Malignant Melanomas

Skin cancers are the most common type of cancers, and there are three main types, which are divided into non-melanoma skin cancers, and malignant melanomas.

Overview

While all skin cancers are cause for concern and require treatment, BCC and SCC are more common than malignant melanoma (sometimes only called ‘melanoma’), and they don’t usually spread to other areas parts of the body.

Melanoma is the rarest type of skin cancer, accounting for around 5% of all skin cancers; but it Is also the most aggressive, and it can spread to other parts of the body, including the organs. When this happens, it is called metastasis.

The term ‘melanoma’ refers to cancers that develop from the upper layers of the skin, when skin cells that cause the skin to be pigmented with melanin (called melanocytes) grow abnormally. When these pigmented skin cells change, the cancer is described as melanoma, as it originated from the melanocytes.

Melanoma skin cancers are serious and require specialist medical attention and treatment, and this is why suspected pre-cancerous lesions or suspicious growths should always be checked by a medical expert.

The earlier a melanoma is caught, the greater the chance of treating it before it spreads, so it must be taken seriously. Caught early, a melanoma should have only spread superficially (i.e. on the surface of the skin), so can potentially be fully excised. If a melanoma is fully excised, the chance of reoccurrence on the same site is low.

There are different types of melanoma, but they are usually treated in the same way. While melanoma skin cancer can affect people at any age the risk increases with age.



The only way to be certain if a mole or mark is melanoma is to have it examined by a doctor, and time is of the essence in treating any skin cancer, but especially melanoma.



Symptoms of Malignant Melanomas

The first signs of melanoma is usually the appearance of a new spot on the skin, or a change in the size, shape or colour of an existing mole. While these symptoms should alert you to visit your doctor, it is also a good idea to make regularly checking your own skin a habit – especially if you are at higher risk for developing a skin cancer.

There is a mnemonic device called the ABCDE method that may be helpful to keep in mind when self-checking the mole or mark. ABCDE stands for;

  • Asymmetry - an irregular shape;
  • Border - the edge is not smooth;
  • Color – the pigmentation is uneven or it has dark spots;
  • Diameter - the spot is larger than the size of a pencil eraser.
  • Evolving or Elevation - changes in size, shape or texture.

The only way to be certain if a mole or mark is melanoma is to have it examined by a doctor, and time is of the essence in treating any skin cancer, but especially melanoma.

Other symptoms may include:

  • Sores that do not heal
  • Pigmentation, redness or swelling that spreads outside the border of a mole or mark to the skin surrounding it
  • Itchiness, tenderness or pain coming from a mole or mark
  • Changes in texture, or scales, oozing or bleeding from an existing mole

As the symptoms are so varied, and because not all melanomas develop from moles, it is critical to discuss new or unusual skin growths with your doctor.

Many melanomas develop in areas of the skin that are exposed to the ultraviolet (UV) light of the sun, but they can also develop in areas that are usually covered up.


In addition to examining the legs, trunk, arms, face and neck, it is important to look at the areas between the toes, underneath fingernails and toenails, on the palms of the hands, the soles of the feet, the genitals and even the eyes.

There are 8 types of melanoma, and they are;

This is the most common type of melanoma. 60-70% of people with melanoma have this type, and it’s most often diagnosed in people aged 30-50. Superficial spreading melanoma usually tends to grow outwards, rather than downwards into the skin. It can develop anywhere on the body, but in men it often develops on the trunk of the body, whereas in women, it is most common on the legs.
This second most common form of melanoma tends to grow down into the deeper layer of the skin, and can grow quite quickly, often presenting as a raised area on the skin surface. 15-30% of people with melanoma have this type, which is most often diagnosed in people in their 50's.
These melanomas develop from very slow-growing coloured patches of skin called lentigo maligna which are flat and grow in the surface layers of the skin. The lentigo maligna might get bigger over several years, and change shape or colour. If it becomes a lentigo maligna melanoma, it starts to grow down into the deeper layers of the skin and may form lumps known as nodules. 5-15% of people with melanoma have this type, which is most common in people aged 60 and over, especially if they have spent a lot of time exposed to the sun.
The word amelanotic means without melanin, which is a pigment, so unlike other melanomas, these are usually red or skin coloured rather than dark coloured. This type of melanoma is quite rare, and 5-15% of people with melanoma have it. Amelanotic melanomas are often difficult to diagnose, and may be mistaken for other skin conditions.
Acral lentiginous melanoma is usually found on the palms of the hands and soles of the feet, or around the big toenail. It can also grow under the fingernails, however it is much more common on the feet than the hands. 5-10% of people diagnosed with melanoma have this type, but it is the most common type of melanoma in people with darker skin tones.
While Melanoma usually develops in the skin and is called cutaneous melanoma (cutaneous means skin), rarely, it can start in the mucous membrane - the layer of tissue inside parts of the body such as the mouth or vagina. When melanoma develops in these tissues, is called mucosal melanoma.
Rarely, melanoma can start in the eye, but when it does, it’s known as uveal melanoma or choroid melanoma. The uvea is the middle layer of the eye and has 3 parts: the iris (the coloured part of the eye); the ciliary body; and the choroid. The majority of uveal melanomas develop in the choroid part of the uvea.
This is a rare type of melanoma that can develop anywhere on the body, but it most commonly develops in the head and neck area. Desmoplastic melanoma is often the same colour as the skin, and can look like a scar. It is more common in men than women.

Causes of Malignant Melanomas

Melanoma is caused by the abnormal growth of skin cells that are pigmented with melanin (called melanocytes).

The primary cause of melanoma is exposure to ultraviolet (UV) light either from the sun, or from harmful artificial tanning practices, such as sunbeds or sunlamps. Factors that may mean someone has an increased susceptibility to malignant melanoma include;

  • Previous skin cancer
  • Fair, or pale skin 
  • A history of sun exposure, or historic use of indoor tanning beds
  • A family history of skin cancer
  • Working outdoors

While adhering to sun awareness advice – for example, staying out of the sun (especially during midday hours) and applying a broad-spectrum sunscreen - is best practice for everyone, patients who have previously had skin cancers should take all precautions to avoid harmful UV rays. Staying in the shade, wearing a wide-brimmed hat and UV-blocking sunglasses outdoors are all recommended.

Treatment at Derma for Malignant Melanomas

Your appointment with the dermatologist will begin with analysis of the affected area, and possibly to perform a full skin check, and together you will discuss your medical history, before a course of treatment for malignant melanoma is recommended.

Many superficial melanoma skin cancers can be treated by excision, which is a relatively painless procedure that can be performed efficiently and effectively. Depending on insurance, treatment can be carried out the same day as consultation.

Please note that further tests – such as a biopsy – will be necessary. Follow-up appointments will be required to ensure that the melanoma is properly treated, and your skin monitored for any changes, as having skin cancer is likely to increase susceptibility.

We see and treat more skin cancer patients than any other doctors in Reading, so you can be assured that Derma will provide the very best care, the latest research and the most effective treatments.

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