The Spread Of Melanoma Metastasis
If you or a family member or friend have recently been diagnosed with melanoma, you may be wondering, just where and why can melanoma spread?
With surgery, melanoma confined to the skin has a 5-year survival rate in 98% of cases. Unfortunately, if the lesion recurs , gets thicker, or spreads from the skin to the lymph nodes or distant organs, it becomes much more dangerous. This occurs in stage III and IV melanoma and is called melanoma metastasis.
Melanomas That Could Be Mistaken For A Common Skin Problem
Melanoma that looks like a bruise
Melanoma can develop anywhere on the skin, including the bottom of the foot, where it can look like a bruise as shown here.
Melanoma that looks like a cyst
This reddish nodule looks a lot like a cyst, but testing proved that it was a melanoma.
In people of African descent, melanoma tends to develop on the palm, bottom of the foot, or under or around a nail.
Did you spot the asymmetry, uneven border, varied color, and diameter larger than that of a pencil eraser?
Dark line beneath a nail
Melanoma can develop under a fingernail or toenail, looking like a brown line as shown here.
While this line is thin, some are much thicker. The lines can also be much darker.
Plasma And Synchrotron Sources Of Extreme Uv
Lasers have been used to indirectly generate non-coherent extreme UV radiation at 13.5 nm for . The EUV is not emitted by the laser, but rather by electron transitions in an extremely hot tin or xenon plasma, which is excited by an excimer laser. This technique does not require a synchrotron, yet can produce UV at the edge of the Xray spectrum. can also produce all wavelengths of UV, including those at the boundary of the UV and Xray spectra at 10 nm.
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What Is The Outlook For Patients With Melanoma
Melanoma in situ is cured by excision because it has no potential to spread around the body.
The risk of spread and ultimate death from invasive melanoma depends on several factors, but the main one is the Breslow thickness of the melanoma at the time it was surgically removed.
Metastases are rare for melanomas < 0.75 mm and the risk for tumours 0.751 mm thick is about 5%. The risk steadily increases with thickness so that melanomas > 4 mm have a risk of metastasis of about 40%.
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How Does The Doctor Know I Have Melanoma
A new spot on your skin or a spot thats changing in size, shape, or color may be a warning sign of melanoma. If you have any of these changes, have your skin checked by a doctor.
The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to melanoma, more tests will be done.
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How Is Melanoma Treated
Your melanoma treatment will depend on the stage of the melanoma and your general health.
Surgery is usually the main treatment for melanoma. The procedure involves cutting out the cancer and some of the normal skin surrounding it. The amount of healthy skin removed will depend on the size and location of the skin cancer. Typically, surgical excision of melanoma can be performed under local anesthesia in the dermatologistâs office. More advanced cases may require other types of treatment in addition to or instead of surgery.
Treatments for melanoma:
- Melanoma Surgery: In the early stages, surgery has a high probability of being able to cure your melanoma. Usually performed in an office, a dermatologist numbs the skin with a local anesthetic and removes the melanoma and margins .
- Lymphadenectomy: In cases where melanoma has spread, removal of the lymph nodes near the primary diagnosis site may be required. This can prevent the spread to other areas of your body.
- Metastasectomy: Metastasectomy is used to remove small melanoma bits from organs.
- Targeted cancer therapy: In this treatment option, drugs are used to attack specific cancer cells. This targeted approach goes after cancer cells, leaving healthy cells untouched.
- Radiation Therapy: Radiation therapy includes treatments with high-energy rays to attack cancer cells and shrink tumors.
- Immunotherapy: immunotherapy stimulates your own immune system to help fight the cancer.
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Symptoms If Cancer Has Spread To The Brain
You might have any of the following symptoms if your cancer has spread to your brain:
- weakness of a part of the body
- personality changes or mood changes
- eyesight changes
J Tobias and D HochhauserJohn Wiley and Sons Ltd
TNM Staging ChartsLippincott Williams and Wilkins, 2009
Improving supportive and palliative care for adults with cancerNational Institute for Clinical Excellence , 2004
Oxford Textbook of Palliative MedicineEds D Doyle and othersOxford Universty Press, 3rd edition 2005
Cancer and its Management J Tobias and D HochhauserWiley Blackwell, 2015
Questions To Ask The Doctor
- How far has the melanoma spread under my skin?
