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Malignant Melanoma - the mole in the skin!

What is Malignant Melanoma?

Malignant melanoma is the cancer of melanocytes which are mainly present in skin and are the cells forming pigment causing tanning of skin. Although it accounts for less than 5% of cancers (malignancies) of the skin generally it is responsible for over 75% of deaths related to skin malignancy, and is the commonest cancer in young adults (20–39 years) being the most likely cause of cancer-related death in this age group. So it should attract more public attention as it is a disease which could be identified at early stages and cured easily.

What are the risk factors to develop malignant melanoma?

The incidence in white population in the UK and USA is doubling every 10 years. A higher number of cases have been reported in white people living near the equator than in temperate zones with the highest numbers (more than 40 per 100 000 per year) seen in white people living in Australia and New Zealand. Auckland of New Zealand is currently said to report the highest incidence per capita. This tumor is rare before puberty and in black people, Asians and Orientals. When it does occur in these races it is most often on the palms, soles or mucous membranes rather than the normal skin of the face and the body.

Ten to fifteen percent of melanomas are familial (occur in families where two or more first degree relatives have a melanoma); here molecular defects in genes like tumor suppressor gene and oncogenes have been linked to these melanomas and it may affect several members of a single family in association with atypical (dysplastic) nevi. Exposure to ultra violet rays (UVR) is the major causative factor for developing malignant melanoma and occurs most often in sun exposed skin particularly in white skinned nations. The risk of developing a malignant melanoma is highest in those with certain types of melanocytic nevi, like atypical nevi, congenital melanocytic nevi and many basal melanocytic nevi, but not all nevi cause malignancy. Only 10–20% of malignant melanomas are formed in pre-existing nevi, with the remaining majority arisingin previously normally pigmented skin. It is important to identify malignant forms from benign nevi.

How does Malignant Melanoma look like?

There are several macroscopic (naked eye) features suggesting that a mole in the skin is likely to be a malignant melanoma rather than a benign melanocytic nevus.

1. Change in size – any adult nevus > 6 mm is suspect (for reference a lead pencil diameter is 7 mm) and anything changing to > 10mm is more likely to be malignant than benign

2. Shape

3. Colour

4. Surface irragularities (nodularity or ulceration)

5. Satellite lesions (discrete pigmented areas spreading away from the primary)

6. Tingling/itching/serosanguinous (pus like) discharge (usually late signs)

7. Blood supply: melanomas > 1 mm thick have a blood supply that can be found with a hand-held Doppler monitor, so ‘Doppler-positive’ pigmented lesions should be excised


How does malignant melanoma progress?

 Eighty percent of invasive melanomas are preceded by a superficial and radial growing phase, shown clinically as the expansion of an irregularly pigmented macule (flat topped, well demarcated lesion, non-palpable lesion) or plaque (large, flat topped, elevated, palpable lesion). Most are multicolored mixtures of black, brown, blue, tan and pink. Their margins are irregular with projections and notches. Malignant cells are at first usually confined to the epidermis (superficial layer of skin) and uppermost dermis (deep layer of skin), but eventually invade more deeply and may metastasize.

What are the types of Malignant Melanoma?

There are four main types of malignant melanoma.

1. Superficial spreading melanoma is the most common type (70%) in Caucasians. Usually arise from pre-existing nevus. Its radial growth phase shows varied colours and is often palpable. A nodule coming up within such a plaque signifies deep dermal invasion and a poor prognosis.

2. Lentigo maligna melanoma occurs on the sun exposed skin of the elderly and is common in women accounting for 5% to 10% of malignant melanoma. An irregularly pigmented, irregularly shaped macule (flat topped, well demarcated, non-palpable lesion) may have been enlarging slowly for many years.

3. Acral lentiginous melanoma occurs on the palms and soles and, it is rare in white-skinned individuals (2–8%) but more common in the Afro-Caribbean, Hispanic and Asian populations(35–60%).

4. Nodular melanoma appears as a pigmented nodule and it is the most rapidly growing and aggressive type accounts to 15%.

How is the severity of the disease determined?

A cancer is staged (stage of a cancer is a measure of severity and denotes the outcome) according to the thickness of the lesion and spreading to the deeper layers of skin, lymph node involvement and spread to distant organs like liver. There are several systems for staging of tumour. The most popular staging systems for melanoma are the TNM classification (Europe) and the American Joint Committee on Cancer Staging. Here the thickness of the lesion is important in staging i.e. the thicker is the lesion, higher becomes the stage and worse is the prognosis (outcome).

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What are the treatment options available for Malignant Melanoma?

Surgical treatment: Surgical excision, with minimal delay, is required. An excision biopsy, with a 2-mm margin of clearance laterally, and down to the subcutaneous fat, is recommended for all suspicious lesions. If the histology confirms the diagnosis of malignant melanoma then wider excision, including the wound of the excision biopsy, should be performed as soon as possible. Elective regional lymph node dissection (known as a block dissection) may benefit patients with tumors of intermediate thickness.

