What is malignant melanoma? Signs, symptoms, treatment

After the announcement that Sarah Ferguson, the Duchess of York, was diagnosed with malignant melanoma, many may now be wondering what are the signs, symptoms and treatment for the skin cancer.

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What is melanoma?

The Mayo Clinic says melanoma starts in the melanocytes, or the cells that make the pigment (melanin) giving skin its color.

Melanoma starts on the skin that usually gets sun exposure, so arms, back, face and legs. But it can form in the eyes, and rarely in the nose and throat. Most, but not all, are caused by exposure to ultraviolet lights — but not just from the sun. UV light also can come from tanning beds and lamps.

Who is at risk?

The risk seems to be increasing in people under the age of 40, according to the Mayo Clinic. The American Cancer Society said that it is one of the most common cancers in people younger than 30.

Men are more likely than women to develop melanoma, depending on their age, but before the age of 50, women are at higher risk. After the age of 50, men’s risk is higher.

The National Institutes of Health said that there could also be a family history of melanoma that could contribute to the risk.

Also, physical traits and other factors may increase a person’s risk, including:

• Blue eyes.
• Fair or pale complexion.
• Red hair.
• Reaction to sunlight (easily sunburned).
• Freckling.
• People who are immunosuppressed.
• A history of other skin cancers.

Reducing risk

You can reduce your risk of melanoma by limiting UV exposure, getting under shade, wearing clothing to cover exposed skin from the sun, putting on sunscreen, wearing a hat and wearing sunglasses.

You also should avoid tanning beds and sunlamps, the American Cancer Society said.

Signs and symptoms

Even if you do everything you can to lessen the risk, you still need to look out for the signs and symptoms of melanoma.

Keep an eye on your skin. If unusual moles, sores or lumps develop, have them checked out. Also if your skin looks or feels differently, that may be a signal.

Normally moles are evenly colored, either flat or raised and either round or oval. They are typically less than 6 millimeters across, or about the size of a pencil eraser.

But it is important to watch moles, making sure they don’t change in size, shape, color or texture. If they do, that could be a sign that melanoma is present.

The American Cancer Society suggests following the ABCDE rule when it comes to moles:

• Asymmetry: One half of the mark doesn’t match the other.
• Border: Edges are irregular.
• Color: The color of the mole varies and may have patches of pink, red, white or blue.
• Diameter: The mole is larger than 6 millimeters, keeping in mind that some melanomas are smaller than that size.
• Evolving: The mole changes size, shape or color.

These are just guidelines and melanomas may not fit the ABCDE rule, so if you see a new spot on your skin, tell your doctor.

Also alert them if you see the following signs: a sore that doesn’t heal, pigment spread from a spot into surrounding skin, redness or swelling beyond the mole’s border, a change in sensation (itchiness, tenderness, pain) and a change in mole’s surface (scaliness, oozing, bleeding).

Testing

If a doctor suspects you have a melanoma, you may be sent to a dermatologist to have the spots looked at more closely. They may use dermoscopy to magnify and light the mark, sometimes seeing below the surface of the skin. They can take images of the area to keep track of any changes.

Doctors may also use reflectance confocal microscopy using a laser to bounce light back, creating a 3D image.

A spectroscopic instrument will measure light wavelength reflections to determine if something is a melanoma, while a special adhesive patch will pick up cells that can then be sent for genetic testing.

If surface tests aren’t enough, a doctor may order a skin biopsy that will remove a portion of the mole under local anesthetic. There are a few types of biopsies, including a deep shave, or saucerization, when a doctor shaves off layers of the skin; a punch biopsy, where doctors remove a deeper core of the skin; and an excisional or incisional biopsy, where a doctor will remove all (excisional) or part (incisional) mole.

If melanoma has spread, then there are additional tests that doctors will perform including:

• Fine needle aspiration (FNA).
• Surgical lymph node biopsy.
• Sentinel lymph node biopsy.

Once the samples are taken, they will be sent to a lab to confirm a diagnosis and, if positive for cancer, to determine which stage it is, how likely it is to spread and a prognosis, the American Cancer Society said.

Treatment

If someone is diagnosed with melanoma, then there are several treatments depending on its stage and other factors, including surgery, immunotherapy, targeted drug therapy, chemotherapy and radiation therapy.

Surgery is the main treatment and is usually used in the early stages of the cancer. Wide excision will remove the entire spot and some of the margins around the cancerous area.

Mohs surgery, or MMS, is when the tumor is removed in very thin layers that are frozen and then examined. The process repeats until the cancer is fully removed.

In rare cases, depending on where the cancer is located — such as on a toe or finger — and if it is too deep, amputation may be needed.

Immunotherapy uses the patient’s immune system to find and destroy cancer cells. The treatment includes PD-1 inhibitor, PD-L1 inhibitor, CTLA-4 inhibitor and LAG-3 inhibitor.

Targeted drug therapy will zero in on parts of melanoma cells and is used in advanced cases, where cancer cells have gene changes.

Chemotherapy is taken either by IV or via the mouth and will travel through the blood to attack cancer cells that have spread.

Radiation therapy uses high-energy rays, such as X-rays, or particles to kill cancer cells. It is rarely used for melanoma skin cancer.

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