Malignant melanoma | definition of malignant melanoma by Medical dictionary Malignant melanoma | definition of malignant melanoma by Medical dictionary Definition Malignant melanoma is a type of cancer arising from the melanocyte cells of the skin. Melanocytes are cells in the skin that produce a pigment called melanin. Malignant melanoma develops when the melanocytes no longer respond to normal control mechanisms of cellular growth. They may then invade nearby structures or spread to other organs in the body (metastasis), where again they invade and compromise the function of that organ. Description Melanocytes are derived from a structure in the human embryo called the neural crest. They are distributed in the epidermis and thus are found throughout the skin. They produce a brown pigment known as melanin and are responsible for racial variation in skin color as well as the color of moles . Malignant degeneration of the melanocyte gives rise to the tumor known as melanoma, which has four subtypes.

These are: superficial spreading, nodular, lentigo maligna, and acral lentiginous melanomas, accounting for 70%, 15% to 30%, 4% to 10%, and 2% to 8% of cases, respectively. Malignant melanoma may develop anywhere on the body. In men, it is most common on the trunk. In women, it is most common on the back or legs. The subtype also may influence where the tumor develops; lentigo melanoma is more common on the face while acral lentiginous melanoma is more common on the palms of the hand, soles of the feet, or in the nail beds. The locally invasive characteristic of this tumor involves vertical penetration through the skin and into the dermis and subcutaneous (under-the-skin) tissues of the malignant melanocytes. With the exception of the nodular variety of melanoma, there is often a phase of radial or lateral growth associated with these tumors. Since it is the vertical growth that characterizes the malignancy, the nodular variant of melanoma carries the worst prognosis. Fortunately, the superficial spreading type is most common.

The primary tumor begins in the skin, often from the melanocytes of a pre-existing mole. Once it becomes invasive, it may progress beyond the site of origin to the regional lymph nodes or travel to other organ systems in the body and become systemic in nature. Lymph is the clear, protein-rich fluid that bathes the cells throughout our body. Lymph will work its way back to the bloodstream via small channels known as lymphatics. Along the way, the lymph is filtered through cellular stations known as nodes, thus they are called lymph nodes. Nearly all organs in the body have a primary lymph node group filtering the tissue fluid, or lymph, that comes from that organ. Different areas of the skin have different primary nodal stations. For the leg, they are in the groin. For the arm, the armpit or axilla. For the face, it is the neck. Depending where on the torso the tumor develops, it may drain into one groin or armpit, or both. Cancer, as it invades in its place of origin, may also work its way into blood vessels. If this occurs, it provides yet another route for the cancer to spread to other organs of the body.

When the cancer spreads elsewhere in the body, it has become systemic in extent and the tumor growing elsewhere is known as a metastasis. Untreated malignant melanoma follows a classic progression. It begins and grows locally, penetrating vertically. It may be carried via the lymph to the regional nodes, known as regional metastasis. It may go from the lymph to the bloodstream or penetrate blood vessels, directly allowing it a route to go elsewhere in the body. When systemic disease or distant metastasis occur, melanoma commonly involves the lung, brain, liver, or occasionally bone. The malignancy causes death when its uncontrolled growth compromises vital organ function. Of the anticipated new cases of cancer for the year 2003 in the United States, malignant melanoma will account for 5% of malignancies in men and 4% in women, being the sixth most common cancer in men and the seventh in women. It is estimated there will be 553,400 total cancer deaths in the United States in 2001. Malignant melanoma will account for 7,800 of these deaths, for an incidence of 1.5% of total deaths related to cancer.

The incidence of primary cutaneous malignant melanoma has been steadily increasing, possibly related to increase of sun exposure. Currently, the risk is about 13 per 100,000 of the population. It affects all age groups but is most commonly seen in patients between 30 and 60 years of age. Sun exposure definitely increases the risk of developing melanoma, particularly in older males. The melanocytes are part of the integument's photoprotective mechanism; in response to sunlight, they produce melanin that has a protective role from the sun's ultraviolet rays. For Caucasians, the amount of melanin present in the skin is directly related to sun exposure. However, it is not so much the total sun exposure that seems important, rather it is the history of sunburn , (especially if severe or at an early age), that correlates with the increased risk. On this basis populations of fair-skinned people living in areas of high sun exposure such as the southwest United States or Australia are subject to increased risk. Malignant melanoma also affects non-Caucasians—though sun exposure probably does not play a role—at a rate of 10% that of Caucasians.

The most common form of melanoma in African Americans is acral lentiginous melanoma. Malignant melanoma may arise in the skin anywhere on the body. It is estimated that 50%-70% develop spontaneously while the remainder start in a pre-existing mole. Causes and symptoms The predisposing causes to the development of malignant melanoma are environmental and genetic. The environmental factor is excessive sun exposure. There are also genetically transmitted familial syndromes with alterations in the CDKN2A gene, which encodes for the tumor-suppressing proteins p16 and p19. In 2003 a group of Swedish researchers reported that 63 out of a group of 71 melanoma patients, or 89% of the group, had mutations in either the NRAS or the BRAF gene. The researchers found that these mutations occur at an early point in the development of melanoma and remain as the tumor progresses. As of early 2003, some researchers think there may be two pathways to malignant melanoma, one involving exposure to sunlight and the other with melanocyte proliferation triggered by other factors.

