Prognosis of Melanomas

Features that affect prognosis of melanomas are tumor thickness in millimeters, depth related to skin structures, type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating lymphocytes, location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Certain types of melanoma have worse prognoses but this is explained by their thickness.

Interestingly, less invasive melanomas even with lymph node metastases carry a better prognosis than deep melanomas without regional metastasis at time of staging. Local recurrences tend to behave similarly to a primary unless they are at the site of a wide local excision since these recurrences tend to indicate lymphatic invasion. When melanomas have spread to the lymph nodes, one of the most important factors is the number of nodes with malignancy.

Extent of malignancy within a node is also important; micrometastases in which malignancy is only microscopic have a more favorable prognosis than macrometastases. In some cases micrometastases may only be detected by special staining, and if malignancy is only detectable by a rarely-employed test known as the polymerase chain reaction (PCR), the prognosis is better.

Macrometastases in which malignancy is clinically apparent (in some cases cancer completely replaces a node) have a far worse prognosis, and if nodes are matted or if there is extracapsular extension, the prognosis is still worse. When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.

The median survival is 6 to 12 months. Treatment is palliative, focusing on life-extension and quality of life. In some cases, patients may live many months or even years with metastatic melanoma (depending on the aggressiveness of the treatment). Metastases to skin and lungs have a better prognosis. Metastases to brain, bone and liver are associated with a worse prognosis.

There is not enough definitive evidence to adequately stage, and thus give a prognosis for ocular melanoma and melanoma of soft parts, or mucosal melanoma, although these tend to metastasize more easily. Even though regression may increase survival, when a melanoma has regressed, it is impossible to know its original size and thus the original tumor is often worse than a pathology report might indicate.

Radiation therapy is often used after surgical resection for patients with locally or regionally advanced melanoma or for patients with unresectable distant metastases. It may reduce the rate of local recurrence but does not prolong survival. Radioimmunotherapy of metastatic melanoma is currently under investigation. What's more, moles are classically removed by laser, surgery, or electrocautery.

Most of these treatments require multiple visits to the doctor. Laser and electrocautery treatments are not always effective because they only reach the outermost layers of the skin, while moles penetrate very deep into the dermal tissue, often beyond the reach of these treatments. Surgery, the other option doctors commonly offer, involves cutting out the mole. The resulting wound requires stitches, which will in turn leave a scar.

Skin Cancer - Basal Cell Carcinoma (BCC)

In the United States, Basal Cell Carcinoma (BCC) accounts for 90 percent of all skin cancers in the southern states, and 47 percent in the northern states. Basal Cell Carcinoma is the most common form of skin cancer in Australia and New Zealand, representing 70-80% of diagnosed skin cancers. Occurrence of Basal Cell Carcinoma mainly occurs on the head and neck. It occurs less often in Asians and rarely among darker skinned races. As with all skin cancers the risk is considered to be related to sun exposure. The positive about Basal Cell Carcinoma is that it is slow-growing and rarely metastasizes throughout the body. However, it is locally destructive and can invade neighboring bone and nerve tissue.

Description - BCC is a malignant epithelial cell tumor that begins as a papule (a small, circumscribed, solid elevation of the skin) and enlarges peripherally, developing into a crater that erodes, crusts and bleeds. BCC originates in the basal layer of the epidermis, the lowest layer of skin.

Signs and Symptoms of Basal Cell Carcinoma - There are five typical characteristics of basal cell carcinoma that are quite different from each other. Two or more features are frequently present in one tumor. BCC sometimes resembles non-cancerous skin conditions such as psoriasis or eczema and requires diagnosis by a trained person. The five warning signs of basal cell carcinoma are:

1. An open sore that bleeds, oozes or crusts, and remains open for three or more weeks. A persistent, non-healing sore is a very common early manifestation.
2. A reddish patch or an irritated area, frequently occurring on the chest, shoulders, arms or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.
3. A smooth growth with an elevated, rolled border and an indentation in the centre. As the growth slowly enlarges, tiny blood vessels may develop on the surface (telangiectases).
4. A shiny bump (nodule) that is pearly or translucent and is often pink, red or white. The nodule can also be tan, black or brown, especially in dark-haired people, and can be confused with a mole or melanoma.
5. A scar-like area (white, yellow, or waxy in appearance) which often has poorly defined borders. The skin itself appears shiny or taut. Although a less frequent sign, it can indicate the presence of a more aggressive tumor.

