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Melanoma is a form of skin cancer that begins in the melanocytes. Melanocytes are skin cells which produce pigments that give us our distinctive skin colour. In the West, melanomas typically arise from the sun exposed areas of the skin such as chest, forehead and limbs. But in Asia this pattern is less common. Melanomas in Asians tend to arise from the hands and feet, which are less exposed to the sun, as well as mucous membranes (internal lining) of the mouth, throat, gastrointestinal tract and vaginal tract in women.
Excessive exposure to ultraviolet (UV) radiation from sunlight or artificial tanning is an important risk factor in the development of melanoma. Limiting one’s exposure to UV radiation can help reduce risk of melanoma. This includes simple measures such as frequent use of sunscreen lotions, slip on long sleeved cloth- ing, wearing a hat to block out the sun. Other causative factors include mutations in cancer causing genes, of which the 2 most important genes in melanoma are BRAF and cKIT.
Knowing the warning signs of melanoma can help ensure that the cancerous changes are detected early and treated before the cancer gets worse. Melanoma can be treated successfully with high cure rates if detected early.
The first signs of melanoma are a change in an existing mole or the development of a new pigmented or unusual-looking growth on your skin. While abnormal moles are associated with melanoma, moles are very common and not all moles are cancerous. To help you identify characteristics of unusual moles that may indicate melanomas or other skin cancers, think of the letters A-B-C-D-E:
A is for Asymmetrical shape. Look out for moles with irregular shapes, such as two very different-looking halves.
B is for irregular Border. Look out for moles with irregular, notched or scalloped borders.
C is for changes in Colour. Look for moles which are very dark coloured or have an uneven distribution of colour.
D is for Diameter. Beware of large moles, especially those that measure more than 5mm.
E is for Evolution. Look for evolving changes to the mole over time, such as a mole that grows in size or changes in colour or shape, or starts to ulcerate and bleed.
Cancerous (malignant) moles vary greatly in appearance. Some may show all of the changes listed above, while others may have only one or two unusual characteristics.
To diagnose melanoma, the oncologist performs a thorough clinical examination including a full skin examination. This is followed by a biopsy of the suspicious lesion. The sample is then examined under the microscope. If melanoma is confirmed, your doctor will then begin to perform tests to confirm the stage of disease. Of note, the thickness of the melanoma, whether there is involvement of the regional draining lymph nodes and presence of distant spread are important indicators of disease stage.
Staging may involve doing a CT or PET scan. Brain imaging may be also needed for people with symptoms like headaches and giddiness. If there are no clearly visible metastases noted on imaging studies, in some patients, a lymph node biopsy may be done to check if there is microscopic spread to the lymph nodes. This is called sentinel lymph node biopsy.
Best treatment of melanoma is through a multi-disciplinary approach. Treatment is guided by the stage and mutational profile (whether the BRAF or cKIT genes within the tumour are mutated) of the melanoma.
In patients with early stage disease, surgery alone may be adequate.
For patients with disease affecting the regional lymph nodes (stage 3 melanoma), following surgery, further adjuvant (preventive) treatment with medications is advised to reduce the risk of cancer relapse.
For patients with advanced melanoma that has spread, outlook has improved significantly with modern day treatment. Agents such as BRAF/ cKIT targeting drugs and immunotherapy have greatly improved the survival of our patients. Immunotherapy uses medicines to stimulate a person’s own immune system to recognise and destroy cancer cells more effectively. Several types of immunotherapy can be used to treat melanoma.
CanHOPE is a non-profit cancer counselling and support service provided by Parkway Cancer Centre, Singapore. CanHOPE consists of an experienced, knowledgeable and caring support team with access to comprehensive information on a wide range of topics in education and guidelines in cancer treatment.
The CanHOPE team will journey with patients to provide support and personalised care, as they strive to share a little hope with every person encountered.