This hypothesis is based on the difference in distribution of moles on the body between patients who develop melanomas on the face and neck, and those who develop melanomas on the trunk. A small percentage of melanomas arise within burn scar tissue. As of 2003, researchers do not fully understand the relationship between deep burns and an increased risk of skin cancer. As mentioned previously, melanin production in fair-skinned people is induced by sun exposure. An exposure substantial enough to result in a mild sunburn will be followed by melanin producing a tan that may last a few weeks. Both ultraviolet radiation and damaging oxygen radicals caused by sun exposure may damage cells, particularly their DNA. It is suspected that this damage induces mutations that result in the development of malignant melanoma. Though these mutations are alterations of the genome causing the melanoma, they are environmentally induced and account for sporadic or spontaneous cases of this disease. A positive family history of one or two first-degree relatives having had melanoma substantially increases the risk on a genetic basis. A family tendency is observed in 8% to 12% of patients.

There is a syndrome known as the dysplastic (atypical) nevus syndrome that is characterized by atypical moles with bothersome clinical features in children under age 10. Such individuals have to be observed closely for the development of malignant melanoma. Chromosome 9p has been identified as being involved in familial predisposition. There are mutations in up to 50% of familial melanoma patients of the tumor-suppressing gene CDKN2A. The actual number of moles increases risk, but the size of the moles needs be considered. Those with 10 larger moles of over 1 cm (0.4 in.) are at more risk than those with a higher number (50-99) of smaller moles. Finally, when a child is born with a large congenital mole, careful observation for change is appropriate because of increased risk. An excellent way of identifying changes of significance in a mole is the ABCDE rule: Asymmetry Diameter greater than 6 mm (0.24 in) Elevation above surrounding tissue. Notice that three of the criteria refer to variability of the lesion (color variegation refers to areas of light color and black scattered within the mole).

Thus small, uniform regular lesions have less cause for concern. It is important to realize that change in a mole or the rapid development of a new one are very important symptoms. Another summary of important changes in a mole is the Glasgow 7-point scale. The symptoms and signs below can occur anywhere on the skin, including the palms of the hands, soles of the feet, and also the nail beds: Change in size Sensory change Diameter greater than 7 mm (0.28 in. In this scheme, change is emphasized along with size. Bleeding and sensory changes are relatively late symptoms. Symptoms related to the presence of regional disease are mostly those of nodules or lumps in the areas containing the lymph nodes draining the area. Thus nodularity can be found in the armpit, the groin, or the neck if regional nodes are involved. There is also a special type of metastasis that can occur regionally with malignant melanoma; it is known as an in-transit metastasis. If the melanoma is spreading through the lymph system, some of the tumor may grow there, resulting in a nodule part way between the primary site and the original lymph node.

These in-transit metastasis are seen both at the time of original presentation or later after primary treatment has been rendered, the latter being a type of recurrence. Finally, in those who either present with or progress to widespread or systemic disease, symptoms and signs are related to the affected organ. Thus neurologic problems, lung problems, or liver problems develop depending on the organ involved. Diagnosis None of the clinical signs or symptoms discussed above are absolute indications that a patient has malignant melanoma. The actual diagnosis is accomplished by biopsy, a procedure that removes tissue to examine under a microscope. It is important that the signs and symptoms are used to develop a suspicion of the diagnosis because the way the biopsy is performed for melanoma may be different than for other lesions of the skin. The doctor may also use a dermatoscope to examine the mole prior to removal. The dermatoscope, which can be used to distinguish between benign moles and melanomas, is an instrument that resembles an ophthalmoscope. An immersion oil is first applied to the mole to make the outer layers of skin transparent. When dealing with an early malignant melanoma, it is very important to establish the exact thickness of penetration of the primary tumor.

Any biopsy that does not remove the full vertical extent of the primary is inadequate. Therefore, if a skin lesion is suspicious, full thickness excisional biopsy is the approach recommended. Shave biopsies and biopsies that remove only a portion of the suspect area are inappropriate. Often, in an early case, the excision involves just the suspicious lesion with minimal normal skin, but it should be a full vertical excision of the skin. If a melanoma is diagnosed, further treatment of this area will often be necessary but does not compromise outcome (prognosis). In some special areas of the body, minor modifications may be necessary about initial total excision, but full thickness excision should always be the goal. (See staging, below.) Once the diagnosis is obtained, careful examination of the patient for regional lymph node involvement should be done. A careful review to uncover any symptoms of widespread disease is also appropriate. The more common patient has an early melanoma, and extensive testing is not usually warranted. Routine testing in this situation involves a complete blood count , a chest x ray , and determinations of blood enzymes including lactic dehydrogenase and alkaline phosphatase.

If the patient has signs or symptoms of more advanced disease, or if the lesion's depth of penetration is sizeable, further imaging studies may be appropriate. These would involve CAT scans of the abdomen, the chest, or regional nodal areas, or a CT or MRI of the brain. Treatment The key to successful treatment is early diagnosis. Patients identified with localized, thin, small lesions (typified by superficial spreading subtype) nearly always survive. For those with advanced lesions, the outcome is poor in spite of progress in systemic therapy. Clinical staging Malignant melanoma is locally staged based on the depth of penetration through the skin and its appendages. There are two ways of looking at the depth of penetration. The Clarke system utilizes the layers of the dermis and the skin appendages present at that layer to identify the depth of penetration. The Breslow system uses the absolute measurement of depth. Though useful conceptually, the Clarke system is used less frequently because of the fact that skin is of different thickness in different regions of the body. The depth of penetration is much greater when the tumor reaches the subcutaneous fat when the skin involved is the back as opposed to the face.

