What Causes Subungual Melanoma
Subungual melanoma is more common in Native American, African American, and Asian individuals. It usually has a brown-black pigment, and a blurred border. When melanoma changes, it means size increase and / or growth speed of the nail or the pigment. When there is no apparent change, we speak of nail dystrophy, which person does not improve despite an adequate treatment. Subungual melanoma extension affects to the pigmentation to the proximal or lateral nail fold , or to the free edge of the nail. The family clinical history of melanoma , as well as dysplastic nevus syndrome, are determining factors in the appearance of the subungual melanoma, since the probability of developing this cancer increases significantly. Professional medical research does not consider the development of this cancer due to prolonged exposure to the sun.
Medical and health professionals have found evidence linking subungual melanoma and trauma. 58% of subungual melanoma of the hand is located in the thumb, and 86% of the subungual melanoma of the foot is located in the first finger, probably because of the larger size of the nail bed , also because they are the more exposed to trauma fingers. The morphology can be very variable, from a longitudinal brown band , to a destruction of the nail articulation, or macular lesions in the nail bed extending from the matrix. Up to 20% of subungual melanoma are amelanotic, making diagnosis especially difficult.
How Fast Does Melanoma Grow
Some types of melanoma can grow very quickly, becoming life-threatening in as little as six weeks. If left untreated it can spread to other parts of the body.
Nodular melanoma is a highly dangerous form of melanoma that looks different from common melanomas and can grow in just a few weeks. Raised and even in color, nodular melanoma are often red, pink, brown, or black. It can be life-threatening if not detected and removed quickly. See your doctor immediately if you notice any of these changes.
Its also important to note that while sun exposure is a major risk factor in melanoma, the disease can develop in parts of the body that get little or no sun exposure.
Different Kinds Of Skin Cancer
There are many types of skin cancer. Some are very rare. Your doctor can tell you more about the type you have.
The two most common kinds of skin cancers are:
- Basal cell cancer, which starts in the lowest layer of the skin
- Squamous cell cancer, which starts in the top layer of the skin
Another kind of skin cancer is called melanoma. These cancers start from the color-making cells of the skin . You can read about melanoma in If You Have Melanoma Skin Cancer.
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Alternative Treatment Options: Radiation Therapy
For Squamous and Basal cell cancer, Mohs surgery is often not the only viable treatment option. The invasive nature of Mohs surgery coupled with the possibility of scarring and the need for antibiotics following the procedure makes some patients uneasy.
If you are searching for a non-invasive alternative, youll want to learn more about Image Guided Superficial Radiotherapy . IG-SRT uses Ultrasound Imaging and Superficial Radiotherapy to treat Basal and Squamous cell cancers with a precise, measured dose of radiation delivered directly under the patients skin surface. It is completely non-invasive and has less of an effect on the patients daily life post-treatment, with no scarring, no need for antibiotics, and no requirement to stop taking certain medications prior to the procedure.
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How Fast Can Melanoma Spread
A second factor that plays an important role in how fast melanoma can spread is the genetic factor. Certain gene abnormalities encourage melanoma to invade the surrounding tissue. This means that certain ways of how cells are composed can affect the speed of the melanoma spreading. This process, though, can vary significantly from one person to another.
If you have been diagnosed with melanoma skin cancer, talk with your doctor about your personal situation and treatment options.
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Melanoma Can Be Colorless
While its true that many melanomas are dark brown to black in color, some melanomas have no color and appear as pink spots or bumps. Beware of isolated pink spots, especially if the spot looks different than the other marks on the skin, says Dr. Marghoob. Pay attention to any spot or mark that has an uneven texture, shape, border, or distribution of colors. In addition, any spot that has changed in some way should prompt a visit to your local doctor.
Tumor Heterogeneity And The Metastatic Cascade
Melanoma initiation is thought to be a clonal event , but tumors subsequently evolve and acquire heterogeneity owing to selective pressures within the tumor microenvironment and the acquisition of genomic instability . Within such heterogeneity, it has classically been thought that relatively rare populations of cells gain the ability to spread and only metastasize very late in tumor progression . These rare tumor cells are thought to drive the metastatic process, which is also thought to be a clonal event . At the distant metastatic site, tumor cells have been proposed to continue a period of uninterrupted growth, resulting in clinically evident disease. Heterogeneity also develops in the metastasis due to selective pressures, and these metastases may in turn seed additional metastases to other sites .
