What is Malignant Melanoma?

Malignant Melanoma is known as the most fearsome type of skin malignancy. Its incidence now is among the fastest growing among the various types of occult cancers. Statistically, melanoma  will occur in one of 60 Americans during 2005. Almost 8,000 deaths will occur as a result. This is why early detection, recognition  and prevention are a must if we are to be successful in helping to minimize patient morbidity and mortality from this skin cancer. You can help yourself by learning how to perform complete skin exams on yourself and other family members. 

Currently, despite our best efforts, the death rate has doubled within the past two decades. Melanoma has the unfortunate distinction of reducing more potential life years than any other adult cancer except for leukemia. What is even more troubling is that this type of cancer is not just for the old. Melanoma has the dubious distinction of being the most common cancer in women between the ages of 25 and 29 years of age, and is second to  breast cancer in the 30 to 35 year age group.  Overall, melanoma is the fifth most common cancer in the young and middle aged populations.

Superficial Spreading Melanoma- note the irregular border,  peripheral rim of decreased pigmentation, and large size (> 6 mm or the size of a "pencil eraser").

Fig. 1

What are the various types of melanoma?

There are five types of melanoma with the prognosis being dependent not on the size of the lesion but on the depth into the skin that it penetrates. The major subtypes of melanoma include: Superficial Spreading type, Lentigo Maligna, Desmoplastic Melanoma,  Acral Lentiginous Melanoma and Nodular melanoma. Melanoma lesions which are flat and superficial in the skin can sometimes remain so for many years. These types of melanoma have  a better survival and cure rate than those which penetrate deeply into the skin.
 

How is melanoma identified?
Melanoma lesions can be identified by the "ABCD" rule . In essence this refers to skin lesions which are Asymmetric, have Border irregularity, develop a multitude of skin Colors, or have a Diameter greater than 6mm. The earliest sign of a melanoma is itching . Moles or freckles which bleed, are tender or grow rapidly should also be evaluated by a dermatologist.  

Melanoma-small discrete lesion with slightly irregular pigmentation.

Fig. 2

What are some useful tips regarding melanoma?
Melanoma can be diagnosed by routine physical examinations and noting if you have a first degree relative have a history of unusual moles or melanoma. A biopsy or sampling of the skin lesion will usually occur if melanoma or premelanoma is though to be present

Your dermatologist may also recommend total body photography or dermatoscopy (magnifying the skin)  to detail the most earliest changes of your moles. Through pattern recognition, and noting any changes, your doctor can keep accurate records and make sure that no abnormal changes develop in your moles. Other more recent techniques to evaluate moles include  ultrasound studies, computer generated analysis of moles, and spectroscopy.

Melanoma Patients Information Page- an excellent source for the latest treatments available for melanoma  patients and a list of support groups. http://www.mpip.org

What are the treatments available  for malignant melanoma?
The treatment of melanoma is  surgical removal of  the lesion with an appropriate margin of normal skin. In some instances, lymph node removal, radiation treatment or chemotherapy are utilized but these treatments are usually reserved for melanoma  which may have spread internally.  Melanoma can also be assessed by other techniques such as a Tumor antigen-90 blood test  which can assess invasive malignancy or lymph node scintigraphy which can identify the sentinel lymph node. Follow up total skin exams, once a diagnosis of melanoma has been made, should be performed every 3 to 6 months.

Melanoma-under the microscope

Fig. 3

Dangerous melanoma cells "fried egg appearance"