Diagnosis of Basal Cell Carcinoma - Diagnosis is almost always by biopsy. Tissue is cut away from the site and examined under a microscope.

Medical Treatment of Basal Cell Carcinoma - Allopathic treatment depends on the size and type of tumor. There are various types of surgery or non-surgical treatments chosen from.

Non-surgical treatment of BCC - Allopathic non-surgical treatments have low success rates.

• Topical application of 5-fluorouracil for 2 to 12 weeks is only beneficial for superficial BCC. Fluorouracil is used to prevent excess cell proliferation as found in skin cancer and psoriasis. It prevents the formation of RNA which in turn prevents the formation of DNA.
• Imiquinoid cream -currently the use of Imiquinoid cream is considered experimental. It is an immune response modifier that stimulates the immune system to release cytokines that destroy cancer cells. Treatment causes significant skin irritation. Not all types of BCC are affected.
• Ionizing radiation: Superficial x-ray. It results in radiation damage, therefore it is used more with older patients. Impaired immune function and general malaise also usually results. Used for facial BCC and appears less effective for BCC occurring elsewhere.

Surgical Removal of BCC - Surgery is the most studied, and most used treatment for removal of a BCC in allopathic medicine. The effectiveness of surgery depends very much on the skill of the surgeon. Various surgical methods:

• Electrodessication and Curettage - the BCC is burned and removed with a scalpel. The main disadvantage of this method is that the tumor often tracks down hair follicles. (9)
• Cryosurgery - liquid nitrogen to freeze burn the BCC.
• Excision surgery- the BCC is cut from the skin with a scalpel. To increase the likelihood of complete removal of the tumor, a portion of normal-appearing skin surrounding the BCC is removed.
• Microscopic or MOHS surgery - the BCC is cut from the skin, along with some of the healthy surrounding tissue. This is examined under a microscope to check for any remaining cancer cells. Tissue is then taken in increments of thin layers of skin, until no more cancer cells are detected. Mohs is the most effective allopathic medical treatment (99% cure rate for primary BCC, 90-95% for recurrent BCC).
• Laser surgery. Lasers are also used as a secondary therapy when topical medications or other techniques are unsuccessful.

Recurrence of BCC - Once a basal cell carcinoma has been removed, another growth can develop in the same place or nearby area. It has been found that 36% of people who develop a basal cell carcinoma will develop a secondary primary BCC within the next 5 years. Radiotherapy can result in more aggressive and invasive cells in a recurrent BCC.

Effective Alternative Treatments - Allopathic medicine is often successful in completely removing BCC's but obviously also often fails, given the high number of recurrences suffered by many people with repeat visits to the doctor and then specialist. These treatments don't always work as well as expected or hoped.

Deadly Skin Cancer Types

An important warning for us all with regard to skin cancer types. Today more patients than ever survive dangerous melanoma than in past generations, but the rate of death for one form of this disease hasn't budged in 30 years.

Nodular melanoma accounts for 14% of melanomas that are diagnosed, but makes up a startling 37% of untimely deaths from the disease according to a recent study.

The reason this form of cancer contributes to so many deaths is that it doesn't always look like what we expect to see. It can appear without warning on the surface of the skin and can be hard to spot because it's often light or nearly colorless, and doesn't adhere to the ABCD characteristics we've all been taught to look for.

Just like the more well known radial melanoma, nodular melanomas start out in skin cells that are called melanocytes that product melanin. Most melanomas stay in the skin's top layer, going down no more than one tenth of a millimeter. Radial melanomas are easier to see as the diameter goes up.

For nodular melanoma the cancerous cells reach a point where they start to grow vertically, sending roots into the fat and other tissues of the body. The depth of the cancer determines how likely you are to survive. For a cancerous growth that goes 3.5 to 4 millimeters deep, only 60% of patients will live for five years.

This latest study examined over 100,000 cases of melanoma diagnosed between the years 1978 and 2007.

They saw that at least 20% of nodular melanomas were fatal. You should understand that there's an acknowledged limitation of the work - not all physicians report the type of melanoma and the team was unable to double check the reports during the study.

While public health officials and others have done a great job of getting the word out about ABCD characteristics when it comes to identifying skin cancer, experts now believe other letters should be added to the mix to help identify the nodular types of these cancers. We've been taught to watch for any of these...

- Asymmetry, one side doesn't match the other

- Borders, where moles have irregular edges

- Color, color changes or a variety of colors

- Diameter, anything over 6 millimeters wide

But we should also be watching our skin surface for E, F and G as well. Any mole or other growth that has all of these characteristics should be checked by a dermatologist at once. They are...

