganelli, I., Gandini, S., Magi, S., Mazzoni, L., Medri, M., Agnoletti, V.,… & Falcini, F. (2013). Sunbed use among subjects at high risk of melanoma: An Italian survey after the ban. British Journal of Dermatology, 169(2), 351-357.