Melanoma – Can You Spot The Enemy?

What is Melanoma?

Melanoma is a serious type of skin cancer which develops in the melanocytes (pigment cells) and usually occurs on parts of the body that have been overexposed to the sun. Melanomas can also occur on parts of the body that has never been exposed to the sun, such as eye, in the lining of the mouth and digestive tract, nervous system, soles of the feet, palms, and under the nails.

How Common is Melanoma?

  • Melanoma is Australia’s National Cancer! One person every 6 hours will die from melanoma.
  • Australia and New Zealand have the highest rates of melanoma in the world. More than 12,000 people are diagnosed with melanoma in Australia every year, contributing to 10% of all cancer diagnoses.
  • Melanoma is the most common cancer in young Australians (15–39 year olds) but incidence for people over 60 is also high and increasing.

How many types are there?

Superficial Spreading Melanoma

It is the most common type of melanoma, affecting about 55–60% of all cases. It can develop on any part of the body. This type of melanoma often grows slowly and becomes more dangerous when it invades the lower layer of the skin (dermis).These are found commonly in younger people and is often related to a pattern of high sun exposure, including episodes of sunburn.

Nodular Melanoma

Approximately 10-15% of melanomas are nodular, commonly found in older people on severely sun-damaged skin on the head and neck. It is a fast- growing and aggressive form of melanoma, spreading quickly into the lower layer of the skin (dermis).

Lentigo Maligna Melanoma

This one is most common in older people and makes up about 10–15% of melanomas. They grow slowly and superficially over many years before it penetrates more deeply into the skin.

Acral lentiginous Melanoma

This is an uncommon type of melanoma (around 1–2%). It is most commonly found on the hairless skin on the soles of the feet or palms of the hands, or under the fingernails or toenails. It may grow slowly before it becomes invasive.

Desmoplastic Melanoma

Yet another uncommon type  (1–2%) often found on the head or neck. Most are skin-coloured hence can be difficult to diagnose. Polypoid and Naevoid are other rarer forms of melanoma.

What are the Risk Factors?

Did you know that anyone can develop a melanoma? But the risk is higher in people who have:

  • unprotected overexposure to the sun
  • Sunburns during childhood/teens that lead to blistering
  • moles with an irregular shape and uneven colour (dysplastic naevi)
  • lots of moles (more than 100 on the body)
  • a previous melanoma or other type of skin cancer
  • a strong family history of unusual moles melanoma
  • pale, fair or freckled skin, especially if it burns easily and doesn’t tan
  • experienced short, intense periods of exposure to UV radiation (eg. solariums)
  • light-coloured eyes (blue or green), and fair or red hair
  • a weakened immune system (e.g past or current non-skin cancers,undergoing chemotherapy /radiotherapy or certain medications).

What to look out for?

The first sign is usually a new spot or a change in an existing mole.

In people who have lots of moles, melanomas stand out and look different from the other moles commonly known as the ‘ugly duckling’ sign.

It is recommended that you do a periodic self inspection of your skin every 3-6 months, when undressed preferably in front of a mirror.

Do you remember your ABCDEs?

The easiest way to detect signs and symptoms is using the ABCDE rule!

  • Asymmetry in shape -lack symmetry (the halves look different) or even chaotic in structure
  • Border– the spot may have an irregular uneven edges (scalloped or notched)
  • Colour – the mole may become increasingly blotchy with different depth and shades of colour (brown, black, blue, red, white, light grey, pink or skin-coloured)
  • Diameter– Melanomas usually are larger in diameter than the eraser on your pencil tip (¼ inch or 6mm), but they may sometimes be smaller when first detected.
  • Evolving (EFG elevated,firm and growing for nodular melanomas) – the spot may increase in height, develop a raised nodule, which is often reddish or reddish brown. It may may appear or begin to grow larger very quickly. In addition, look out if the mole appears crusty,is itchy and bleeds.

How is melanoma diagnosed?

If you have a skin lesion, spot or discolouration that is of concern to you, it is recommended that you consult your GP or a skin cancer doctor as soon as possible!

Dermatoscopy

This is a non-invasive form of examination in which a hand held tool called a dermatoscope is used to assess pigmented skin blemishes and moles. It gives excellent vision of the skin with magnification. If a skin lesion appears suspicious under the dermatoscope, a biopsy is taken for further evaluation.

Biopsy

A biopsy is an invasive form of examination in which a sample of tissue is taken from the suspicious skin lesion and examined under a microscope by a pathologist to determine its abnormal cellular properties.

A sentinel node biopsy (SLNB) is a technique sometimes used to determine whether melanoma has metastasised to the lymph nodes. The procedure involves the injection of a radioactive blue tracer dye around the site of the primary lesion and then examination of the first lymph node to take up the dye.

Can Melanoma be treated?

Yes, it can if detected early! Treatment for melanoma depends on:

  • the stage of disease and location of cancer
  • the severity of symptoms and your general health and wishes.

What treatment options are available?

  • Surgery for a primary melanoma: A wide local excision surgery is the main treatment. This includes the removal of the primary melanoma with adequate excision margins to ensure that all the high-risk cells surrounding the melanoma are removed. If the wound is small it can usually be closed with stitches or staples. A skin graft may be required for a larger wound.
  • Surgery to remove lymph nodes: If lymph nodes are positive for melanoma they are surgically excised most commonly from the neck, armpit (axilla) or groin regions.
  • Chemotherapy is a systemic treatment (involving the whole body) which focuses on removing cancer cells by targeting rapidly dividing cells
  • Radiotherapy is a localised treatment that uses high energy radiation to remove cancer cells. It does this by damaging the DNA of cells that are dividing.
  • Immunotherapy treatments work by stimulating a patient’s own immune system so that it can recognise and destroy cancer cells more effectively.

Can Melanoma be prevented?

Absolutely, Melanoma is preventable in majority of cases!

The most effective way to prevent melanoma is to adopt sunsmart behaviours early in life. These behaviours should continue throughout life to minimise the risk of developing melanoma.These include:

  • Avoid the sun or use protective measures when the UV index is higher than 2
  • Use a SPF50+ broad spectrum (UVA and UVB) on all areas of exposed skin
  • Wear sun-protective-clothing and a broad-brimmed-hat
  • Wear sunglasses
  • Avoid solariums
  • Perform regular self skin examinations
  • Most importantly, have yearly skin checks with your GP or a trained Skin Cancer Doctor.

Useful websites:

https://www.cancervic.org.au

https://melanoma.canceraustralia.gov.au/home

https://melanomapatients.org.au

https://www.melanoma.org.au/

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