What Is The Cause Of Superficial Spreading Melanoma
Superficial spreading melanoma is due to the development of malignant pigment cells along the basal layer of the epidermis. The majority arise in previously normal-appearing skin. About 25% develop within an existing melanocytic naevus, which can be a normal common naevus, an atypical or dysplastic naevus, or a congenital naevus.
What triggers the melanocytes to become malignant is not fully known. Specific genemutations such as BRAFV600E have been detected in many superficial spreading melanomas and these mutations may change as the disease advances.
Damage by ultraviolet radiation results in a degree of immune tolerance, allowing abnormal cells to grow unchecked. This can occur from exposure to natural sunlight, particularly if sunburn has occurred, and artificial sources of ultraviolet radiation from sun beds / solaria.
How Serious Is My Cancer
If you have melanoma, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage describes the growth or spread of the melanoma through the skin. It also tells if it has spread to other parts of your body.
Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.
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Most Melanoma Does Not Start In A Preexisting Mole
Melanoma can develop in a preexisting mole, says Dr. Marghoob, but nearly 70% of skin melanomas do not. Rather, they occur in normal skin. Moles themselves are not cancerous, and it is extremely rare for a mole to transform into a melanoma, says Dr. Marghoob. That said, he adds, having many moles helps identify people who are at an increased risk for developing melanoma somewhere on their skin.
Since most melanoma develops on normal skin, Dr. Marghoob stresses the importance of protecting the entire surface of the body, including areas with many moles and areas without any moles. Some people use sunblock only where they have moles because they think the moles themselves are dangerous, adds Dr. Marghoob. Stay safe by applying broad-spectrum sunblock with an SPF of at least 30, wearing sun-protective clothing, or using a combination of the two approaches.
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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.
What Happens At Follow
The primary purpose of follow-up is to detect recurrences early, but it also offers an opportunity to diagnose a new primary melanoma at the first possible opportunity. A second invasive melanoma occurs in 5-10% patients an unrelated melanoma in situ affects in more than 20% of melanoma patients.
The Australian and New Zealand Guidelines for the Management of Melanoma make the following recommendations for follow-up for patients with invasive melanoma.
- Self-skin examination
- Routine skin checks by a patient’s preferred health professional
- Follow-up intervals are preferably six-monthly for five years for patients with stage 1 disease, three-monthly or four-monthly for five years for patients with stage 2 or 3 disease, and yearly after that for all patients.
- Individual patients needs should be considered before an appropriate follow-up is offered
- Provide education and support to help the patient adjust to their illness
The follow-up appointments may be undertaken by the patient’s general practitioner or specialist, or they may be shared.
Follow-up appointments may include:
- A check of the scar where the primary melanoma was removed
- A feel for the regional lymph nodes
- A general skin examination
- A full physical examination
- In those with many moles or atypical moles, baseline whole-body imaging and sequential macro and dermoscopic images of melanocytic lesions of concern
In those with more advanced primary disease, follow-up may include:
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What Is Superficial Spreading Melanoma
Superficial spreading melanoma is the most common subtype of melanoma skin cancer, accounting for about 70 percent of cases, according to the NCI.
The name may be long, but it hints at how this type of cancer behaves. Superficial refers to the horizontal growth pattern of cancer cells. When it develops, superficial spreading melanoma tends to spread slowly outward but remains for quite a while in the same layer of the epidermis where it began before invading other layers of tissue.
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:
- lungs
- brain
- 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.
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Skin Exam And Physical
You may have had a complete skin exam during your last dermatology appointment. Dermatologists often perform this exam when a patient has a suspicious spot on their skin that could be skin cancer.
During a complete skin exam, your dermatologist examines you head to toe. This exam includes a look at all of your skin, including the skin on your scalp, face, genitals, and the bottoms of your feet. Your dermatologist will also examine your nails and look inside your mouth.
If you did not have a complete skin exam before being diagnosed with melanoma, youll have one at your next appointment.
During a complete skin exam, your dermatologist may use a device called a dermatoscope
This device provides a closer look at the spots on your skin.