Steps in Melanoma Metastasis. After formation of a primary tumor, melanoma cells are thought to enter into lymphatic vessels, traverse to the lymph node, and subsequently enter into systemic circulation via the thoracic duct. After reaching systemic circulation, cells must adhere to the microvasculature of a target organ, extravasate, and subsequently proliferate in order to form a clinically relevant metastasis. The mechanisms regulating either success or failure at any step are likely important and probably differ amongst different melanomas and different target organs.
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Where Else Does Melanoma Spread To
When melanoma advances to stage 3, it means the tumor has spread to the lymph nodes or the skin around the primary tumor and lymph nodes. In stage 4, the cancer has moved to other areas far beyond the lymph nodes, like your internal organs. The most common places melanoma spreads to are the:
- stomach, or abdomen
These growths will cause different symptoms, depending on which areas it has spread to. For example, you may feel breathless or constantly cough if the cancer has spread to your lungs. Or you may have a long-term headache that wont go away if it has spread to your brain. Sometimes the symptoms for stage 4 melanoma may not appear for many years after the original tumor was removed.
Talk to your doctor if youre feeling new pains and aches or symptoms. Theyll be able to help diagnose the cause and recommend treatment options.
Fast Growing Melanomas Have Distinct Traits
By David Douglas, Reuters Health
3 Min Read
NEW YORK – Melanoma skin cancers that are growing rapidly exhibit a number of identifying characteristics. According to Australian researchers, rapidly growing melanomas are thicker, symmetrical, or elevated, have regular borders, and often itch or bleed. They do not fit the ABCD rule for melanoma, which stands for asymmetry, border irregularity, color irregularity, large diameter, the team notes.
Because of their rapid growth, lead investigator Dr. Wendy Liu told Reuters Health, there is only a small window of opportunity to capture these melanomas in their early stage of development.
Rapidly growing melanomas can occur in anyone, she added, not necessarily those with large numbers of moles and freckles. In fact, they more often occur in those without large numbers of moles and freckles, and elderly men. Morphologically, they are more often red — rather than brown and black — symmetrical, elevated and symptomatic.
Liu of the Alfred Hospital in Melbourne and colleagues describe their observations in 404 melanoma skin cancer patients in the medical journal Archives of Dermatology.
One third of the melanomas grew 0.5 mm per month or more. These fast growing tumors tended to be thicker with a faster mitotic rate . As well as being more likely to be symmetrical, symptomatic, and elevated, these lesions were also likely to have regular borders and lack the pigment melanin.
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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.
Red Flag #: Chest Pain And Trouble Breathing
Melanoma is also known to spread to the lungs, though Dr. Zaba notes that most people dont experience noticeable symptoms in the lungs until a tumor has gotten pretty large. A cough that just wont quit or recurring chest infections can signal that the cancer has traveled to the lungs, Dr. Polsky says. Shortness of breath or trouble breathing can also be a red flag.
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Temporal And Spatial Complexity Of Metastasis
Metastasis involves a series of steps which must be completed before the emergence of clinically meaningful metastatic disease . These steps are further complicated by additional observations from human melanoma patients which add temporal and spatial complexity to metastasis. Many melanoma patients are cured after excision of their primary tumor however, some are not, and will have disease recurrence. Melanoma recurs less frequently at the site of the original primary tumor, instead more commonly recurring at different sites in the body as metastatic lesions. These recurrence patterns suggest that melanoma cells had already spread before excision of the primary tumor, even though this spread might not have been clinically apparent at that time. In melanoma patients, metastatic recurrence can occur within a relatively short period of time, but takes > 5 years in about 40% of patients., , , The period in between initial excision of the primary tumor and subsequent metastatic recurrence is often referred to as metastatic dormancy, where previously disseminated tumor cells are thought to persist in a relatively non-proliferative state.
What Are The Symptoms Of Nodular Melanoma
Most skin cancer screening guidelines tell you to check for the ABCDE symptoms of skin cancer. But there are additional warning signs that can alert you to possible nodular melanoma.
Also, unlike some other types of skin cancer, nodular melanomas typically begin as a new growth, rather than developing within a preexisting mole.
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Signs And Symptoms Of Melanoma
The most common sign of melanoma is the appearance of a new mole or a change in an existing mole.
This can happen anywhere on the body, but the most commonly affected areas are the back in men and the legs in women.
Melanomas are uncommon in areas that are protected from sun exposure, such as the buttocks and the scalp.
In most cases, melanomas have an irregular shape and are more than 1 colour.
The mole may also be larger than normal and can sometimes be itchy or bleed.
