Malignant Melanoma

You can develop melanoma anywhere on the body. Sometimes those even develop on the eyes and internal organs. Men more commonly develop melanoma on their upper back, while women develop it on legs.

It is important to know how to spot melanoma as it is easier to treat melanoma when it's at an early stage. Melanoma can appear as scaly patches, moles, raised bumps, or open sores.

Following are some warning signs that point towards the diagnosis of a melanoma:

• Border
  The edges of a melanoma are not smooth.
• Asymmetry
  One half of a melanoma does not resemble the other half.
• Colour
  The colour of a melanoma is uneven and mottled, with shades of black, brown, red, grey, or white.
• Diameter
  The size of the spot is more than that of a pencil tip.
• Evolving
  The spot is changing in shape, size, or colour.

All melanomas don’t necessarily fit the above criteria. Therefore, you must talk to your doctor if you experience sores that don’t go away, abnormal rashes, bumps, or changes in the skin or any pre-existing moles.

Another way you can recognize a melanoma is by noticing if it looks different from the other moles you have. A melanoma usually looks different from the other moles you have, so you should talk to a doctor if you notice anything like that.

Normal moles are uniform in colour, such as tan, brown or black. They have a well-defined border separating the mole from the surrounding skin. They are oval or spherical and generally smaller than 1/4 inch or 6 millimetres in diameter. Most moles appear in childhood, and new moles may develop until 40. Most people may have 10 to 40 moles by the time they are adults. The nature of moles may change over time; some may even disappear.

One of the biggest risk factors for developing melanoma is overexposure to sunlight, especially if you are exposed to sunburns when you are young. Research has proven that most melanomas develop due to UV rays from the sunlight.

Due to exposure to UV rays, the DNA of a cell undergoes damage due to which certain genes that affect the growth and division of cells change. When the skin cell’s DNA is damaged, the potential for problems goes on increasing and those cells only keep on multiplying.

The risk of melanoma also increases by UV radiation from tanning beds, which are now a recognised carcinogen. Although melanoma can affect anyone, following are some groups of people who are at an increased risk of developing the disease:

• Family history of melanoma
• Personal history of melanoma
• Freckles, fair skin, red or blonde hair, and blue eyes
• Excessive exposure to sunlight, including development of blistering sunburns
• Those residing at high altitudes or near the equator. Living in these areas increases the exposure to UV rays.
• Many atypical moles
• History of tanning bed use
• Weakened immune system
• Although melanoma can affect people of all skin types, it is more common in white people. Dark-skinned people usually get melanoma on their soles, palms, and nails.

Types of Melanoma

Hidden melanomas: When melanoma develops in parts of the body that are not sun-exposed such as between the toes, on the palms, soles, scalp, or the genital organs, they are called hidden melanomas. They are named so as they usually occur in areas where most people wouldn't check. Hidden melanomas are commonly seen in people with darker or hyperpigmented skin.

• Acral-lentiginous melanoma
  It is a rare type of melanoma that can present under a fingernail or a toenail. It can also occur on the palms of the hand or soles of the feet and is more common in black people or people with hyperpigmented skin.
• Mucosal melanoma
  It occurs in the mucous membranes lining the nose, mouth, oesophagus, anus, urinary tract and the vagina. It is quite difficult to detect because they resemble the lesions found in similar medical conditions.
• Ocular melanoma
  It occurs in the eye, most commonly in the uveal part, the layer beneath the white portion of the eye called the sclera. Ocular melanoma can cause vision changes, and it can be diagnosed with an eye exam.

If you notice a suspicious looking mole or other spot, you must talk to your doctor, who may remove it and examine it under the microscope to look for malignant cells. This process is called a biopsy.

After the skin biopsy results are reviewed and evidence suggestive of melanoma is found, the next step is to determine if the disease has spread. This process is known as staging. Once melanoma is diagnosed, it is categorised on the basis of certain factors including its appearance under the microscope and how deeply it has spread. One of the most important characteristics used to predict outcomes is the thickness of the tumour.

Following are the stages of melanoma:

• Stage 0
  It is also referred to as Melanoma in situ and is confined to the epidermis, the topmost layer of the skin.
• Stage I
  It is primary melanoma that is low-risk because there is no evidence of metastasis. The patient is generally curable with surgery.
• Stage II
  Features suggestive of high risk of recurrence are present but no evidence of metastasis can be seen.
• Stage III
  At this stage, the melanoma has spread to the surrounding skin and/or lymph nodes.
• Stage IV
  The melanoma has involved the distant lymph nodes or other parts of the body.

