Melanoma Treatment - The Arsenal against a Fatal Disease

Melanoma is the deadliest form of skin cancer and has been spreading like wild fire over the last decade. It is curable, but for melanoma treatment to be fully effective, early diagnosis is imperative. Melanoma treatment may take the form of surgery, chemotherapy in early stages, and biological or radiation therapies in extreme cases. Melanoma takes on four forms. Both superficial spreading melanoma, the most common form accounting for 70% of all melanoma cases and lentigo maligna begin as flat or elevated irregularly shaped tan, brown or black patches.

Both these forms of skin cancer begin as localized tumors, but left untreated, they penetrate deeper and spread to other parts of the body. Acral lentiginous melanoma is a superficial melanoma common amongst Asians and African-Americans.

Nodular melanoma is the most severe form, beginning as invasive cancer and when malignant, shows a lump. It accounts for 10-15% of melanoma cases. Prevention is always better than cure. Melanoma can be prevented by reducing the sun exposure, especially between 10am and 4pm with adequate clothing and sun blocks with a sun protection factor (SPF) of at least 15. Children are vulnerable to sunrays and it has been proved that juvenile sunburns greatly increase the risk of adult melanoma. Melanoma remedy is most effective in the early stages.

This means that you should be aware and alert about every symptom of the disease. You should be especially concerned about your existing moles changing shape or color and of course, new ones appearing unexpectedly. Typical melanoma moles are lop-sided with irregular borders. Advanced melanoma moles have swellings, oozing, itching or bleeding. Melanoma remedy varies according to the progression of the disease. Actinic Keratoses or sun damage leading to skin cancer can be treated by laser resurfacing, TCA peel skin peels or the application of Efudex cream.

In the early stages, surgery to remove the tumor and the adjacent healthy tissues is effective enough to destroy the metastatic cancer cells. The amount of tissue removed depends upon the spread of the cancerous growth. Surgical melanoma remedy may also involve a skin graft to replenish the lost tissues. If the melanoma spreads to the lymph nodes, surgery may also involve removal of these. Advanced melanoma treatment includes chemotherapy. This either involves the use of cancer drugs in capsule form or intravenous injections to kill the cancer cells.

Biological and radiation therapies are the last bastions of melanoma treatment. In the former, laboratory-generated cancer-combating substances called biological response, modifiers (BRMs) like tumor vaccines, interleukin-2, or interferon-alfa are administered to the melanoma patient.

Radiation therapy involves the use of x-rays to destroy cancer cells that have spread throughout the body. This form of melanoma treatment can last several sessions. Its side effects include topical redness, dryness and rashes, which disappear over time. However, changes in skin color and texture may occur after a few years. Melanoma treatment should be undergone only under strict medical guidance to ensure complete remedy and prevent a recurrence.

Surgery for Melanomas

Nevi are so common that they have a wide range of classifications. Blue nevi occur very deep in the dermis. Compound nevi are very dark in color and are slightly raised. Intradermal nevi are usually flesh-colored and raised. Intramucosal nevi occur in the mouth or genital area. Nevi of ito and nevi of ota are found on the shoulder or face, which are flat and brownish in appearance.

Clark’s nevi are also called dysplastic nevi. They tend to stem from abnormal cell growth and can be pre-cancerous. These moles tend to be larger with irregular borders and coloration. As a result, they look like melanomas, and are often removed to confirm the diagnosis. Dysplastic nevi do not morph into melanomas, but are markers of risk when there are many of them.

Epidermal nevi usually appear on the upper half of the body. The recognized cause of these nevi is genetics. Giant hairy nevi are often very large and hairy and are unsightly. In terms of health, they can pose a risk as melanoma may be present in approximately 10-15% of the cases. Spitz nevi usually occur on children. They are often reddish in color and are raised.

Diagnostic punch or excisional biopsies may appear to excise the tumor, but further surgery is often necessary to reduce the risk of recurrence. Complete surgical excision with adequate margins and assessment for the presence of detectable metastatic disease along with short- and long-term followup is standard.

Often this is done by a wide local excision with 1 to 2 cm margins. Melanoma-in-situ and lentigo malignas are treated with narrower surgical margins, usually 0.2 to 0.5 cm. Many surgeons consider 0.5 cm the standard of care for standard excision of melanoma-in-situ, but 0.2 cm margin might be acceptable for margin controlled surgery (Mohs surgery).

The wide excision aims to reduce the rate of tumour recurrence at the site of the original lesion. This is a common pattern of treatment failure in melanoma. Considerable research has aimed to elucidate appropriate margins for excision with a general trend toward less aggressive treatment during the last decades.

Mohs surgery has been reported with cure rate as low as 77% and as high as 98% for melanoma-in-situ. Melanomas which spread usually do so to the lymph nodes in the region of the tumor before spreading elsewhere. Attempts to improve survival by removing lymph nodes surgically were associated with many complications but unfortunately no overall survival benefit.

Although controversial and without prolonging survival, sentinel lymph node biopsy is often performed, especially for T1b/T2+ tumors, mucosal tumors, ocular melanoma and tumors of the limbs. A process called lymphoscintigraphy is performed in which a radioactive tracer is injected at the tumor site in order to localize the sentinel nodes.

Further precision is provided using a blue tracer dye and surgery is performed to biopsy the nodes. Recently the technique of sentinel lymph node biopsy has been developed to reduce the complications of lymph node surgery while allowing assessment of the involvement of nodes with tumor.

As with other skin abnormalities, moles are classically removed by laser, surgery, or electrocautery. Most of these treatments require multiple visits to the doctor. Surgery, the option doctors commonly offer, involves cutting out the mole. The resulting wound requires stitches, which will in turn leave a scar.