It turns out that the Breslow measurement is more reproducible and thus more useful; therefore, for purposes here, depth of penetration by absolute measurement (Breslow) is used in local staging. Stage I and stage II have no involvement of the regional lymph nodes and are thus localized to the site of origin. These stages are subdivided on the basis of penetration. Stage Ia is 0.75 mm or less (1 mm = 0.04 in), and Stage Ib is 0.75-1.5 mm penetration. Stage IIa is 1.5-4.0 mm and Stage IIb is over 4.0 mm or into the subcutaneous fat. In stage III and IV, there is disease beyond the primary site. Stage III is defined by the presence of in-transit or regional nodal metastasis or both. Stage IV is defined by the presence of distant metastasis. Once the diagnosis of malignant melanoma has been established by biopsy and the stage has been identified using the results of the examination and studies, a treatment plan is developed. Melanoma is not cured unless it is diagnosed at a stage when it can be isolated and removed surgically.

Considerations revolve around the extent of the local and regional nodal surgery for stages I through III. For stage IV patients, or those that are treated and then develop recurrence at distant sites, chemotherapy or immunotherapy is planned. Studies are in progress to improve the results from traditional chemotherapeutic regimens. Adjuvant therapy (auxiliary drug treatment used to make possibility of relapse less for those at high risk) is also considered. Surgical therapy for the primary site is that of wide local removal of the skin including subcutaneous tissue surrounding the lesion. In the past, wide excisions were large and encompassed 2 in. of tissue in all directions wherever feasible. It has been shown that such wide local excisions are not necessary and the issue has become: how wide is enough? Studies from the World Health Organization Melanoma Group and by the Melanoma Intergroup Committee in the United States have provided general guidelines based on the depth of penetration of the melanoma. These guidelines and anatomic considerations need to be kept in mind by the surgeon. The next issue in primary management is whether the patient should have the regional lymph nodes removed in addition to treatment of the primary tumor.

The problems associated with the resection of regional lymph nodes are those of lifelong edema or swelling in the extremity. Though it does not occur in all patients (5% to 20%, depending on the extremity and extent of the dissection), it can be a disabling symptom. Certainly, if it could be ascertained that there was disease in the nodes, resection (removal) would be appropriate. However, if there was no disease, the risk of edema should be avoided. In patients with no signs of regional disease, depth of penetration of the primary tumor helps guide the decision. If the tumor penetrates less than 1mm, dissection is not usually done. If it is 1-2 mm, node dissection may be done at the time of primary treatment or the patient may be observed and only undergo lymph node dissection if the area later shows signs of disease. If the patient has enlarged lymph nodes or the depth of the tumor has led to the evaluation by CAT scan showing enlarged nodes, resection of the nodes will be considered. In the latter case, more extensive imaging of the lung, liver, or brain may be appropriate to be sure the patient does not already have stage IV disease.

Questions related to which patients should have resection of regional lymph nodes have led to an intermediary procedure known as sentinel node mapping and biopsy. Intermediate thickness melanomas between 1 and 4 mm deep (0.04 and 0.16 in.) may have nodal involvement even if the examination and any other studies done are normal. If a radioisotope tracer or blue dye is injected into the area of the primary tumor, very shortly it will travel to the lymph nodes draining that area. These sentinel nodes are thus identifiable and are the most likely to harbor any regional metastatic disease. If these nodes alone are biopsied and are normal, the rest of the lymph node group can be spared. If they show microscopic deposits of tumor, then the full resection of the lymph node group may be completed. This procedure allows selection of those patients with intermediate thickness melanoma who will benefit from the regional lymph node dissection. Patients with metastatic melanoma who do not respond well to other therapies may be candidates for treatment with aldesleukin. Aldesleukin is a form of interleukin, a specific kind of biological response modifier that promotes the development of T-cells.

These cells are part of the lymphatic system and can directly interact with and fight cancer cells. Although aldesleukin is produced naturally in the body, its therapeutic form is developed via biotechnology in a laboratory setting. Treatment is considered palliative, which means that it provides comfort but does not produce a cure. Side effects, however, can be severe, and range from flu-like symptoms to whole-body infection ( sepsis ) and coma . Some patients, such as those with IIb or stage III melanoma, are at high risk for the development of recurrence after treatment. Although these patients are clinically free of disease after undergoing primary treatment, they are more likely to have some microscopic disease in the body that studies have not yet been able to identify. In an effort to decrease the rate of relapse, adjuvant therapy may be considered. Interferon alpha 2a is an agent that stimulates the immune system. This adjuvant therapy may slightly increase the duration of a patient's disease-free state and lengthen overall survival. However, interferon alpha 2a has high toxicity and patients may not tolerate the side effects.

Unfortunately, treatment for those patients who present with or go on to develop systemic disease usually fails; melanoma that has metastasized to the brain is particularly difficult to treat. The chemotherapeutic agent dacarbazine, or DTIC, seems to be the most active agent. Overall responses are noted in about 20% of patients, and they last only two to six months. Combination therapy may be an option. The regimen of DTIC + BCNU (carmustine) + cisplatin + tamoxifen delivers a response rate of 40%. Combining biologic or immunologic agents such as interferon with standard chemotherapeutic agents is under study and showing improved response rates, though toxicity is substantial and only the healthier, younger patients tolerate the treatment. Some researchers are investigating the reasons why melanomas are so resistant to chemotherapy. One suggestion as of late 2003 is that the genes ordinarily responsible for apoptosis (cell self-destruction) do not function normally in melanomas. The development of new drugs to treat melanoma depends on a better understanding of the complex processes involved in apoptosis.

