Cancer is defined as abnormal cells that grow in an uncontrolled way, and in some cases, spread to other areas. Melanoma is the type of cancer when the abnormal cells are Melanocytes – they type of cells that make melanin in your skin. The reality is that every day, cells in your body, including some of your Melanocytes mutate and become abnormal. In fact, it is “normal” to have some abnormal cells in your body. However, normally the abnormal cells die, or your body, recognizing them as abnormal, kills them. In rare cases, however, they don’t die, your body doesn’t recognize them, or something cause many of them to mutate, and that’s when you get a Cancerous growth. Hence, things that either cause normal cells to turn abnormal, or prevent your body from fighting abnormal cells, are most often the causes of cancer. Below are a number of theories for what might cause melanoma specifically. In addition, you can read more about what causes melanoma to spread once you have it.
Exposure to Ultraviolet Light
The cause mainly attributed to melanoma is too much ultraviolet (UV) radiation reaching the skin. UV rays from the sun and other sources (such as tanning booths) can damage skin cells, causing the cells to grow abnormally. Most typically, the type of DNA damage caused by UV radiation to cells is called thymine dimerization, which if not repaired, can cause gene mutations on the cell, essentially making them “abnormal” cells.
Beyond increasing the risk of cancer, overexposure, and especially regular acute overexposure (i.e. getting sunburn a lot) can have a number of negative health consequences. It can repress the immune system, causes retinal diseases, and cause other health challenges.
On the other hand, not enough sun exposure can also be detrimental to your health. In fact, recent science actually suggests that moderate sun exposure actually offers more benefits than risks(3). The main reason is that your body naturally produces vitamin D when your skin is exposed to the sun. In fact, moderate sun exposure is often considered much more efficient for getting your body the vitamin D it needs, over taking vitamin D supplements. Additionally, and almost ironically, when your body gets the appropriate level of vitamin D it needs, such as that produced by moderate sun exposure, it can actually reduce the risk of some cancers by up to 60%(4).
How much sun exposure is “moderate” or enough? That’s a difficult question to answer, however, the following guidelines can help:
Impaired Immune System
Melanoma in particular, responds better than most other cancers to immune system stimulants. This is because your body’s immune system can be very helpful in fighting and killing melanoma cells. The corollary is that if you have an impaired immune system, your risk of developing melanoma goes up. There are a variety of theories about things that could impair your immune system, and cause you to become more susceptible to melanoma:
Genetics and Family History
It is generally understood that about 90% of melanomas are spontaneous. This means that they are the result of a specific cell mutation in a person (from too much UV radiation, for example). Hence, those 90% are not the result of genetics, and have nothing to do with whether melanoma “runs in the family.” However, about 10% of melanomas are the result of genetics. This is not because one generation passed melanoma itself down to another. Rather, what gets passed through genetics are gene mutations that can make you more susceptible to melanoma. In essence, if you have skin cancer in general, or melanoma specifically, in your family history, you should take extra precautions to avoid the main causes of melanoma listed above.
As a general rule, genetic risk for melanoma is suspected if two or more close relatives, such as a parent, sibling or child, is diagnosed with melanoma. There are several other factors as well which can indicate that melanoma is genetic and can “run in the family”, including:
General references
http://www.inchem.org/documents/ehc/ehc/ehc160.htm
http://www.who.int/uv/publications/proUVrad.pdf
Other references
(3) http://www.pnas.org/content/105/2/668.abstract
(4) http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=PubMed&cmd=Search&term=Am.%20J.%20Clin.%20Nutr.[Jour]%20AND%202007[pdat]%20AND%20Lappe%20J[author]
(5) http://ods.od.nih.gov/factsheets/vitamind.asp
(6) http://healthlibrary.epnet.com/GetContent.aspx?token=0d429707-b7e1-4147-9947-abca6797a602&chunkiid=95460
(7) http://sustainableproduction.org/downloads/Causes%20of%20Cancer.pdf
(8)http://www.cancer.org/docroot/PED/content/ped71WhatYouNeedToKnowAboutSkinCancer.asp
(9) http://cat.inist.fr/?aModele=afficheN&cpsidt=16190623
(10) http://gucancers.asco.org/patient/Learning+About+Cancer/Genetics/The+Genetics+of+Melanoma
After melanoma is confirmed by a melanoma biopsy, and the stage of melanoma is determined, there are a broad number of drug treatments that are used to reduce or eliminate melanoma tumors, and to combat the spread of melanoma. Some treatments are used by themselves, while other protocols incorporate multiple treatments together, designed to improve the results.
