Specialists Write In About Melanoma

Dr. Pendharkar is a practicing dermatologist (skin doctor) and Dr. Sivendran is a practicing Oncologist (cancer specialist). Please read their posts below for more information about a deadly type of skin cancer: Melanoma 

Melanoma 
By Dr. Ninad Pendharkar, Dermatologist

May is melanoma awareness month. Melanoma is a type of skin cancer that arises from melanocytes, which are the cells in the skin that create pigment. Unfortunately, the incidence of melanoma has been increasing. It is now the most common type of cancer in young adults aged 25-29. When identified early and treated, the cure rate is very high. However, a delay in detection increases the chance of it spreading to other parts of the body and being fatal.

Since early diagnosis is paramount in managing melanoma, it is important to examine your skin for any new or changing moles. The ABCDEs of melanoma can help in early detection.

      A-     Asymmetry (one half of the lesion looks different than the other half)

      B-     Border (irregular or poorly defined or scalloped boundaries of the lesion)

      C-     Color (varied color from one area to another; shades of tan, brown & black are present; sometimes white, red and blue)

      D-     Diameter (larger than the size of a pencil eraser)

      E-     Evolving (a lesion that looks like it has been changing in size, shape or color)

Another helpful detection tool is the “ugly duckling sign.” When examining your moles, look for the one mole or lesion that looks different than all the others. If you see any of these signs, it is important to see your doctor. Sometimes melanomas can itch, hurt or bleed. But most of the time there are no symptoms associated with melanoma.

Anyone can develop melanoma. However, people with fair skin, people who burn easily, and people with many moles are at an increased risk. Ultraviolet (UV) radiation is a major cause of melanoma. This could be from the sun, indoor tanning beds and sun lamps. Recent studies have shown that use of indoor tanning beds can increase your risk for melanoma by almost 75%.

If your doctor finds a spot that looks suspicious, the doctor will remove it or part of it and send it to the lab for analysis. This is called a skin biopsy and is typically a quick, safe and easy procedure to perform in the office. If the biopsy report states that the lesion is a melanoma, it will usually tell your doctor how deep the melanoma has grown into the skin. Based on this result, patients will require further surgery to remove skin cancer with a safety margin of normal skin around it. If the melanoma is deeper than a certain level, patients may need another type of biopsy called a sentinel lymph node biopsy. This helps doctors identify whether the melanoma has spread to nearby lymph nodes. If the melanoma has spread, then patient will need to see an oncologist (cancer doctor) for further testing and treatment.

As mentioned previously, early detection is the key for better outcomes. If the melanoma is early and only in the top layer of the skin, patients can be cured with surgical removal of the cancer. However, prevention is always better than cure. As a result, limiting UV sun exposure, using broad spectrum sunscreens of SPF 30 or higher, sun protective clothing, and avoiding the use of indoor tanning beds are critical in preventing melanoma.

Treatment of Advanced Melanoma: Perspective of a Cancer Doctor

By Dr. Shanthi Sivendran, Oncologist.

May is melanoma awareness month and important advances have been made in the treatment of advanced melanoma.  Stage IV or metastatic melanoma describes melanoma that starts in the skin and travels to some other part of the body such as the liver, lung, or brain.  When this occurs melanoma is rarely curative and the goals of treatment are to balance a patients quality and quantity of life.  

Historically, the average survival with someone with metastatic melanoma (spread beyond the skin) has been about six months.  For many years the only Food and Drug Administration (FDA) approved drugs were traditional chemotherapy and an immunotherapy called Interleukin 2.  Both were difficult therapies to tolerate.  Chemotherapy goes through the body and kills anything that grows fast.  That is potentially great for killing cancer but the price can be significant side effects from the temporary destruction of certain normal cells that also grow fast.  Chemotherapy has also not been very effective in the treatment of metastatic melanoma.  

Breakthroughs in research however have led to the FDA approval of two new medications in the treatment of metastatic melanoma - vemurafenib and ipilimumab.  These drugs are a significant break from chemotherapy because instead of killing anything that grows fast they only target specific pathways that drive the growth of melanoma.  For example, a mutation in BRAF pathway has been implicated in melanoma cancer growth.  Targeting BRAF with a drug that specifically inhibits it, vemurafenib, has been shown to improve overall survival from 6 months to 10 months.  Ipilimumab targets the immune system and has also improved survival in this disease.  Because these drugs are "targeted" drugs they come with a different potentially more tolerable set of side effects in comparison to traditional chemotherapy.  The introduction of these new drugs has provided new options for patients with this tough disease and have opened pathways for new research and clinical trials. 

The best treatment however for melanoma is prevention and early detection.  Talk to your family doctor and dermatologist about ways to reduce your risk of melanoma including wearing sunblock, avoiding excessive sun exposure, and wearing sun protective clothing.  If you have any moles you are concerned about bring it to the attention of your doctor.  As Ben Franklin said "An ounce of prevention is worth a pound of cure."

 Photo of asymmetrical melanoma Click here to go to National Cancer Institute website