- Evolving, where the mole or nodule is changing quickly over a short period of time

- Firm to the touch

- Growing for more than two to three weeks

Also good to know, nodular melanoma can happen in a mole, but are more likely to develop without warning on normal skin

In most cases the various skin cancer types, including melanomas are easy to detect, treat and cure. Dermatologists suggest that you get to know your own skin by doing full body self-exams once each month. If you're worried about something you see... get to the doctor right away. Often patients realize something is wrong. Don't give up if the first physician you see doesn't respond as you like... keep looking until you find one who will take action.

Prevent Skin Cancer

If you don't know by now: Wear Your Sunscreen! Suncreen with SPF 15 or higher can significantly reduce the possibility of melanomas, the malignant tumors that contribute to skin cancer. The good news is that melanomas, when recognized and treated early, are almost 100% curable. The big problem with malignant melanomas lies in their being ignored, undetected or untreated, causing the cancer to spread elsewhere in the body. In 2007, the United States population is estimated at encountering close to 60,000 new instances of melanoma, according to the American Cancer Society.

Self-examination is the best way to combat these melanomas. Your Dermatologist can provide professional care annually and instruct you on how to competently check your body for melanomas. These self-exams should be performed monthly, looking out for two kinds of moles, normal moles (round, brown blemishes or "beauty marks") and dysplastic nevi (atypical moles). If there is a history of melanoma in your family, you are at a greater risk for skin cancer. There are three main types of skin cancer; basal cell carcinoma, squamous cell carcinoma, and melanoma. Self-examination gives you a higher chance of catching unusual moles and potentially saving your life. If, upon examining, you find any moles that are raised, bleeding, oddly shaped or different than the last time you checked them, see your Dermatologist immediately. A good rule of thumb is to follow the skin cancer ABCDE rule.

A- asymmetry: look for abnormalities in symmetry - does it look the same on both sides?

B-border: blurry, uneven or rough edges in an early melanoma

C- color- multi colored moles or moles that have changed color. Moles can range from brown, black, tan, red, white, blue, pink, purple or gray.

D- diameter- Melanomas are typically larger than your average mole, about the size of a pencil eraser or larger than 1-4 " in diameter.

E- Elevation/Evolving- any mole that has an uneven surface, is raised or changes in color, shape or size should be brought to your doctor's attention. Additionally, bleeding, scabbing or itching are also warning signs of potential melanoma.

Men and women should pay close attention to areas of the body that are repeatedly exposed to the most sun including the chest, neck, tips of the ears, face, hands, back and lower legs, forearms and shoulders. Dangerous UVA and UVB rays from the sun and repeated exposure to these rays can effectuate skin cancer. If you live in a very sunny climate, like Australia, Arizona or Florida you are at a higher risk for skin cancer. If you have experienced major sunburns as a child, this can also be a contributing factor. It is very important to shield yourself from the sun with protective clothing, high SPF sunscreen (15, 30 or higher) and wear it on your face daily. Even in Winter! If you have pale skin, are susceptible to sunburns, have light-colored eyes, work outside in the sun often, use tanning booths, or have many existing moles you are at a higher risk of contracting skin cancer. People who have had chemotherapy or diseases such as HIV, lymphoma or other immune system destructive diseases are also at a higher risk for melanoma.

Things To Look For With Skin Cancer

The other day, I was taken by the hair coloring of a clerk at the local store. I commented on how beautiful it was, with the dark base and the natural-looking streaks, as if the sun had touched her alone; and we began a conversation of how when we were younger we would not have to use any hair dyes: we just sprayed SunIn on our hair and laid out in the sun for an hour or two.

This of course led us to discussing the near impossibility of doing that now, as we have blasted the ozone layer(s) so hard we have created a direct line between us and the harsher (more deadly) rays of the sun (and no, SunIn is a pump spray, not an aerosol, so we didn't have to go there with culpability and irony and all). But you probably didn't come here to read regarding hair coloring techniques that are sun-free or chemical free, for that matter at least not specifically. You came looking for information on the different types of skin cancer.