Alternative treatment Though radiation therapy has a minimal role in the primary treatment of malignant melanoma, for patients who have metastatic disease, radiation may be helpful. This is true in patients who have developed tumor deposits in such areas as the brain or bone. Prognosis Almost all patients survive stage Ia malignant melanoma, and the suvivorship for stage I overall is more than 90%. Survival drops in stage IIa to about 65% at five years and is worse yet for stage IIb at slightly over 50%. Stage III has a survival rate at 5 years of 10%-47%, depending on the size and number of regional nodes involved. Stage IV malignant melanoma is almost always a fatal disease. Coping with cancer treatment For those with familial tendencies for malignant melanoma, genetic counseling may be appropriate. Psychological counseling may be appropriate for anyone having trouble coping with a potentially fatal disease. Local cancer support groups may be helpful and are often identified by contacting local hospitals or the American Cancer Society.

Prevention Though it is difficult to prove that sunscreens statistically reduce the frequency of malignant melanoma at this time, most authorities recommend their use as protection from ultraviolet light (considered a major factor in the development of melanoma.) Avoidance of severe sunburns is recommended. Key terms Adjuvant therapy — Treatment given to patients who are at risk of having microscopic untreated disease present but have no obvious symptoms. Dermis — The deeper portion or layer of the skin beneath the epidermis. Dysplastic nevus syndrome — A familial syndrome characterized by the presence of multiple atypical appearing moles, often at a young age. Epidermis — The uppermost layer of skin cells. Genome — The genetic makeup of a cell, composed of DNA. Immunotherapy — A form of treatment that uses biologic agents to enhance or stimulate normal immune function. Integument — The medical name for the skin. Lymph node dissection — Surgical removal of a group of lymph nodes. Lymphedema — Swelling of an arm or leg following surgical removal of the lymph nodes that drain the limb. Melanocytes — Skin cells derived from the neural crest that produce the protein pigment melanin.

Metastasis (plural, metastases) — A tumor growth or deposit that has spread via lymph or blood to an area of the body remote from the primary tumor. Nevus (plural, nevi) — A medical term for mole. Resection — The act of removing something surgically. Skin appendages — Structures related to the integument such as hair follicles and sweat glands. Variegation — Patchy variation in color. Resources Books Abeloff, Armitage, Lichter, and Niederhuber. Clinical Oncology Library. 2nd ed. London: Churchill Livingstone, 1999. Beers, Mark H., MD, and Robert Berkow, MD, editors. "Dermatologic Disorders: Malignant Tumors." Section 10, Chapter 126. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004. Beers, Mark H., MD, and Robert Berkow, MD, editors. "Dermatologic Disorders: Moles." Section 10, Chapter 125 In The Merck Manual of Diagnosis and Therapy.

Whitehouse Station, NJ: Merck Research Laboratories, 2004. Beers, Mark H., MD, and Robert Berkow, MD, editors. "Dermatologic Disorders: Reactions to Sunlight." Section 10, Chapter 119. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004. Periodicals Brown, C. K., and J. M. Kirkwood. "Medical Management of Melanoma." Surgical Clinics of North America 83 (April 2003): 283-322. Carlson, J. A., A. Slominski, G. P. Linette, et al. "Malignant Melanoma 2003: Predisposition, Diagnosis, Prognosis, and Staging." American Journal of Clinical Pathology 120 , Supplement (December 2003): S101-S127. Eigentler, T. K., U. M. Caroli, P. Radny, and C. Garbe.

"Palliative Therapy of Disseminated Malignant Melanoma: A Systematic Review of 41 Randomised Clinical Trials." Lancet Oncology 4 (December 2003): 748-759. Halder, R. M., and C. J. Ara. "Skin Cancer and Photoaging in Ethnic Skin." Dermatologic Clinics 21 (October 2003): 725-732. Horig, H., and H. L. Kaufman. "Local Delivery of Poxvirus Vaccines for Melanoma." Seminars in Cancer Biology 13 (December 2003): 417-422. Jellouli-Elloumi, A., L. Kochbati, S. Dhraief, et al. "Cancers Arising from Burn Scars: 62 Cases." [in French] Annales de dermatologie et de venereologie 130 (April 2003): 413-416. McWilliams, R. R., P. D. Brown, J. C. Buckner, et al.

"Treatment of Brain Metastases from Melanoma." Mayo Clinic Proceedings 78 (December 2003): 1529-1536. Omholt, K., A. Platz, L. Kanter, et al. "NRAS and BRAF Mutations Arise Early During Melanoma Pathogenesis and Are Preserved Throughout Tumor Progression." Clinical Cancer Research 9 (December 15, 2003): 6483-6488. Rockmann, H., and D. Schadendorf. "Drug Resistance in Human Melanoma: Mechanisms and Therapeutic Opportunities" Onkologie 26 (December 2003): 581-587. Weinstock, Martin A. "Early Detection of Melanoma." JAMA, The Journal of the American Medical Association 284 (August 16, 2000): 886. Whiteman, D. C., P. Watt, D. M. Purdie, et al.

"Melanocytic Nevi, Solar Keratoses, and Divergent Pathways to Cutaneous Melanoma." Journal of the National Cancer Institute 95 (June 4, 2003): 806-812. Organizations American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. National Cancer Institute (NCI). NCI Public Inquiries Office, Suite 3036A, 6116 Executive Boulevard, MSC8332, Bethesda, MD 20892-8322. (800) 4-CANCER or (800) 332-8615 (TTY).

