Melanoma is the most aggressive of skin cancer type and experts caution that its incidence is increasing. However, with a few simple precautions you can minimize the risk.

What is melanoma?
Melanoma is a type of cancer that forms from a few cells called melanocytes. Melanocytes produce a substance called melanin, which is responsible for the color of the skin, hair and eyes. Melanin also protects from the harmful UV rays of the Sun. If the skin gets too many ultraviolet rays, melanocytes can start to divide uncontrollably and thus begins the cutaneous melanoma.

However, melanocytes are found in various parts of the body, melanomas may exist elsewhere such as the eye, gastrointestinal tract or nervous system.

Melanoma can appear in normal skin or in a mole, and it is the most serious of skin cancers because it spreads very rapidly through the lymphatic system or the blood vessels, leading to produce metastases in lymph nodes and other areas of the human body such as the liver, lungs, bones and brain.

melanoma types, causes, diagnosis, and treatment

Types of Melanoma

The 4 most common types of melanoma are:
  • Lentigo malignant-melanoma: implies 5-10% of melanoma cases. It appears almost always in over 60 years old people, in the face and on sun-damaged skin. It has a slow growth surface and takes long to penetrate deeply; metastases, therefore, are late and are limited to the cervical lymph nodes.
  • Superficial spreading melanoma: is the most common, about 70% melanoma cases. It is most common in people aged 40-60 years old and its usual location is said: men and women in the trunk legs. Its surface growth lasts less than lentigo malignant-melanoma type, may still take months or years to penetrate deeply and spread.
  • Acral lentiginous melanoma: represent 10% of all melanomas and are located mainly on the palms, soles, under the nail and lip. Its surface growth is short and quickly grows in depth, without showing typical signs of bleeding, itching or pain. It is more frequent in black people and Asians.
  • Nodular melanoma: 10-15% of cutaneous melanomas. Its color is homogeneous and their size does not increase much; grows deep quickly and is difficult to do early detection. It is the most aggressive type.

Risk Factors for Melanoma

These are the most common risk factors that predispose to melanoma:

Exposure to Sun's Rays
The continuous and regular sun exposure is probably not an important risk factor in the formation of melanoma such as sunburn. Burns are the most harmful mild / moderate (which cause pain for less than two days and end up in a peeling of the skin) and the severe (pain or blisters for more than two days). The most serious burns for the development of melanoma are occurring in childhood and adolescence; that in adulthood increases the risk of melanoma over the next 10 years.

Sensitive Skin
Skin types are divided into I to VI phototypes , according to the degree of ease to tan or burn. The types I and II are the most sensitive to sunlight; it is clear skin that suffers burns often and hard tan, and melanoma can arise more frequently in these people. However, people with higher phototypes have darker skin and tanning appears very soon, thus protecting from the sun's ultraviolet rays.

Multiple Moles
Moles, also known as nevus, are confined dark spots, and can be congenital (existing since birth) or acquired (appear throughout life, mainly since puberty). The total number of nevi, which a person has is linked to genetics, but  also closely related to the amount of solar radiation that is exposed during childhood.

People with 50 or more nevi have an added risk factor for developing melanoma, so it should be evaluated by a dermatologist.

Atypical Mole
They are nevus which alone already constitute a risk factor to develop into melanomas. They are flat, like spots, and meet at least three of the following characteristics:
  • Jagged edges in the form.
  • Fuzzy edges on the boundary.
  • Various colors.
  • More than 5 mm in diameter.
  • Redness.

Family History
Melanoma is associated with a genetic predisposition as in other cancers, so that a melanoma risk will be higher if a family member has suffered it. The closer the family the greater is the risk, younger has suffered from the disease, and more number of affected family has.

Weakened Immune System
The consumption of drugs, transplant patients, those infected with HIV / AIDS, cancer patients or autoimmune diseases are causes of depression of the immune system, which facilitates the development of cancers, including melanoma.

Diagnosis of Melanoma

How can I identify a melanoma?

