Melanoma
Melanoma is one of the most serious and aggressive forms of skin cancer. Melanoma is a malignant tumor that originates in the cells of the skin that produce skin pigment (called melanocytes). The majority of melanomas are black or brown. However, some melanomas do not make pigment and are skin-colored, pink, red, purple, blue or white. Melanoma is most common in persons of Northern European ancestry, and far less common in Native Americans, Africans and Asians. Factors that may predispose to melanoma include: Excessive sun exposure (including tanning bed use), having numerous or large and irregular moles, having very fair skin that burns or blisters easily after sun exposure, especially when associated with natural red hair color. Genetic susceptibility also appears to strongly contribute to melanoma development. About one in ten patients who has melanoma also has other family members who have had melanoma.
The number of people who develop melanoma is increasing steadily. Currently in white Americans, there is a 1 in 64 chance of developing melanoma in one’s lifetime. If melanoma is recognized and treated early, it is nearly 100 percent curable with surgery. If not detected in a timely fashion, melanoma can advance and spread to other parts of the body, where it becomes hard to treat and is frequently fatal. The American Cancer Society estimates that in 2007, there will be 59, 940 new cases and 8,110 deaths from melanoma.
Treatment of melanoma traditionally has involved surgery-usually a wide excision of the skin around the melanoma. Risk for further spread of melanoma (metastasis) is determined by how deeply the melanoma invades into the skin, and whether it was bleeding (ulcerated): In addition, a procedure called a sentinel lymph node biopsy may be performed to evaluate whether melanoma has started spreading to lymph glands. If lymph gland involvement is detected, further surgical removal of lymph nodes in that area may be performed. The number of lymph glands involved with melanoma is a strong indicator that melanoma cells are already spreading in the body, and therefore can help establish the risk of dying from melanoma.
Using information about the extent of melanoma obtained from surgery, laboratory testing and from X-rays or scans (termed staging), melanoma physicians can estimate the risk that the melanoma will spread and be fatal. Using this information, there is frequently discussion of additional treatment (“adjuvant treatment”) designed to decrease the risk of melanoma recurrence for patients who have already had surgical treatment.
If melanoma has already spread (or metastasized) to distant areas in the body, such as skin, liver, or lungs, other drug treatment options are available. These include immunotherapy (drugs that activate the immune system to fight the melanoma), chemotherapy (drugs that kill cancer cells) and signaling inhibitors (new drugs that block key pathways that cancers need to grow and divide). There may, at times, be a role for additional surgery or radiation treatments. One specific challenge is the high percentage of metastatic melanoma patients that develop brain involvement. Specific new treatment approaches have been developed to deal with this challenge, since most drugs do not adequately get into the brain.
