What Is Metastatic Melanoma
Metastatic melanoma is melanoma that has spread beyond its original site in the skin to distant tissue sites. There are several types of metastatic melanoma. There may be spread through the lymphatic system to local lymph nodes. This may show up as swollen lymph glands or as a string of skin tumors along a lymphatic chain. Melanoma may also spread through the bloodstream , where it may appear in one or more distant sites, such as the lungs, liver, brain, remote skin locations, or any other body location.
What Is A Melanocyte
Melanocytes are skin cells found in the upper layer of skin. They produce a pigment known as melanin, which gives skin its color. There are two types of melanin: eumelanin and pheomelanin. When skin is exposed to ultraviolet radiation from the sun or tanning beds, it causes skin damage that triggers the melanocytes to produce more melanin, but only the eumelanin pigment attempts to protect the skin by causing the skin to darken or tan. Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes in the melanocytes, resulting in uncontrolled cellular growth.
About Melanin
Naturally darker-skinned people have more eumelanin and naturally fair-skinned people have more pheomelanin. While eumelanin has the ability to protect the skin from sun damage, pheomelanin does not. Thats why people with darker skin are at lower risk for developing melanoma than fair-skinned people who, due to lack of eumelanin, are more susceptible to sun damage, burning and skin cancer.
How Dangerous Is Melanoma Its All A Matter Of Timing
Skin cancer holds the unfortunate distinction of being the worlds most common cancer. Though its prevalence around the globe is disturbing, there is some good news: When caught early, skin cancers are almost always curable.
You might already know that catching a cancer early means a more favorable prognosis. But it can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Melanoma should never be underestimated, but treating a tumor early rather than after it is allowed to progress could be lifesaving.
Leland Fay, 46, understands better than most the seriousness of this distinction. When the Monument, Colorado native was diagnosed with melanoma in 2012, he was given a bleak prognosis due to the advanced stage of the tumor it had already reached stage IV.
Leland hadnt thought much of the little black mole on his head a few months earlier, when a dermatologist froze it off during a routine exam. But the mole resurfaced, bigger than it had been originally. After a biopsy and imaging tests, doctors told Leland it was melanoma, and that it had already spread. He could have as few as six weeks to live.
To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumor site.
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Comparing Metastatic Melanoma Cells In Lymph Versus Blood
Most studies of cancer cell metastasis in people have focused on cells circulating in the blood. Thats because its much easier to collect patient blood samples than it is to collect samples of lymph, the clear fluid that carries immune cells through vessels of the lymphatic system, Dr. Morrison said.
Dr. Morrisons team found that human melanoma cells injected into lymph nodes in the mice were more likely to form distant tumors than melanoma cells injected into blood.
To study the role of lymph in metastasis, lead investigator Jessalyn Ubellacker, Ph.D., a postdoctoral researcher in Dr. Morrisons lab, figured out how to collect melanoma cells from lymph in mice. This allowed the team to do the first side-by-side comparison of melanoma cells spreading through lymph and through blood in the same animal, Dr. Morrison said.
Next the team found that melanoma cells in lymph experienced less oxidative stress than melanoma cells in blood. That offered a potential explanation for why melanoma cells from lymph nodes were surviving better and better able to form a tumor, Dr. Morrison said.
Further experiments showed that melanoma cells in blood are vulnerable to ferroptosisa form of cell death that occurs when lipids damaged by oxidative stress build up in the outer membrane of a cell. By contrast, melanoma cells from lymph nodes were protected from ferroptosis.
Lymph Nodes As A Stopover On A Cancer Cells Journey
Movement of melanoma cells into lymph nodes is not necessarily an endpoint, but rather a stopover on the cells journey elsewhere, wrote Barbara Grüner, Ph.D., of University Hospital Essen in Germany, and Sarah-Maria Fendt, Ph.D., of the Leuven Center for Cancer Biology in Belgium, in .
These results provide a first step towards understanding the protective environment of lymph, Drs. Grüner and Fendt wrote. To what extent findings apply to tumor types other than melanoma, and to humans, remains to be determined. If the results are relevant to human disease, innovative ways must be found for them to have a therapeutic impact.