Other Surface: nodular and/or irregular, ragged, sloughy, ulcer; oozing Treatment: wide excision and biopsy; lymphadenectomy and radiation therapy if there is associated lymphatic spread Verrucous carcinoma of the foot (epithelioma; carcinoma cingulatum) Location: at any skin site; predilection for plantar skin Progression: initially resembles verruca plantaris; slowly progressive to form a nodular lesion and later a soggy, foul-smelling ulcer with sinuses somewhat remote from the main lesion Cellular involvement: obviously malignant epidermal cells invade the dermis Treatment: as for SCC Figure 1: Bones of the foot. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall, Copyright Elsevier, (2006). melanoma a tumor arising from melanocytes, dendritic cells of neuroectodermal origin, or melanoblasts. They are most common in the skin, eye and oral cavity of dogs and aged gray horses, but occur occasionally as congenital lesions in pigs, goats and cattle. An inherited, malignant melanoma is recorded in swordtail-platyfish hybrids.

amelanotic melanoma one containing little or no melanin. benign m's usually pigmented plaques or nodules. Those with junctional activity are analogous to the human compound junctional nevus. congenital melanoma of pigs a single or multiple pigmented tumor of the skin or viscera that grows slowly and may metastasize. Spontaneous regression is common. An inherited form seen in Sinclair miniature pigs. dermal melanoma a tumor which arises from rests of melanocytes in the dermis, remnants of neural crest precursors. Pigmentation is variable. It is usually benign. malignant melanoma a malignant, rapidly growing, frequently ulcerated mass, consisting of either spindle cells or epithelioid cells or a mixture of the two, with a marked tendency to metastasize. The tumor cells may or may not (amelanotic) be pigmented. Although melanomas in pigs and cattle are usually benign and are not treated, those in horses, dogs, cats and occasional cases in sheep, goats and pigs are malignant. Called also nevocarcinoma.

Skin Cancer | Skin Cancer Treatment | Burbank | Pasadena | Glendale CA Types of Skin Cancer Squamous Cell Carcinomas & Pre-Conditions Squamous cell carcinoma affects more than 200,000 Americans each year. This cancer can occur on many areas of the body but is most common in areas exposed to the sun and is confined to the epidermis. Anyone with a high amount of sun exposure is vulnerable to and can develop squamous cell carcinoma. People with fair skin and light hair and eyes are at a higher risk for the condition. Pre-cancerous conditions can act as early warning signs for the disease and speed up treatment. Some of the common precursor conditions include Actinic or Solar Keratosis and Bowen’s Disease. Bowen’s Disease often appears as a persistent red-brown, scaly patch similar to psoriasis or eczema. If it is left untreated, it can invade deeper into the skin layers and form squamous cell skin cancer. Basal Cell Carcinomas Basal cell carcinomas are the most common malignancy in humans. They occur most commonly in Caucasian or lighter skin people who have high sun exposure and are between the ages of 40-80.

Most Basal Cell Carcinomas (BCC) occur on the head, nose and neck. There are different variations of BCC, including nodular, pigmented, sclerosing and superficial. Nodular BCC is similar to a non-healing sore which is round or oval and often pink, skin-colored or red with a wax-like border and occurs mostly on the face or nose in the form of a singular lesion. Superficial cell BCC might appear as round, irregularly shaped scaly plaques that might be raised and have a translucent rolled border. Superficial cell BCCs are usually found on the trunk. Pigmented BCCs are similar to the nodular or superficial lesions but are pigmented instead, making them a darker color – often brown, black or blue. Sclerosing BCCs are the least common yet most aggressive form. These appear as yellow or hyper-pigmented lesions that might look like scars. Melanoma Malignant melanoma is the most serious of all skin cancers. If not treated promptly, this cancer could be fatal. Malignant melanoma often first appears as a mole, which grows and is uneven in size, shape or color.

To monitor the symptoms of melanoma, it is important to watch and observe the rate of growth for a mole. In men, melanoma is usually found on the area between the shoulders and hips or on the head and neck. In its early stages, melanoma is called cutaneous melanoma. It is referred to as metastatic melanoma when it begins to spread. While spreading, melanoma cancer cells can also be found in other areas of the body, such as the lymph nodes, liver, lungs or brain. Some common risk factors of melanoma include prior family history, non-cancerous unusual moles, many males older than 50, several freckles, fair skin and light eyes, severe sunburns and immunosuppressive therapy. Common signs or symptoms of melanoma include a skin growth that increases in size and is a varied tan, brown, pink, red or multicolored, a mole that rapidly changes in size, color or texture, a growth that continuously itches, burns and scabs, or a long-lasting open sore. To assess whether or not a mole could be malignant, it is helpful to follow the ABCDE’s rule.

Moles that are Asymmetrical or irregular in shape, have uneven Borders, contain multiple shades or Color usually brown and black, and often have a over 6mm Diameter are more likely to be malignant and should be examined immediately. What causes skin cancer? Skin cancer is the most common cancer type in the United States and makes up 50 percent of all cancers. The most common causes of skin cancer are genetics or exposure to ultraviolet radiation or UV rays from the sun. Artificial sources of UV rays such as tanning beds can also cause skin cancer. People living in an area with a high level of UV ray exposure are more likely to get skin cancer. How can it be prevented? The key in skin cancer prevention is protection from the ultraviolet rays of the sun. Since skin cancer often occurs after a lifetime of prolonged sun exposure, it is best to develop safe sun exposure habits from childhood. Exposure to the sun, especially the midday sunlight, should be avoided. Protective clothing such as hats and long sleeved shirts can help block out the harmful radiation.

