Melanoma: Risk Factors and Treatment

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Table of Contents

Introduction
Melanoma
Risk Factors
Treatment Modalities for Melanoma
Conclusion
References

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.

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