Dr. Morrisons team is already looking into existing drugs that might make cancer cells more vulnerable to ferroptosis and block the protective effects of lymph, he said. The idea would be to see if such a drug could be given early in the disease course of melanoma to prevent it from spreading.
If we can find a therapy that blocks disease progression in mice, then we would go into clinical trials to see if it works in humans, he added.
Dr. Salnikow said multiple approaches will likely be needed to prevent the spread of melanoma, because different biological factors may be important for metastasis in different people.
One of the interesting questions to answer is whether MCT1 is also helping to protect these melanoma cells metastasizing through lymph, and were doing those experiments now, Dr. Morrison said.
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Can Melanoma Be Prevented
You can’t control how fair your skin is or whether you have a relative with cancerous moles. But there are things you can do to lower your risk of developing melanoma. The most important is limiting your exposure to the sun.
Take these precautions:
- Avoid the strongest sun of the day between 10 a.m. and 4 p.m.
- Use broad-spectrum sunscreen whenever you’re in the sun.
- Wear a wide-brimmed hat and cover up with long, loose cotton clothing if you burn easily.
- Stay out of the tanning salon. Even one indoor tanning session increases your risk of getting melanoma.
Also, be sure to check your moles often . Keep dated records of each mole’s location, size, shape, and color, and get anything suspicious checked out right away.
Not all skin cancer is melanoma, but every case of melanoma is serious. So now that you know more about it, take responsibility for protecting yourself and do what you can to lower your risk.
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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.
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What Are The Symptoms Of A Cancerous Mole
For the most part, both common and atypical moles should stay the same, regarding size, shape, and color-and it’s when any mole, old or new, begins to change, that you should take notice.
There are a few different ways to examine moles to see if they’re concerning. The first is called the ABCDE method, says Dr. Zeichner, who describes the acronym below:
- A: Asymmetry, when one side does not look like the other side.
- B: Border, when the border is jagged or punched out rather than smooth.
- C: Color, when a mole has multiple colors to it, like brown, black, white, or blue.
- D: Diameter, when a mole has a diameter greater than six millimeters .
- E: Evolution, when a mole changes in shape or appearance over time.
Another common symptom of cancerous moles is discomfort like itchiness or pain, according to the AADA.
Seeing brand-new moles pop up on your skin-also known as acquired moles-may also be something to watch out for. Though common, these moles lead to melanoma more often than congenital moles. According to The Skin Care Foundation, only 20%-30% of melanomas are found in existing moles-the other 70%-80% arise in “normal-looking” skin. So, if you have a new mole that looks concerning, you should get it checked out.
Are There Different Kinds Of Skin Cancer
There are many types of skin cancer. Your doctor can tell you more about the type of skin cancer you have.
Basal cell and squamous cell skin cancers are much more common than melanoma and dont often spread to other parts of the body. Melanoma is more deadly because it is more likely to spread to other parts of the body.
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What Are The Four Main Types Of Melanoma Of The Skin
Superficial spreading melanoma
What you should know: This is the most common form of melanoma.
How and where it grows: It can arise in an existing mole or appear as a new lesion. When it begins in a mole that is already on the skin, it tends to grow on the surface of the skin for some time before penetrating more deeply. While it can be found nearly anywhere on the body, it is most likely to appear on the torso in men, the legs in women and the upper back in both.
What it looks like: It may appear as a flat or slightly raised and discolored, asymmetrical patch with uneven borders. Colors include shades of tan, brown, black, red/pink, blue or white. It can also lack pigment and appear as a pink or skin-tone lesion .
Lentigo maligna
What you should know: This form of melanoma often develops in older people. When this cancer becomes invasive or spreads beyond the original site, the disease is known as lentigo maligna melanoma.
How and where it grows: This form of melanoma is similar to the superficial spreading type, growing close to the skin surface at first. The tumor typically arises on sun-damaged skin on the face, ears, arms or upper torso.
What it looks like: It may look like a flat or slightly raised, blotchy patch with uneven borders. Color is usually blue-black, but can vary from tan to brown or dark brown.