Look out for a mole that gradually changes shape, size or colour.
Superficial spreading melanoma are the most common type of melanoma in the UK.
Theyre more common in people with pale skin and freckles, and much less common in people with darker skin.
They initially tend to grow outwards rather than downwards, so they do not pose a problem.
But if they grow downwards into the deeper layers of skin, they can spread to other parts of the body.
You should see a GP if you have a mole thats getting bigger, particularly if it has an irregular edge.
Many Melanomas Dont Require Immediate Treatment
Many people have this concept that all melanomas are extremely rapidly growing cancers, says Dr. Marghoob. They think that waiting even one day after the diagnosis of melanoma can be fatal.
While some subtypes of melanoma do grow extremely fast, says Dr. Marghoob, most early melanomas dont require immediate treatment, allowing ample time to detect, treat, and cure them. Dr. Marghoob advises checking your skin on a monthly basis. If you notice a changing spot on your skin, dont delay in getting it checked out by a dermatologist, he says. And if your doctor does think you may have a melanoma, know that for most people its not necessary to rush to treatment. Most people can take the time they need to meet with doctors and understand their options.
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What Are The Clinical Features Of Superficial Spreading Melanoma
Superficial spreading melanoma tends to occur at sites of intermittent, intense sun exposure, especially on the trunk in males and the legs in females .
Superficial spreading melanoma presents as a slowly growing or changing flat patch of discoloured skin. At first, it may resemble a melanocytic naevus , ephelis , or lentigo. It becomes more distinctive in time, often growing over months to years or even decades before it is recognised. Like other flat forms of melanoma, it can be recognised by the ABCDE signs: Asymmetry, Border irregularity, Colour variation, Different, and Evolving. The EGF signs indicate nodular melanoma.
Superficial spreading melanoma clinical features may include:
- Irregular asymmetrical shape
- Irregular border which may be ill-defined and smudgy in places
- Variable pigmentation: colours may include light brown, dark brown, black, blue, grey, pink, and red
- There may be skip areas that are skin coloured, or white scars due to regression
- Different – the odd-mole-out or ‘ugly duckling’ is different from that person’s usual naevi.
- It may be larger in size than most moles: > 6 mm and often 12 centimetres in diameter at diagnosis: however aim for diagnosis when less than 6mm
- Change over days, weeks, months, or years.
A rare variant of superficial spreading melanoma is the verrucous melanoma on the limbs and back of middle-aged and elderly men.
Invasive may be indicated by the following features:
Prevalence And Risk Factors
The incidence of melanoma is increasing across all ages, including a more than 600% increase in young adults from 1970 to 2009 . Melanoma is the sixth most common cancer in men and women and the second most common cancer in women ages 20 to 29 in the United States.
Based on the most recent US data, there will be about 178,560 new cases of melanoma in 2018: 87,290 in situ and 91,270 invasive. At current rates, 1 in 27 white men and 1 in 42 white women will develop an invasive melanoma over a lifetime. An estimated 9,320 people will die of melanoma in 2018: 5,990 men and 3,330 women. Apart from these statistics, if melanoma is detected and treated before it invades the deeper layers of skin, the 5-year survival rate is 99%.2,3
The primary risk factor for melanoma is exposure to UV radiation . Most melanomas arise in previously normal skin, and only 20% to 30% arise from pre-existing nevi. Although there are several genetic syndromes that predispose individuals to melanoma, these account for less than 15% of melanomas. These syndromes include xeroderma pigmentosa and familial atypical mole-melanoma syndrome .2,3
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Red Flag #: Bone Pain Or Fractures
The bones are considered a late-stage site of melanoma metastasestypically, it doesnt spread to the bones until its already spread to another area of the body first. Melanoma can cause pain in the bones where its spread, and some peoplethose with very little body fat covering their bonesmay be able to feel a lump or mass. Metastatic melanoma can also weaken the bones, making them fracture or break very easily. This is most common in the arms, legs, and spine. If you feel any sharp, sudden, or new pains that wont go away, talk to your doctor.
Where Are Nodular Melanoma Growths Found
The most common growth sites for nodular melanoma are the neck, head, and trunk of the body. Unlike some other types of skin cancer, nodular melanomas typically begin as a new growth, rather than developing within a preexisting mole.
It can take as little as 3 months for this type of cancer to spread internally. Nodular melanoma can quickly progress to an advanced stage. Advanced stages of nodular melanoma are more difficult to treat than earlier stages of the disease.
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