What is melanoma?

Melanoma refers to a group of cancerous tumors, mainly of the skin. These cancers are composed of melanocytes. Melanocytes are cells that produce melanin, the pigment that colors the skin, hair, and iris of the eye.

Melanoma often spreads and causes cancerous tumors in other parts of the body. Because it is the most life- threatening form of skin cancer, early diagnosis is important.

How does it occur?

Normally, melanocytes slowly convert substances to melanin through several chemical steps. This chemical process can be altered by external influences (such as sunlight, heat, heavy metals, and ionizing radiation), which can cause the cells to change into cancer cells and reproduce uncontrollably.

You may be at higher risk for a melanoma if you have:

• a family history of melanomas

• a fair complexion and light eyes

• experienced lengthy exposure to the sun (especially at a young age)

• experienced lengthy exposure to tar and arsenic products

• a history of sunburns

• experienced one or more severe sunburns any time in the past, especially as a teenager

• many pigmented nevi, which are skin blemishes including freckles, moles, and light to dark spots similar to freckles.

In the U.S., the incidence of melanoma varies with latitude, with more than three times as many cases in the South. It occurs slightly more often in males and is uncommon in the black race.

What are the symptoms?

Melanoma usually develops on exposed areas of skin, but it may occur anywhere on the body, including under the nails and in the eyes.

The most common symptom of the early stages of melanoma is a change in a mole you may have had since childhood. The mole may:

• enlarge

• become darker, lighter, or patchy; change color from brown to blue, black, red, and/or white

• develop an irregular or dark, spreading border

• itch

• turn into a scab and not heal for weeks

• become lumpy

• bleed for no apparent cause or just bleed easily

• become scaly or ulcer-like.

Sometimes melanoma may develop on normal skin where no previous mole existed.

The symptoms of advanced melanoma (or a melanoma that has spread) include:

• sores or changes in your skin occurring on parts of the body other than the original site

• weight loss

• change in bowel habits

• bone or abdominal tenderness.

How is it diagnosed?

To diagnose a melanoma, your doctor will:

• review your symptoms

• examine you and record the size, and color of the mole or growth

• order a biopsy of any suspicious mole-like growth or affected area of skin

• examine you for any enlarged lymph nodes.

You may also need:

• a complete blood count (CBC)

• a liver function test

• a chest x-ray

• urine tests.

Your doctor may need to order liver, brain, and bone scans.

If you have advanced melanoma, the doctor will give you an extensive physical exam focusing on:

• locating affected areas at other sites on the skin

• locating enlarged lymph nodes

• detecting jaundice or enlargement of the liver and spleen; melanoma is one of the few cancers that can spread to the spleen.

How is it treated?

Treatment usually consists of surgically removing the entire melanoma and a generous border of healthy tissue, to ensure that all of the cancerous tissue is removed. In some cases, you may have a skin graft to avoid having a large scar. Usually no further treatment is required, but follow-up is necessary.

If the melanoma is advanced and has spread to other parts of your body, treatment options include chemotherapy, radiation, immunotherapy, or surgery.

How can I take care of myself?

If you have been diagnosed with melanoma, try to lessen the stress and anxiety you may be feeling by following these guidelines:

• Follow your physician's instructions.

• Learn about your condition and recommended treatments.

• Discuss all options with your physician.

• Exercise according to your doctor's prescription.

• Get plenty of rest.

• Maintain a healthy diet.

• Drink less coffee and alcohol.

• Drink four to eight glasses of water a day.

• Use relaxation exercises.

• Seek professional help for talking through stressful events and developing positive coping skills.

How can I help prevent recurrence of melanoma?

It is important to follow your doctor's treatment plan to prevent recurrence. In addition, follow these suggestions:

• Protect yourself from exposure to the sun by wearing a broad-brimmed hat and always use protective skin lotion with paraaminobenzoic acid (PABA) or other proven ingredients such as cinnamate.

• Use a chemical sunscreen with an SPF (sun protection factor) of 25 or higher.

• Stay out of the sun from 11 a.m. until 2:30 p.m., the hours of strongest sunlight.

• Keep the follow-up schedule set by your doctor.

• Be aware of any signs or symptoms of recurrence and report them promptly.