Acral lentiginous melanoma
What you should know: This is the most common form of melanoma found in people of color, including individuals of African ancestry.
Can Melanoma Be Cured
Melanoma that’s caught early, when it’s still on the surface of the skin, can be cured.
Untreated melanoma can grow downward into the skin until it reaches the blood vessels and lymphatic system. This lets it travel to distant organs, like the lungs or the brain. That’s why early detection is so important.
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Early Warning Signs Of Melanoma
The key to detecting melanoma early is to know what to look for and where to look for it. This isnt always easy, as melanoma can be a master of disguise. It may look like an age spot, a bruise, a sore, a cyst, a scar or a dark line beneath your nail. You may not feel a melanoma, but there are times that it may itch, hurt or bleed.
The ABCDE method may help you determine whether an abnormal skin growth may be melanoma:
- A is for asymmetry: Does the mark look different on each half?
- B is for border: Are the edges jagged or irregular?
- C is for color: Is your lesion uneven in color with specks of black, brown and tan?
- D is for diameter: Is your lesion getting larger?
- E is for evolving or elevation: Has your lesion changed in size, shape or texture over the past few weeks or months?
If the answer to any of these questions is yes, or even maybe, see a dermatologist for a proper evaluation. The only way to be sure whether a mole is melanoma is to visit a doctor.
Other melanoma warning signs may include:
- Sores that dont heal
- Pigment, redness or swelling that spreads outside the border of a spot to the surrounding skin
- Itchiness, tenderness or pain
Complementary And Alternative Treatments
It’s common for people with cancer to seek out complementary or alternative treatments. When used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life. Others may not be so helpful and in some cases may be harmful. It is important to tell all your healthcare professionals about any complementary medicines you are taking. Never stop taking your conventional treatment without consulting your doctor first.All treatments can have side effects. These days, new treatments are available that can help to make many side effects much less severe than they were in the past.
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Benign Tumors That Start In Melanocytes
A mole is a benign skin tumor that develops from melanocytes. Almost everyone has some moles. Nearly all moles are harmless, but having some types can raise your risk of melanoma. See Risk Factors for Melanoma Skin Cancer for more information about moles.
A Spitz nevus is a kind of mole that sometimes looks like melanoma. Its more common in children and teens, but it can also be seen in adults. These tumors are typically benign and dont 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.
Skin Exam And Physical
If youve been diagnosed with melanoma, youve already had a skin biopsy. This biopsy was taken when you had part of the suspicious spot removed. After it was removed, a doctor looked at the spot under a microscope to find out if it contained cancer cells. This is currently the only way to tell if someone has skin cancer.
After getting the diagnosis, the next step is to get a complete skin exam and physical.
During the physical, your dermatologist will feel your lymph nodes. This is where melanoma usually goes when it begins to spread. It usually travels to the lymph nodes closest to the melanoma.
If there is a risk the cancer could have spread, your dermatologist may recommend that you have a lymph node biopsy. If a sentinel lymph node biopsy is recommended, it can be performed at the time of your surgery for melanoma.
After the skin exam and physical, your dermatologist may recommend testing, such as a CAT scan, MRI, or a blood test. These can also help detect spread.
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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.
How Common Is It
Overall, skin cancers are the most common cancers in the United States. But melanoma is less common than the other two major types, basal cell and squamous cell carcinoma.
Each year about 91,000 people in the U.S. are diagnosed with melanoma of the skin, according to the American Cancer Society. By comparison, about 3.3 million are diagnosed with one or more basal cell or squamous cell carcinomas.
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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. 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.
Common Places For Melanoma To Spread
Melanoma can spread from the original site on your skin and form a tumor in any organ or body tissue, but its most likely to metastasize to the lymph nodes, liver, brain, lungs, and less commonly, the bones. Melanoma really likes the brain and the liver, says Lisa Zaba, M.D., dermatologic oncologist at Stanford Medical Center in San Jose, CA. If you notice any of the following red flags, it might mean your melanoma has spread and warrants a call to your doctor right away.
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