Regularly applying sunscreen, 30 minutes prior to sun exposure in two layers 15 minutes apart and reapplying 3-4 hours during exposure, can also protect against the UV radiation. Preventing skin cancer is an early step that everyone can take by following a simple skin protection regime. Skin Cancer Treatments There are many treatment options available for skin cancer including curettage and electrodessication, cryosurgery, routine excision, light and laser therapy and Mohs micrographic surgery. If the melanoma is localized, or limited to the skin, it can be removed by a surgical excision. Basal and squamous cell carcinomas can be treated with excision, curettage, light or laser therapy, Mohs micrographic surgery or occasionally by topical prescriptions or cryosurgery. Topical Prescriptions There are two cream medications that have been used to treat superficial or small skin cancers, 5 fluorouracil cream and imiquimod cream. This treatment is not 100% effective but can be very useful in patients who cannot tolerate surgery or radiation therapy.

Cryosurgery Freezing (Cryosurgery) skin cancers is not done in the US much anymore as we have more effective treatments with less pain and shorter healing times now. We do use this method for pre-cancerous actinic keratosis lesions. Light & Laser Therapy Skin cancer can be treated with light or laser therapy. The laser therapy is often used for cancers that involve the outer layer of the skin. The light therapy is most often used to heal common conditions such as Actinic Keratoses that occur from sun damage. Photo Dynamic Therapy (PDT) technology can also be used to enhance the effectiveness of these treatments. Photo Dynamic Therapy combines a light source and a photosynthesizing agent to target and destroy cancerous cells. It was recently approved by the FDA to treat certain cancers including Actinic Keratosis. Curettage & Electrodessication This method was the most popular surgical method for removing skin cancers until Moh’s Micrographic Surgery became available in most cities in the US. We still use this skin cancer removal method for certain patients who cannot tolerate regular surgery or radiation treatments, such as those that are very old, very ill or are confined to skilled nursing facilities.

The cure rate can be as high as 93% with this technique. Radiation Therapy Basal Cell Carcinomas and Squamous Cell Carcinomas are radiation sensitive but Melanoma is not. In select skin cancer patients and lesions, this method may be recommended. As recurrence of the cancer in radiated skin is a possibility, most Dermatologists reserve this treatment for very select patients. Radiation therapy may also be used in conjunction with surgery for lesions that are more likely to metastasize. Traditional Surgery and Mohs Micrographic Surgery Mohs is a method of excising skin cancers such as Basal and Squamous Cell Carcinomas under local anesthesia. Mohs surgery combines the surgical removal of the tumor with an immediate microscopic examination of the tumor and its underlying diseased tissue. Where further cancer is noted, additional layers are taken until a level free of tumor is reached.

By removing tissue only where cancer is known to be present, the technique combines a high cure rate, has the lowest change of regrowth, minimizes the potential for scarring or disfigurement and is the most exact and precise means of removal.Traditional surgery ( non Moh’s) is often used for skin cancers below the neck that are not very large, that have a more benign histopathology and in cases where the patient cannot tolerate the length of surgical time needed in Moh’s surgery cases. Skin Cancer – Types & Risk Factors | Everyday Health Medically Reviewed by Rosalyn Carson-DeWitt, MD Most cases of this common cancer can easily be prevented. Skin cancer is the most common form of cancer in the United States. Most cases of melanoma , the deadliest type of skin cancer, are caused by exposure to ultraviolet (UV) light from the sun, tanning beds, or sunlamps. UV rays are a form of invisible radiation that can penetrate skin and change skin cells. Of the three types of UV rays — UVA, UVB, and UVC — UVA rays are considered the most dangerous when it comes to increasing the risk of skin cancer.

Prevalence According to the American Cancer Society (ACS), 76,690 Americans — roughly 60 percent of them men — were diagnosed with melanomas of the skin in 2013. Another 5,880 were diagnosed with what are known as non-epithelial skin cancers, such as sarcomas. The ACS reports that nearly 12,000 Americans die each year from melanomas and non-epithelial skin cancers. These figures do not include basal cell and squamous cell carcinomas , two other common forms of skin (explained below). Types of Skin Cancer There are several types of skin cancer, including: Melanoma: A melanoma is a cancerous growth that most frequently develops in the skin. This type of growth can also form in any part of the body that contains melanocyte cells, including the digestive tract, eyes, lymph nodes, and meninges (membranes lining the brain and spinal cord). Basal cell carcinoma (BCC) : BCC is the most commonly diagnosed skin cancer. It can develop on regions of the body that receive regular sun exposure, including the face and hands.

Fortunately, BCC rarely spreads and is usually treatable, due to its slow growth rate. A common form of BCC is nodular basal cell carcinoma. In nodular BCC, lesions typically appear brown, black, or blue in color. Squamous cell carcinoma (SCC): SCC appears on body parts that have experienced higher levels of sun exposure, including the face, lips, and back. Lesions can appear rough, scaly, lumpy, or flat, and they may bleed easily. SCC is more likely to spread than BCC. Merkel cell carcinoma (MCC): MCC, also known as neuroendocrine carcinoma, is a rare type of skin cancer. Lesions can be flesh-colored or bluish-red, and they can develop on your face, head, or neck. Kaposi sarcoma (KS) : KS lesions can grow under the skin; in the lining of the mouth, nose, and throat; or in other body organs. In recent years, they have been associated with HIV/AIDS , but there are other causes of KS, including other infections. KS lesions typically appear red or purple in color and are made of both cancer cells and blood cells. They may be painful.