- Has it spread anywhere else?
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
What Screening Tests Are Available
The most important screening test for melanoma is a skin examination because the vast majority of cutaneous melanomas are visible on the skin. Generally speaking, it is recommended that everyone get annual skin checks with a healthcare provider who works in the dermatology field. Your doctor may recommend something called Mole Mapping, or a similar system by which you can track changes to moles and other lesions through periodic photographs. Additionally, you should be examining your skin routinely at home. Because you see your skin every single day, you are the most likely person to notice any changes to it. At least once a monthwe suggest after you get out of the showeryou should do a self-check of your skin, using the ABCDEs as a guide, and look for any itching or bleeding moles or lesions. Also look for any spots that dont appear like others on your skinthese are called Ugly Ducklings. The prognosis for melanoma is best when it is found early, making skin examinations very important.
If you have a family and/or personal history of melanoma, you may want to talk to your healthcare provider about whether genetic testing would be beneficial.
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How Do Doctors Determine The Staging And Prognosis Of A Melanoma
The most useful criterion for determining prognosis is tumor thickness. Tumor thickness is measured in fractions of millimeters and is called the Breslow’s depth. The thinner the melanoma, the better the prognosis. Any spread to lymph nodes or other body locations dramatically worsens the prognosis. Thin melanomas, those measuring less than 0.75 millimeters when examined microscopically, have excellent cure rates, generally with local surgery alone. For thicker melanomas, the prognosis is guarded.
Melanoma is staged according to thickness, ulceration, lymph node involvement, and the presence of distant metastasis. The staging of a cancer refers to the extent to which it has spread at the time of diagnosis, and staging is used to determine the appropriate treatment. Stages 1 and 2 are confined to the skin only and are treated with surgical removal with the size of margins of normal skin to be removed determined by the thickness of the melanoma. Stage 3 refers to a melanoma that has spread locally or through the usual lymphatic drainage. Stage 4 refers to distant metastases to other organs, generally by spread through the bloodstream.
Moffitt Cancer Centers Approach To Melanoma Treatment
If you have been diagnosed with melanoma on your scalp, Moffitt Cancer Center can offer comprehensive treatment services. Within our Cutaneous Oncology Program, we have a full team of specialists who collaborate routinely to ensure our patients receive the individualized treatment they deserve. With regular tumor board meetings, supportive care programs and immunotherapy options, you can count on receiving top-notch care and encouragement from our entire team.
Get started by filling out a new patient registration form or calling .
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Merkel Cell Carcinoma: A Rare Skin Cancer On The Rise
Merkel cell carcinoma is a rare type of skin cancer that affects about 2,000 people in the United States each year.
Though its an uncommon skin cancer, cases of Merkel cell carcinoma have increased rapidly in the last couple of decades.
This type of cancer starts when cells in the skin, called Merkel cells, start to grow out of control.
Merkel cell carcinomas typically grow quickly and can be difficult to treat if they spread.
They can start anywhere on the body, but Merkel cell carcinomas commonly affect areas exposed to the sun, such as the face, neck, and arms.
They may look like pink, red, or purple lumps that are firm when you touch them. Sometimes, they can open up as ulcers or sores.
Risk factors include:
What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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How Common Is Melanoma
Melanoma accounts for only about 1% of all skin cancers, but causes the great majority of skin cancer-related deaths. Its one of the most common cancers in young people under 30, especially in young women.
Melanoma incidence has dramatically increased over the past 30 years. Its widely accepted that increasing levels of ultraviolet exposure are one of the main reasons for this rapid rise in the number of melanoma cases.