Immunological treatment: Surgery cures most patients with early melanoma, but its effect on survival is less as the disease advances. Immunotherapy involves treating with immune mediators for certain malignancies. Here low dose α-interferon appears to improve the disease and may improve overall survival rates.

Chemotherapy: Although rarely curative, chemotherapy can be used to control the disease process in patients with severe disease.

Here what is most important to be noted is to identify suspicious lesions at the initial stages so that the treatment will be simple surgical removal and the prognosis is always better after treatment. It is said that at stage I the 5 year survival is nearly 85-95% (In cancers, the prognosis is expressed as survival; in malignant melanoma, it is expressed as 5 year survival). Therefore, presenting for early medical care in case of presence of a suspicious lesion should always be encouraged.


Kimberly Schimmel from North Carolina, USA on September 24, 2011:

Thank you for this important information. My sister works in a cancer clinic and is religious about sunscreen because of what she's seen.

Abhimanyu Singh Baghel from Satna, Madhya Pradesh (India) on September 24, 2011:

That was an extremely useful hub. Although there were several terms that were over my head, but still I found it very helpful and I'll share it with my friends and relatives for sure. I am feeling really lucky for being an asian that i am not that much prone to this deadly cancer! But at the same time i am feeling really sorry for all those who are suffering from this disease. We need to spread a lot of awareness amongst people about this disease as I myself heard it for the first time. Thanks a lot to you all Nadeeshan. You people have been sharing very useful stuff that is definitely very helpful and you people are the real care takers of humanity. :)

Thumbs Up and useful!

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 30, 2011:

Thank you lundmusik! Glad to follow you on hubpages as well!

lundmusik from Tucson AZ on August 30, 2011:

This is an incredible article,, thanks so much,, and for following me on twitter,,,

Sueswan on August 29, 2011:

Hi Nadeeshan,

I really appreciate that you take the time to answer my questions.

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 29, 2011:

Thank you Sueswan, glad that this was useful!

Yes of course, moles can develop anywhere on your body regardless of the fact that the area is exposed to sunlight or not. However, moles occurring in areas exposed to sunlight have a higher rate of malignant transformation (becoming cancerous).

Thanx again for your comments and you are always welcome for questions and comments!!

Sueswan on August 28, 2011:

Hi Nadeeshan,

Thank you for this very important and valuable hub.

I have had a mole(not bigger than a pencil eraser) on the side of my fourth toe for over 10 years, maybe longer. It has not changed in size or appearance.

I never asked my doctor about it.

Can moles still develop even in an area that is not exposed to the sun?

I did have a mole that my doctor was very concerned about. He asked how long I had it. When I told him since I was a baby, his concern went away.

Voted up and awesome.

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 27, 2011:

Thank you Gypsy Willow for sharing your valuable experience. Living in a country where Ayurvedic remedies are very well established and highly appreciated, I have seen many instances where natural plants exceed the potential of modern medicine in alleviating many medical conditions.

Thank you once again!!

Gypsy Willow from Lake Tahoe Nevada USA , Wales UK and Taupo New Zealand on August 27, 2011:

Have you heard of the plant Euphorbia or Spurge (the garden variety)? I have been using this for years to cure moles and plantar warts. I recently used it to rid my face of a precancerous tumor my doctor wanted me to have cut out. The plant exudes a white sap when cut and this kills the wart or whatever. Recent tests in UK have proved it can kill cancerous skin tumours too. There is another plant in UK called Greater Celendine with yellow sap that is perhaps more effective. Hope you find this info useful.

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 24, 2011:

Thank you always exploring! Your comments are always encouraging.

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 24, 2011:

Thank you SubRon7! Glad to hear your appreciation!

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 24, 2011:

Dear Derdriu,

Thank you for your constructive comments on the clarity as well as the images in this hub, which we believe are quite important for the improvement of the quality of the hubs. We feel glad for this being useful and interesting. You are always welcome for future comments.

Thank you once again!

Chathurika Dhanasekara (author) from Kandy - Sri Lanka on August 24, 2011:

Thank you for your comment WillStarr,

Though I believe it is unnecessary to visit the dermatologist once a year, it would be important to self examine using two mirrors when necessary, or get the skin checked at home at least once a year, especially for those who had been living distant from the equator.

Ruby Jean Richert from Southern Illinois on August 23, 2011:

Thank you for sharing your knowledge with us.

James W. Nelson from eastern North Dakota on August 23, 2011:

Scary stuff, Nadeeshan, but thank you for sharing this hub.

Derdriu on August 23, 2011:

Nadeeshan301: Thank you for sharing this information in such a clear style. The images are slightly unsettling but important for understanding and even possibly identifying this form of cancer.

Voted up + useful + interesting

WillStarr from Phoenix, Arizona on August 23, 2011:

A melanoma on his back took the life of my wife's beloved uncle. All of us should visit a dermatologist at least once a year, and have our skin checked, especially where we cannot see clearly, like on our backs.

Use sun block every day. There's no such thing as a healthy tan.

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