Early detection of melanoma is essential to prevent the spread of cancer for the rest of the body. In the early stages the patient survival is 90-95%, while in the case of advanced melanoma survival drops to 20% and treatment options are reduced. Therefore, it is advisable to examine the entire length of the skin with the help of mirrors once a month and go to the dermatologist to the discovery of a cutaneous macha with warning signs.

There are several simple and quick methods to detect warning signs that indicate the possible development of melanoma. No method is foolproof and they should be used in unison.

ABCDE Rule
Melanoma have the following characteristics:
  • Asymmetry.
  • Irregular, Scalloped edges.
  • Heterogeneous coloration (2 or more tones: black, Brown, reddish...).
  • Diameter greater than 5 mm.
  • Evolution with bleeding, itching, redness, hardening...

Seven Criteria of Glasgow
It consists of three major criteria that are worth 2 points each and four minor criteria that are worth 1 point each. A lesion is suspected of melanoma if you add 3 or more points:

Major criteria:
  • Change of size.
  • Change of shape.
  • Change of color.
Minor criteria:
  • 7mm or more in diameter.
  • Inflammation.
  • Bleeding.
  • Itching or pain.

"The Ugly Duckling"
It is a very simple method to detect a group of moles that look different from the rest and examine it thoroughly using the methods described.

Where occurs most often?
Man melanoma usually occur more frequently in the trunk, between the shoulders and hips, and the head and neck. On the other hand, in women, it appears most frequently at the bottom of the legs.
In black people, melanoma usually arises under fingernails or toes, in the palms of hands and soles of the feet.

Melanoma Treatment

The ideal treatment is surgical excision of melanoma, and patient survival depends on the degree of invasion that has the tumor. It is usually removed with a margin of 0'5 - 3cm, but there are also more detailed techniques such as Mohs surgery. Mohs surgery involves removing all of the melanoma, preserving the maximum healthy tissue around it, thanks to the implementation of systematic intraoperative biopsies.

Lymph nodes are only removed if it is shown that there is tumor metastasis by palpation (indurate low mobility and pain lymph), or by the sentinel lymph node technique. Sentinel lymph node is the node that receives a cancerous metastasis before any other, if this is not affected, none more it will be. Thanks to the injection of a radioactive substance in melanoma, that seeps up to a first node, which is the sentinel node, which is extracted and analysed microscopically.

To ensure the effects of immunotherapy with interferon-surgery α is used; radiotherapy is only used on lentigo malignant-melanoma, and sometimes it is the only option in very elderly or unfit for surgery people. See more about radiation therapy

Prevention of Melanoma

There are two essential steps in preventing melanoma: self-examination and protection from UV rays.
Self-examination should be performed once a month; the whole body extension should be inspected with the help of mirrors, without forgetting the bottom of nail, the folds between the fingers and the scalp. Each mole or unusual spot should abide by the rules which have been mentioned above, and in case of doubt, always consult to a dermatologist. Remember that early diagnosis of melanoma can save your life.

UV protection should include certain measures:
  • Avoid exposure to the Sun between 11:00 to 16:00.
  • Always use sunscreen with an appropriate index for the skin type. Repeat the application of cream every two hours, and after a bath or a lot of sweat, even if the product indicates water resistance.
  • Dry thoroughly after a bath prevents burns due to the "magnifying effect" of raindrops.
  • Wear protective clothing if you are going to be exposed too long to the Sun and have a sensitive skin phototype. This includes a hat or CAP, sunglasses and light long sleeve.
  • Maximized all these measures in places where light is reflected in the environment (sea, snow, and desert).
  • Avoid UV rays booths; been shown that their use increases the risk of developing melanoma and other skin cancers.
  • Watch medication that increases the sensitivity to sunlight, so consult your doctor for it and read the prospectuses.
  • Children under 6 months should not be exposed to the sun, and children under 3 years may only do so with a very high protection.

Finally, insist on the consultation to the dermatologist about any suspicious sign on a patch of skin; patients with more than 50 moles or a melanoma family history should see dermatologist regularly for a full test.

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