At your next appointment, youll receive a physical. During your physical, your dermatologist will ask how youre feeling and about your health, illnesses, and injuries. Your dermatologist will also want to know what diseases run in your family and the medications you take.
During your physical, your dermatologist will check your lymph nodes to find out if any feel swollen. There are many reasons for swollen lymph nodes. For example, if you have an infection or recently received a vaccination, lymph nodes can feel swollen. When you have melanoma, the swelling might be a sign that the cancer has spread.
If youre unsure what diseases your close blood relatives have had, try to find out
The Causes Of Melanoma
Tanning is not the sole cause for melanoma however. If only this horrid disease were that simple. Genetics play an equally sinister role in this story. Weve known for a long time that if you have melanoma, your first degree relatives are much more likely to get melanoma as well. Many of the new treatments specifically target various genetic mutations and genes associated with melanoma. Shared genes with pancreatic cancer and possibly now even some forms of breast cancer are being studied. But tanning is not off the hook. If someones genetic makeup is the dry cornfield, tanning is the match and kerosene.
As far as mammalian skin goes, human skin in general is a disaster. It offers virtually no protection from the sun. Even very dark African American skin only an SPF of around 13. Pig skin is the closest equivalent to human skin in its make-up and organization. Surgical trainees usually begin their studies by operating and sewing pigs feet and we still sometimes use pig skin grafts when necessary. It has been said Also like humans, pigs enjoy lying in the sun, tan in response to the sun, and enjoy drinking large quantities of beer.
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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.
A Very Interesting Study Of Melanoma Stage 1 2 And 3
From 2004 to 2012, 150,000 adults with stage 1, 2 and 3 were studied.
For those who waited more than 90 days to get surgical treatment, survival rate decreased regardless of disease stage.
For stage 1 melanoma, a surgery delay beyond the first 29 days had a negative impact on overall survival.
For stage 1 disease, patients were five percent more likely to die if they received treatment between 30 and 59 days.
Between 60-89 days? The mortality rate was 16 percent.
For 91-120 days it was 29 percent.
Beyond four months it was 41 percent.
From these results, researchers infer that the ideal timing for treatment is fewer than 30 days from diagnosis.
So we know that delaying treatment is very strongly associated with mortality rate from this cancer and thats with stage 1.
You can imagine the jump in numbers if a diagnosed stage 2 or especially 4 melanoma were investigated in a similar fashion.
A study such as this is the closest that we can come to determining the answer to How long does it take for stage 2 melanoma to progress to stage 4.
If youve been diagnosed with stage 2 disease, DO NOT PUT OFF TREATMENT.
If this means cancelling a much-anticipated vacation, then this is what you must do.
The vacation can wait. Your lungs and brain cant. The first two organs that melanoma usually spreads to are the lungs and brain!
In fact, if your diagnosis is stage 1, your treatment should come first, before any vacations or anything else.
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Could It Just Be A Bruise
Just for some reference, here are some images of bruises of the toe and toenail for you to compare.
The marking on this toenail is a bruise. Note the mark goes across the nail and you can see some bruising on the skin too.
This bruised toenail has a white mark where the damage was caused and the mark looks like blood.
Where there is a marking at the base of the nail like in this image, this is usually caused by impact damage kicking something for example.
You Of Course May Not Think The Tiny Speck Is Melanoma But Over Time Its Going To Get Bigger Or Spread Superficially
How long does this take to happen, or to put it another way, how fast does this spreading or growth occur?
Melanomas can either have not spread past the skin or already be metastatic by the time you find a 1 mm lesion, says Dr. Jennifer Gordon, who is board certified by the American Board of Dermatology she practices at Westlake Dermatology located in Austin, Texas.
Dr. Gordon points out, however: A 1 mm lesion would be rare to be already metastatic.
This would be the nodular type of melanoma, which is an uncommon sub-type of this skin malignancy.