Epidermoid cysts: Sometimes called sebaceous cysts (although they are actually different), epidermoid cysts are noncancerous. They appear as small bumps beneath the skin, most often on the face, neck, and torso. Sebaceous cysts are less common. They arise from sebaceous glands, which secrete oily matter that lubricates your hair and skin. Risk Factors Risk factors vary for different types of skin cancer. However, any of the following can increase your risk of developing skin cancer: Lighter natural skin color Family or personal history of skin cancer Excessive sun exposure A history of sunburns, particularly early in life Skin that burns, freckles, or reddens easily, or becomes painful in the sun Blue or green eyes What is Melanoma? | Melanoma Research Foundation Acral Lentiginous Melanoma Lentigo Maligna Melanoma Mucosal Melanoma can occur in any mucous membrane of the body, including the nasal passages, the throat, the vagina, the anus, or in the mouth Ocular Melanoma , also known as uveal melanoma or choroidal melanoma, is a rare form of melanoma that occurs in the eye.

Learn more about CURE OM , the MRF’s initiative focused on ocular melanoma Unlike other cancers, melanoma can often be seen on the skin, making it easier to detect in its early stages. If left undetected, however, melanoma can spread to distant sites or distant organs. Once melanoma has spread to other parts of the body (known as stage IV), it is referred to as metastatic melanoma , and is very difficult to treat. In its later stages, melanoma most commonly spreads to the liver, lungs, bones and brain; at this point, the prognosis is very poor. What causes melanoma? Research suggests that approximately 90% of melanoma cases can be linked to exposure to ultraviolet (UV) rays from natural or artificial sources, such as sunlight and indoor tanning beds . However, since melanoma can occur in all melanocytes throughout the body, even those that are never exposed to the sun, UV light cannot be solely responsible for a diagnosis, especially mucosal and ocular melanoma cases. Current research points to a combination of family history, genetics and environmental factors that are also to blame. Read our Melanoma Fact Sheet for more information!

Taking steps to prevent melanoma is therefore the best first step in protecting yourself and your skin. It is important to learn about all of the risk factors . Support the MRF I have vitiligo, will I get skin cancer? I have vitiligo, will I get skin cancer? I have vitiligo, will I get skin cancer? "Speaking of Vitiligo..." I have vitiligo, will I get skin cancer? Posted On: Saturday, July 19, 2014 Posted By: John E. Harris This question comes up in my clinic all the time. Vitiligo patients are frequently told by their dermatologists that they are at a high risk for skin cancer because they are lacking the natural protection of the skin pigment melanin against the sun’s harmful rays. It seems to be a reasonable warning, since we know that sun exposure increases the risk of skin cancer, particularly in younger people who have experienced severe burns. Also, recent studies reveal that the use of tanning beds increase the risk of melanoma, a deadly skin cancer.

It is also true that the lack of pigment in the skin in vitiligo patients, which results from the loss of the pigment-producing cells called melanocytes, makes them more likely to burn when spending time in the sun. So, it’s not surprising that dermatologists warn their vitiligo patients about an increased risk for skin cancer. The problem is that research studies don’t seem to support this warning. During my training in dermatology and when trying to learn as much as I could about vitiligo, I used to attend the “Vitiligo” lecture at the yearly American Academy of Dermatology meeting. Dr. James Nordlund , a long-term expert on vitiligo who began studying the disease with Dr. Aaron Lerner almost 40 years ago, was the main speaker. Every year he would say that, although it seems obvious that vitiligo patients are at an increased risk for skin cancer due to their loss of pigment, he rarely saw it in his patients. And he has seen a LOT of patients with vitiligo.

In fact, I distinctly remember him saying that he could count the number of vitiligo patients that he’s seen with skin cancer on one hand, and in all but one of those patients the cancer appeared in normally pigmented skin, suggesting it wasn’t even the pigment loss that caused it. Dr. Nordlund also studied patients with albinism, a completely different disease in which the patients have normal numbers of melanocytes, but have no pigment because the cells are missing a key protein required to make it. Albino sufferers get skin cancers VERY frequently, and can even die of this complication. But Dr. Nordlund noticed a distinct contrast between patients with each disease, as vitiligo patients exposed to extreme sun in Africa rarely developed cancer, while albino patients in the same sun often developed multiple cancers on their skin. He ended by saying he did not know WHY this was the case, but that this was his experience. And I was fascinated. It was not long thereafter that a study performed in the Netherlands reported that patients with vitiligo appeared to be at a LOWER risk for skin cancer than healthy controls in comparison.

In the study, they surveyed vitiligo patients over the age of 50 and their healthy partners as controls, asking about skin cancer risk factors (sun exposure, family history, etc), and whether they ever had a skin cancer. It turned out that the vitiligo patients reported 3 times fewer skin cancers (including melanoma, squamous cell carcinoma, and basal cell carcinoma) than their healthy partners, suggesting that vitiligo patients may be relatively protected from skin cancer. This lower risk was not simply due to staying out of the sun more, using more sunscreen, or by avoiding other known risk factors for cancer. How could this be? The short answer is, we don’t know for sure. But there are some clues. Recent studies into the genetics of vitiligo revealed that versions of genes that INCREASE the risk for vitiligo simultaneously DECREASE the risk for melanoma, and vice-versa. This kind of makes sense, because vitiligo occurs when the immune system kills normal melanocytes in the skin, resulting in white spots that lack pigment (read more about this here ).