The speculation and theory does hold some evidence against chemicals in a-hem-health and beauty products; and it does point to the sun's 'damaging rays' as a possible cause, etc., but here, since we aren't medical professionals, specialist, or experts, the info on the types of skin cancer is going to be basic and absent of finger-pointing, if you will:

There are three types of skin cancer: Basal Cell Carcinoma (a.k.a. non-melanoma skin cancer); Squamous Cell Carcinoma; and Melanoma. Melanoma (also, Cutaneous Melanoma, Malignant Melanoma) - Cancer cells are growing in the melanocytes, the cells that are responsible for skin pigmentation. According to University of Maryland medicine and other experts, of all of the types of skin cancer, Melanoma is 'the rarest and the most virulent.' It is typically found in people with fair skin, light hair, and/or light eyes, even even however it is possible in others with different complexions, and as the experts above also assert, does not exempt those with dark brown or black skin. Identifiable symptoms include, most commonly, a mole changing color, size, shape, or state (starts oozing or bleeding), or a mole that UMM notes 'feels itchy, hard, lumpy, swollen, or tender to the touch.' Squamous Cell Carcinoma-Also called non-melanoma skin cancer, Squamous Cell Carcinoma usually begins as a red-looking, scaly patch or patches of skin, or can appear as nodules.

Of the three types of skin cancer, Squamous, affecting Caucasians, usually fair-complected, is the second most common and shows up, typically, on the ears (ear-rims), face, lips, and mouth. Basal Cell Carcinoma - The second of the types of skin cancer, Basal Cell Cancer, typically starts as a 'small, fleshy bump or nodule,' most commonly found on the head, neck, and/or hands. Of the three types of skin cancer, Basal Cell Carcinoma, which is typically found in Caucasians, say those at UMM, make up 'more than 90 percent in the U.S.. My mother had the second most common of the types of skin cancer, on her lip, and while we at first teased her that it was herpes, she was smart enough to know it was a 'sun blister' and quick enough to catch it by going to a specialist.

That's the good news, to give you hope when you bemoan the loss of days picnicking, swimming, and 'bathing' under the magnificent sun.

Skin Cancer

Skin cancer is such a disease that can occur to any individual. The medical experts till today could not specify the age group of occurrence. They could not either successfully reduce the chances of occurrence because every year the statistics of cancer patients is increasing. Skin cancer is not as harmful as the other types of cancers. The cancerous cells usually affect the other normal cells and impair the normal functioning of the organs. Hence cancer spreads to the other organs also. But a patient suffering from skin cancer does not face the same hazard. But yet a person experiences a very discomfort feeling because the skin is of the body is affected. The skin cancer is divided into two types. The type of skin depends upon the origination of the cells. In the United States the incidence has become so high that almost 1 million of the people are prone to skin cancer every year.

The symptoms of the cancers are usually not noted earlier. Initially, the cancer grows is the form of precancerous lesions known as dysplasia. This tumor is not a cancer but later on it develops cancerous cells within them. These tumors are actually benign in nature and the treatment of the tumors is also easy. But in case, they are neglected for a long period of time they becomes malignant. when the cancer has developed then it spreads to the other organs and affects the normal functioning of the skin.

There are three main categories of skin cancer. They are Basal Cell Carcinoma, Squamous Cell Carcinoma and melanoma. Melanoma occurs rarely and the rate of occurrence of BCC and SCC is 90% of the total cancers. These two types do not spread to the other organs thus impairing their normal functioning. But melanoma has the property of metastazing. Metastazing means spreading of the cancerous cells to the other organs. When SCC is caused then outer lining of the elliptical cells is affected. The BCC and SCC both the diseases are treated in the same way. Melanoma, as the disease is severe compared to the two diseases, it is treated with chemotherapy techniques because the disease is often spread to the other cells.

Like the other cancers, one should be aware of the skin cancer symptoms and hence we can start the treatment as early as possible. Till today, no one knows the exact symptoms that can be noticed before the occurrence of skin cancer, but factors like hereditary, earlier skin cancers can cause cancer easily. One should be aware of these factors. If somebody from the family is already suffering from skin cancer then the other members should take care of. The skin cancer originates from the moles of the skin that is known as dysplastic nevi. The disease is more easily caused to people who are aged. Now-a-days due to the sun exposure and the high level of radiation released by the sun or UV factors skin cancer can be caused very easily. One should avoid the sun burns or apply ointments that protect you from the harmful radiations of the sun.

But yet, the organizations such as WHO are taking steps to reduce the chances of these cancers. In this way, the people all over the world are becoming aware of the spread of the disease. If a person has any doubt regarding his skin problem, he must immediately visit the doctor and take treatments as frequently as possible.