Doctors use several different tests to stage melanomas. These tests may include:

Sentinel Lymph Node Biopsy: For those who have melanomas deeper than 0.8 mm, have ulceration in any size of tumour, or less bothersome characteristics under the microscope, a sentinel lymph node biopsy may be performed to determine if the disease has spread. Those diagnosed through sentinel lymph node biopsy are found to have higher survival rates than those diagnosed with the disease via a physical examination.

• Sentinel Lymph Node Biopsy
  For those who have melanomas deeper than 0.8 mm, have ulceration in any size of tumour, or less bothersome characteristics under the microscope, a sentinel lymph node biopsy may be performed to determine if the disease has spread. Those diagnosed through sentinel lymph node biopsy are found to have higher survival rates than those diagnosed with the disease via a physical examination.
• Computed Tomography (CT) scan
  If melanoma has spread to the internal organs, a CT scan can diagnose it.
• Magnetic Resonance Imaging (MRI) scan
  If the melanoma has spread to the brain or the spinal cord, an MRI scan can diagnose it.
• Positron Emission Tomography (PET) scan
  A PET scan can help diagnose melanoma in lymph nodes and other body parts that lie at a distance from the primary skin spot of melanoma.
• Blood tests
  Lactate dehydrogenase may be checked before treatment by carrying out blood tests. Other tests include blood cell counts and blood chemistry levels.

Treatment of melanoma depends on the general health of the patient and the stage of the disease. Surgery is usually the mainstay of treatment. It involves resecting the cancer in addition to some healthy surrounding tissue. The amount of healthy tissue that has to be removed depends on the location and size of the cancer. The excision is usually performed under local anaesthesia but more advanced cases may need other treatments that are combined with surgery. Following are the treatment options for melanoma:

• Melanoma Surgery
  Surgery can cure melanoma if it is attempted in an earlier stage. The surgery is usually performed under general anaesthesia and focuses on removing the cancerous cells apart from a portion of the surrounding healthy tissue.
• Lymphadenectomy
  If the melanoma has spread, the lymph nodes around the site of primary diagnosis need to be removed. This prevents the spread to other body parts.
• Metastasectomy
  The procedure is performed to remove bits of melanoma from organs.
• Targeted cancer therapy
  Drugs are used to damage specific cancer cells. As the therapy is targeted, only the cancer cells are attacked and the healthy cells are left untouched.
• Radiation Therapy
  This therapy includes treatments with high-energy rays to destroy the malignant cells and shrink tumours.
• Immunotherapy
  During this therapy, the immune system of the patient is stimulated so that it fights the cancer more efficiently.

Following are some measures you can take to prevent melanomas:

Avoid sun exposure, especially during peak hours (10 am to 4 pm).

Avoid using tanning beds. You can go for a spray tan instead.

Wear sunglasses, brimmed hats, long-sleeved shirts and pants whenever you are exposed to sunlight.

Use a broad-spectrum sunscreen with a good SPF everyday. Reapply the same if you are sweating or swimming in the sun

Use a lip balm with SPF.

Early diagnosis of melanoma is associated with better treatment outcome and fewer complications. Therefore, you should not take any skin changes such as appearance of a new mole or change in the appearance of a pre-existing mole lightly. Talk to your doctor and seek immediate medical attention if you notice any such changes. Your doctor will perform a physical examination and some investigations to look for signs of cancer.

Choosing a plant-based diet over an animal-based diet can help prevent melanomas and certain other cancers. This is because plants pack a powerful punch that increases immunity against cancers. They are also cholesterol-free, rich in nutrition, and fibre-rich.

There is no denying that a healthy diet helps strengthen the immune system. A strong immune system is vital to help fight diseases, including cancers. Following are some tips you can consider:

• Daily tea drinking
  Tea contains polyphenols that help strengthen the immune system. There are more of these in green tea than black tea or any other tea.
• High vegetable consumption
  Consuming cruciferous and leafy vegetables is associated with the prevention of invasive melanoma.
• Weekly fish intake
  Research has proven that those who eat fish regularly have a low incidence of the disease than those who don’t.

Being diagnosed with a melanoma can be quite scary. You must be careful about any skin changes you notice and discuss those with a healthcare provider. This will provide you with the best chance of catching the disease in its earlier stages when it is the most treatable. If you are looking for the best malignant melanoma treatment hospital in Indore, your search is over. Our oncology team comprising the best medical oncologists in Indore formulates a comprehensive treatment plan for each patient after discussing the pros and cons of every procedure with you and your family. The treatment of melanoma is dependent on the size of the cancer, its stage and the extent of its spread. The patient's personal preferences and overall health are also considered when deciding the next treatment options for a particular case of melanoma.