Some melanoma treatments are used when tumors are present and measurable. These treatments tend to focus on the goal of reducing or eliminating tumors that are already present. Other treatments are used in what is called the "adjuvant" setting, which means that there is no evidence of melanoma tumors in the body. These adjuvant treatments focus on the goal of preventing melanoma tumors from forming in the future.
Melanoma treatment depends on the stage of growth it has reached. In most cases, your doctor will recommend surgery to remove the melanoma tumors. For more advanced stages, your doctor will also likely recommend additional treatment which could include immunotherapy or chemotherapy.
The typical protocols for melanoma treatment are based on Stages is outlined here:
Stage Protocol for Melanoma Treatment
After treatment, your doctor will want to see you every 3 to 6 months for the next 5 years. During these visits, your doctor will check to see whether the cancer has returned and if you have any new melanomas. If the melanoma has metastasized, you will also most likely need to get new scans, either a CT scan or an MRI or a PET scan, depending on the stage the melanoma reached.
Additionally, experimental treatments are treatments being tested in a clinical trial. In order for you to get into a clinical trial to receive the experimental treatment, you need to find it, qualify for it, and get accepted into it. Once accepted, many trials will pay for the melanoma treatment, and some will even pay for travel expenses.
There is a lot of evidence that your mind can have a very positive effect on the success of the treatment of melanoma. In fact, the science of Psychoneuroimmunology is built around the idea that your thinking, emotions, and mental state can have a profound affect and influence on your body and your immune system. Many melanoma patients have used mind-body techniques to help them significantly in their treatment and its successful outcome.
Below is a list of a number of strategies to use your mind to help in your battle against melanoma. Not every strategy is going to work for everyone, so don’t feel bad if you try a strategy and it doesn’t work for you. These strategies are listed here because they have worked for others, and what is important is to try and find the strategies that work for you. How will you know what could work for you? Read through them and try the ones that sound or feel like they fit with who you are.
After a melanoma biopsy is performed, and once it is confirmed to be melanoma, there are several systems used for describing how advanced melanoma is (“staging”). These “stages” can inform you as to how serious the condition is, and what type of treatment is best suited for you.
The three main staging systems are(1):
The "Stages" (scientifically known as the TNM Scale)The TNM system is the most common across all cancers for categorizing the Stage of the cancer. Determining the “Stage” of melanoma can can help your doctor understand the prognosis, as well as the appropriate treatment options for that Stage.
Melanoma is divided into 5 different stages:
Read more about the melanoma Stages, the prognosis, and the TNM scale
The Breslow scaleThe Breslow scale measures the thickness of the tumor in terms of millimeters. Breslow thicknesses are often grouped into categories because studies have shown that the thickness of the tumor is highly predictive of the risk of whether it has spread or will recur once removed. Those categories are often characterized by thickness of tumor in the following way:
< 1mm: Very unlikely that the melanoma has grown deep enough to start spreading
1-2mm: There is some risk that some cells have broken off and begun to spread
2-4mm: The risk that the melanoma has begun to spread is higher
> 4mm: It is a high risk that the melanoma has begun to spread
Note that the thickness of the tumor only measures the risk that it has begun to spread. There are still many tumors greater than 4mm thick that have not started to spread yet. This is why further diagnostic testing is usually warranted by your doctor.
Read more about melanoma and the Breslow scale
The Clark level (or Clark scale)
The Clark scale (often referred to as the “Clark level”) is another way of measuring the thickness of the tumor, however, it is not based on the thickness in millimeters, rather, it is based on how many layers deep in the skin the melanoma has penetrated. There is some debate as to which system of thickness measurement (Breslow or Clark) is more predictive of the risk of spreading of the melanoma, though a major study performed at John’s Hopkins demonstrated that the Breslow thickness was, in almost all cases, much more significantly predictive of risk and outcome. Regardless, the pathology report on a melanoma tumor still often lists the Clark level. The following are the 5 Clark Levels:
Level I: The melanoma is only in the epidermis (also called “in situ”). If completely removed, this type of tumor will not metastas and is generally considered to have a 100% cure rate
Level II: The melanoma has penetrated the second layer of the skin, called the papillary dermis
Level III: The melanoma has penetrated the papillary dermis, and is pressing up against the reticular dermis, which is the third layer of the skin.