I realize this offers little comfort, but it is the unfortunate truth, continues Dr. Gordon. There are multiple types of melanomas, such as:
- Melanoma in-situ
- Nodular melanoma
- Desmoplastic melanoma, etc.
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Stop Tumors In Their Tracks
Every melanoma has the potential to become deadly, but the difference between an in situ melanoma and one that has begun to metastasize cannot be overstated. There is a drastic change in the survival rate for the various stages of tumors, highlighting the importance of detecting and treating melanomas before they have a chance to progress. Its impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.
To be sure youre spotting any potential skin cancers early, The Skin Cancer Foundation recommends monthly skin checks, and scheduling an annual total body skin exam with a dermatologist. These skin exams can help you take note of any new or changing lesions that have the potential to be cancerous, and have them biopsied and taken care of before they can escalate.
Trust your instincts and dont take no for an answer, Leland says. Insist that a doctor biopsy anything you believe is suspicious.
What Is The Outlook For Patients With Nodular Melanoma
The risk of spread and ultimate death from invasive melanoma depends on several factors, but the main one is the measured thickness of the melanoma at the time it was surgically removed.
The Melanoma Guidelines report that metastases are rare for melanomas < 0.75mm 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 chance of metastasis of about 40%.
New Zealand statistics gathered by the Cancer Registry between 1994 and 2004 revealed 15,839 invasive melanomas. Of these, 52% were under 0.75 mm in thickness, 22% were between 0.76 and 1.49 mm, 15% were between 1.5 and 3 mm in thickness and 11% were more than 3 mm in thickness. Thicker tumours were slightly more likely to be diagnosed in males and more likely in older people than younger ones.
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What Is A Subungal Melanoma
The term subungal just means under the nail and is often used to describe a mark or problem that appears below the nail surface.
There are 3 main classifications or types for this disease that refer to the location of the melanoma:
- Subungal the issue is found in the nail bed or matrix and is under the nail.
- Ungual the melanoma grows from underneath the nail plate.
- Periungual where the melanoma is found on the skin surrounding the edges of the toenail.
Causes Of Superficial Spreading Melanoma
All types of melanoma are caused by slight changes in genetic material called gene mutations. Some gene mutations are inheritedthey may run in the family and be present from birth. Others are ones that develop over time due to different factors. For example, ultraviolet rays from the sun penetrate a persons DNA and cause slight changes in the genes. As the cells naturally grow and divide, they may pass on these mutations to new cells.
In melanomas caused by a gene inheritance, researchers have identified the specific gene mutations that lead to melanoma. These include the BRAF oncogene, which is responsible for about half of all melanomas, as well as the genes NRAS, CDKN2A, NF1 and CDK4.
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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.
Should The Lymph Nodes Be Removed
If the local lymph nodes are enlarged due to metastatic melanoma, they should be removed entirely. This requires a surgical procedure, usually under general anaesthetic. If they are not enlarged, they may be tested to see if there is any microscopic spread of melanoma. The test is known as a sentinel node biopsy.
In New Zealand, many surgeons recommend sentinel node biopsy for melanomas thicker than 1 mm, especially in younger persons. However, although the biopsy may help in staging cancer, it does not offer any survival advantage. The necessity for sentinel node biopsy is controversial at present.
Lymph nodes containing metastatic melanoma often increase in size quickly. An involved node is usually non-tender and firm to hard in consistency. If this occurs between planned follow-up visits, let your doctor know promptly.
If the melanoma is widespread, other forms of treatment may be necessary but are not always successful in eradicating cancer. Immunotherapy, biologics such as ipilimumab, and the BRAFinhibitorsdabrafenib and vemurafenib are showing promise.
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What Do Stage 4 Tumors Look Like
A change to an existing mole or normal skin can be the first sign that the cancer has spread. But the physical symptoms of stage 4 melanoma arent the same for everyone. A doctor will diagnose stage 4 melanoma by looking at the primary tumor, the spread to nearby lymph nodes, and whether the tumor has spread to different organs. While your doctor wont base their diagnosis only on what your tumor looks like, part of their diagnosis involves looking at the primary tumor.
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