Occurrence In The United States
The American Cancer Society estimates that 106,110 cases of cutaneous melanoma will be diagnosed in the United States in 2021 . Overall rates of melanoma rose rapidly over the past 3 decades. From 2007 to 2016, the rate increased by 2.2% per year in men and women ages 50 and older, while decreasing by 1.2% per year in individuals younger than 50 years of age.
Although melanoma accounts for only about 1% of skin cancers, it is responsible for the vast majority of deaths from skin cancers. The American Cancer Society estimates that 7180 people in the US will die of melanoma in 2021.
What Does Melanoma Look Like
Melanoma is a type of cancer that begins in melanocytes . Below are photos of melanoma that formed on the skin. Melanoma can also start in the eye, the intestines, or other areas of the body with pigmented tissues.
Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. However, melanoma may also appear as a new mole. People should tell their doctor if they notice any changes on the skin. The only way to diagnose melanoma is to remove tissue and check it for cancer cells.
Thinking of “ABCDE” can help you remember what to look for:
- Asymmetry: The shape of one half does not match the other half.
- Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
- Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
- Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea .
- Evolving: The mole has changed over the past few weeks or months.
Melanomas can vary greatly in how they look. Many show all of the ABCDE features. However, some may show changes or abnormal areas in only one or two of the ABCDE features.
Tests That Might Be Done
Biopsy: In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is. There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.
Lab tests of biopsy samples: If melanoma is found, lab tests might be done on the cancer cells to see if they have certain gene changes. This might affect your treatment options.
Chest x-ray: This test may be done to see if the melanoma has spread to your lungs.
Ultrasound: This test uses sound waves and their echoes to make pictures of the inside of your body. Ultrasound might be used to look at lymph nodes near the tumor to see if the cancer has spread there.
CT or CAT scan: This test uses x-rays to make detailed pictures of your insides. A CT scan may be used to see if nearby lymph nodes are swollen or if organs like the lungs or liver have spots that might be from the spread of melanoma. If any spots are found, a CT scan might be used to guide a needle into the spots to do a biopsy.
MRI scan: This test uses radio waves and strong magnets instead of x-rays to make detailed pictures of your insides. It’s very good for looking at the brain and spinal cord. This test can help show if the cancer has spread.
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What Causes Melanoma Skin Cancer
Many risk factors for melanoma have been found, but its not always clear exactly how they might cause cancer.
For example, while most moles never turn into a melanoma, some do. Researchers have found some gene changes inside mole cells that may cause them to become melanoma cells. But its still not known exactly why some moles become cancerous while most dont.
DNA is the chemical in each of our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.
Some genes control when our cells grow, divide into new cells, and die:
- Genes that help cells grow, divide, and stay alive are called oncogenes.
- Genes that keep cell growth in check, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.
Cancers can be caused by DNA mutations that keep oncogenes turned on, or that turn off tumor suppressor genes. These types of gene changes can lead to cells growing out of control. Changes in several different genes are usually needed for a cell to become a cancer cell.
What Causes Foot Melanoma
Like melanoma that occurs in other parts of the body, exposure to ultraviolet rays is the most common cause of foot melanoma. According to the American Academy of Dermatology, exposure to excessive sunlight and tanning bed use as a teen or young adult significantly increases your risk for melanoma. Excessive UV exposure can also turn a noncancerous mole into melanoma.
Wearing sunscreen and protective clothing can help prevent melanoma when youre outdoors. However, the feet are often neglected in this process and left exposed to UV rays.
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Risk Of Further Melanomas
Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups.
Your doctor will decide how often you will need check-ups everyone is different. They will become less frequent if you have no further problems.
After treatment for melanoma it is important to limit exposure to the sun’s UV radiation. A combination of sun protection measures should be used during sun protection times .
As biological family members usually share similar traits, your family members may also have an increased risk of developing melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using a combination of sun protection measures during sun protection times.
It is important to monitor your skin regularly and if you notice any changes in your skin, or enlarged lymph glands near to where you had the cancer, see your specialist as soon as possible.