Level IV: The melanoma has penetrated the third layer of skin, called the reticular dermis (also sometimes called the “deep dermis”)
Level V: The melanoma has penetrated into the subcutaneous tissue or fat.
One thing that sometimes confuses patients is whether “Stage 1” is the same as “Clark Level I.” The answer is, no. They are two separate systems for categorizing melanoma, and are not related. In almost all cases, your doctor will rely on the Number Stages system (also known as the TNM system) to determine what type course of action is best for you to take.
Melanoma is a less common form of skin cancer, but generally considered to be the most serious and dangerous. Melanoma generally begins in the skin, but if left untreated, can spread into your lymphatic system, and eventually to other organs such as the lungs, liver, and brain. Luckily, melanoma can be cured if it’s found and treated, and the earlier it is found, the more successful treatment can be. This is why doctors and dermatologists often recommend regular skin checks if you have abnormal looking moles, or a history of Melanoma or skin cancer in your family.
Read more about melanoma and its history
What causes melanoma?
The most common cause of Melanoma is generally considered to be too much sun exposure. There is some debate over whether the problem is the total amount of sun exposure (ex. you always have a sun tan), or if it is the total amount of acute exposure (ex. you often get sun burns). Regardless, the overexposure to the sun causes normal skin cells to mutate and become abnormal (see also Cell Mutations). Normal cells in your body have a life cycle (just like you), and at the end of their life, go through “dying” process (see Cell Apoptosis). However cancer cells that have mutated don’t go through the normal life cycle. Instead, they grow and multiple and do not die off. As they grow, they begin to destroy the other normal cells around them. There are a number of other theories and ideas about what causes Melanoma.
Read more about the causes of melanoma.
What are the symptoms?
The first sign of Melanoma is often a change in a mole, birthmark, or other skin growth. Sometimes you may not have observed this change, especially if you have not been paying careful attention to your skin. In that case, signs of a melanoma or risk of melanoma could be the presence of abnormal or atypical moles. Abnormal moles are those which are lumpy, raised, and rounded.
Read more about melanoma symptoms.
How is it diagnosed?
If your doctors observes a growth on your skin they suspect could be melanoma, they will remove a sample of tissue from that area (this is called a melanoma biopsy), and send that sample to be checked. A pathologist will examine the tissue sample under a microscope to check to see if it is cancer. Most of the time the report produced (called a pathology report) is highly accurate. However, sometimes your doctor will request a second pathologist to look at the tissue sample if there is any doubt.
If the pathologist determines that there is cancer, your doctor may order a number of other tests. Melanomas which are small and shallow are often easily removed with a simple surgical process that in most cases will be a complete cure. However, if the melanoma is large, and more importantly, deep, it is more likely to have begun to spread, and your doctor may wish to take a number of diagnostic measures. First, they may decide to check your lymph nodes for melanoma. They may also order one of a number of different scans (PET, CT, MRI, PET/CT) which can help them determine if, how and where the melanoma may have spread.
Read more about how melanoma is diagnosed.
What are the Stages and their prognosis?
The prognosis for melanoma varies significantly depending on the Stage of the cancer. The Stages range from Ia to IVd. If it is caught early, it is highly curable with surgery alone. If it is caught late, once it has already begun to metasta, the prognosis is not as favorable.
It’s important to remember, however, that statistics are only statistics. No matter what your stage or statistical prognosis, always remember that you are a strong and powerful person and you can overcome any challenge that you face, including this one. We provide comprehensive information on melanoma treatment.
Read more about the prognosis of the Stages of melanoma.
How do you prevent Melanoma?
The most commonly accepted cause of melanoma is over-exposure to UV rays, typically from too much sun. Hence, the easiest way to prevent melanoma is to avoid too much sun, and especially to take preventative measures (ie. wear sunscreen) to avoid sun burns.
Because Melanoma has been shown to have a genetic predisposition, it can run in families. Those people with a history of melanoma or other skin cancers, should be especially cautious to avoid over exposure to UV rays.