Therefore, if vitiligo patients have an overactive immune system that kills normal melanocytes, it makes sense that they are able to clear the abnormal melanocytes of melanoma. In fact, there are a few reports of patients with widespread melanoma that become spontaneously cured of their disease, and all of them have simultaneously developed vitiligo. Also, new treatments for melanoma that increase the immune attack of the tumors also cause vitiligo. So vitiligo protects against melanoma, which is good news. However why vitiligo protects from non-melanoma skin cancers like squamous cell carcinoma and basal cell carcinoma cannot be explained by these observations. This seemed like the right time to write this blog entry, because I had a vitiligo patient in my clinic last week who was very afraid she was going to get skin cancer and she was relieved, to the point of tears, when I told her about this new information. In addition, today I read a post on the Vitiligo page on Facebook by a woman who was scared that her son would get skin cancer and was afraid to take him to the beach on vacation. I often give my patients this “good” news when I first see them in my clinic.

And they always say, “That’s not what my other doctors told me!” It is completely understandable that dermatologists assume that the risk of skin cancer is high in patients with vitiligo, but the available evidence does not support this. Also, some dermatologists are reluctant to use light therapy in vitiligo patients, which is too bad because it is the most effective treatment that we have (read more about this here ). Studies show that narrow-band UVB phototherapy is very safe and, as far as we can tell, does not increase the risk of skin cancer for patients, including those with vitiligo. I inherited the “Vitiligo” lecture at the AAD from Dr. Nordlund, and I also address this important issue, but now with these new studies as added proof. HOWEVER, IT IS VERY IMPORTANT TO MAKE THIS CLEAR: Having vitiligo does not mean you cannot get skin cancer. It is still possible – remember, Dr. Nordlund DID have vitiligo patients with skin cancer, and I have one patient who has early signs of pre-cancer on the skin.

I was also emailed by a prominent dermatologist who told me that he has had a few vitiligo patients with skin cancer in his career, and that I shouldn’t tell vitiligo patients to ignore sun protection completely. So it is still important to protect yourself from burning in the sun. And in addition to increasing the risk of skin cancer, it can make vitiligo worse! What is melanoma skin cancer? What is melanoma skin cancer? Key statistics for melanoma skin cancer What is melanoma skin cancer? Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can then spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer? Melanoma is a cancer that usually starts in a certain type of skin cell. Types of skin cells The 3 main types of cells in the top layer of the skin (called the epidermis) are: Squamous cells: These are flat cells in the outer part of the epidermis that are constantly shed as new ones form. Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer.

These cells constantly divide to form new cells to replace the squamous cells that wear off the skin’s surface. As these cells move up in the epidermis, they get flatter, eventually becoming squamous cells. Melanocytes: These are the cells that can become melanoma. They make a brown pigment called melanin, which gives the skin its tan or brown color. Melanin protects the deeper layers of the skin from some of the harmful effects of the sun. For most people, when skin is exposed to the sun, melanocytes make more of the pigment, causing the skin to tan or darken. Melanoma skin cancers Melanoma is a cancer that begins in the melanocytes. Other names for this cancer include malignant melanoma and cutaneous melanoma. Most melanoma cells still make melanin, so melanoma tumors are usually brown or black. But some melanomas do not make melanin and can appear pink, tan, or even white. Melanomas can develop anywhere on the skin, but they are more likely to start on the trunk (chest and back) in men and on the legs in women. The neck and face are other common sites.

Having darkly pigmented skin lowers your risk of melanoma at these more common sites, but anyone can get melanoma on the palms of the hands, soles of the feet, and under the nails. Melanomas in these areas make up a much larger portion of melanomas in African Americans than in whites. Melanomas can also form in other parts of your body such as the eyes , mouth, genitals, and anal area, but these are much less common than melanoma of the skin. Melanoma is much less common than basal cell and squamous cell skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught early. Other skin cancers There are many other types of skin cancer. Skin cancers that are not melanomas are sometimes grouped as non-melanoma skin cancers because they develop from skin cells other than melanocytes. They tend to behave very differently from melanomas and are often treated with different methods. Basal cell and squamous cell skin cancers Basal cell and squamous cell cancers are by far the most common skin cancers, and actually are more common than any other form of cancer.

Because they rarely spread (metastasize) to other parts of the body, basal cell and squamous cell skin cancers are usually less concerning and are treated differently from melanoma. These cancers are discussed in Skin Cancer: Basal and Squamous Cell . Less common skin cancers Other types of non-melanoma skin cancer are much less common than basal and squamous cell cancers and are treated differently. They include: Many types of benign (non-cancerous) tumors can develop from different types of skin cells. Benign tumors that start in melanocytes A mole (nevus) is a benign skin tumor that develops from melanocytes. Almost everyone has some moles. Nearly all moles (nevi) are harmless, but having some types can raise your risk of melanoma. See the section Risk factors for melanoma skin cancer for more information about moles. A Spitz nevus is a kind of mole that sometimes looks like melanoma. It’s more common in children and teens, but it can also be seen in adults. These tumors are generally benign and don’t spread. But sometimes doctors have trouble telling Spitz nevi from true melanomas, even when looking at them under a microscope.

Therefore, they are often removed, just to be safe. Benign tumors that develop from other types of skin cells Seborrheic keratoses: tan, brown, or black raised spots with a “waxy” texture Hemangiomas: benign blood vessel growths, often called strawberry spots Lipomas: soft growths made up of fat cells Warts: rough-surfaced growths caused by some types of human papilloma virus (HPV) Most of these tumors rarely, if ever, turn into cancers. There are many other kinds of benign skin tumors, but most are not very common. <!-- SS_END_OPENREGIONMARKER(region1)--> <!-- SS_BEGIN_CLOSEREGIONMARKER(region1)-->

Question: A type of cancer arising from the melanocyte cells of the skin is known as what?
Answer: MALIGNANT MELANOMA