Melanoma Risk Factors, Treatment and Prevention

Melanoma is the deadliest of all types of skin cancer. Unfortunately, too many people delay treatment, even when they know they have a potentially life-threatening disease.

The lifetime risk of getting melanoma, according to the American Cancer Society, is about one in 40 for Caucasians, one in 200 for Hispanics, and one in 1,000 for African-Americans. The average age of people diagnosed with melanoma is 62, but it can begin at almost any age.

The older a person is, the longer they wait to get treatment. JAMA Dermatology reported that 20 percent of Medicare patients wait a month-and-a-half to have surgery.

Melanoma starts with one cell or a small group of cells. The pathway that those cells take to ultimately become skin cancer is complex. Lots of things have to go wrong, but they can go wrong quickly (within months) or over a period of years. Though the average age of diagnosis is 62, the process of developing the disease may have begun as early as childhood.

Risk Factors

Those in the high-risk category for melanoma are fair-skinned and sun-sensitive, although anyone can develop the condition. Redheads, blondes, and people with blue or green eyes are especially susceptible. The more moles, large moles, and unusual moles you have, the higher your risk. You are more likely to have the condition if your parents, siblings, cousins, aunts, or uncles have had a melanoma. Your chances increase if you have had a previous melanoma, a basal cell carcinoma, or a squamous cell carcinoma.

In addition, the events or conditions below also make you more likely to develop melanoma:

• Age 50 and older
• No regular contact with a dermatologist
• Being male
• Outdoor summer jobs or outdoor activities early in life
• Freckles on the upper back
• Prior radiation treatments
• Chronic lymphoma or leukemia

“One of the most common misconceptions about melanoma is that it only affects adults who are white,” warns UCLA dermatologist Lorraine Young, MD. “The disease can occur in children and in people with darker skin types.”

What Does It Look Like?

The distinguishing characteristic of melanoma is uncontrolled growth of cells called melanocytes. These cells produce melanin, which is one of the body’s coloring agents. Most melanomas have a black or blue-black color, and they appear abnormal and unsightly.

The American Academy of Dermatology, the American Cancer Society, and the Skin Cancer Foundation all promote the A-B-C-D-E method of identifying potential melanomas. If you recognize the signs, or if you notice a change in a mole, see a dermatologist as soon as possible.

How Is it Diagnosed?

Early detection and treatment is key. The deeper a melanoma has penetrated, the deadlier it becomes. If it reaches beyond lymph nodes in the immediate area, the five-year survival rate is only 18 percent.

A medical history, biopsies, and imaging tests are used to diagnose melanomas. They are classified and treated according to stages of development. The American Society of Clinical Oncology provides these details about each stage of melanoma. Each of the four stages has subgroups, which further describe the melanoma’s status.

• Stage 0: Melanoma cells found only in the outer layer of the epidermis.
• Stage I: Primary melanoma is still only in the skin and is very thin.
• Stage II: The melanoma is thicker than in stage I; extends through the epidermis and further into the dermis; slightly higher chance of spreading.
• Stage III: The melanoma has spread through the lymphatic system, either to a lymph node located near where the cancer started or to a skin site on to a lymph node.
• Stage IV: The melanoma has spread through the bloodstream to other parts of the body.

What Are Melanoma Survival Rates?

Five-year survival rates depend on the stage, and stages are on a scale of zero to four, plus subtypes in four of the stages. Stages are determined by 1) how deeply the tumor has penetrated the skin, 2) a break (ulceration) on the surface of the tumor, 3) involvement of lymph nodes, and 4) metastasis.

Survival rates are estimates and do not apply to individual melanoma patients. Age (older), ethnicity (African-American), and a weakened immune system can have a negative effect on survival. The study used to determine survival rates included some people diagnosed with melanoma who may have died from other causes, meaning the actual survival rates may be higher.

Surgery

Early-stage melanomas can be removed by simple procedures at a dermatologist’s office. In some cases, the entire area can be excised (cut out) during a biopsy without further treatment. Melanomas that have spread beyond the surface of the skin are more difficult to treat with surgery. In Mohs micrographic surgery—used for delicate areas, such as the nose, lips, and ears—the surgeon uses a microscope to examine the tissue and excises the growth layer by layer until only healthy tissue remains.

Medications

Chemotherapy, in pill or intravenous form, destroys cancer cells for several months, but the treatment does not yet have a record of curing melanomas. Other “targeted” drugs attack genetic mutations in the BRAF gene, which account for about one-half of all melanomas, according to the American Cancer Society. Drugs that target the BRAF protein are not likely to be effective in patients who have a normal BRAF gene.

Using a combination of drugs has become an effective treatment method. UCLA researchers found that two drugs —dabrafenib (Tafinlar) and trametinib (Mekinist)—combined with immunotherapy were more effective than current standard treatment. The triple treatment therapy worked to sensitize patients’ immune systems and increase immunotherapy.

The New England Journal of Medicine reported that a combination of ipilimumab (Yervoy) and nivolumab (Opdivo) improved more than 70 percent of melanoma patients and could change future treatment options.

Radiation

Radiation can kill cancer cells, including those produced in melanoma, but it is not considered a cure because it is not always 100 percent successful. A common side effect is fatigue that usually subsides after treatment has been completed. The American Cancer Society lists the following uses of radiation in cases of melanoma:

• After surgery for an uncommon type of melanoma called desmoplastic melanoma
• After surgery in an area where lymph nodes are removed
• When melanoma has come back after surgery
• To relieve symptoms caused by the spread of melanoma (palliative therapy).

Is Melanoma Preventable?

There are more steps you can take to lower your risk of melanoma than for any other type of cancer, including: 1) using a sunscreen with a sun protection factor (SPF) of 30 to 50; 2) avoiding unnecessary exposure to the sun; 3) wearing clothes that protect your arms, legs, face, neck, and ears; 4) conducting monthly self-exams; and 5) scheduling an annual exam with a dermatologist.

For more information about melanoma and other conditions that can affect the skin, purchase Skin Care at www.UniversityHealthNews.com.

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