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Melanoma – Causes, Symptoms and Treatment

Melanoma is a malignant skin tumor arising from pigment-producing cells called melanocytes. It is the most dangerous form of skin cancer and requires early detection and treatment.

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Things worth knowing about "Melanoma"

Melanoma is a malignant skin tumor arising from pigment-producing cells called melanocytes. It is the most dangerous form of skin cancer and requires early detection and treatment.

What is Melanoma?

Melanoma (also called malignant melanoma) is a type of skin cancer that develops from melanocytes – the pigment-producing cells of the skin. Melanocytes produce melanin, the pigment responsible for skin color and UV protection. When these cells undergo malignant transformation and begin to grow uncontrollably, a melanoma develops. Although melanoma is less common than other skin cancers, it is responsible for the majority of skin cancer-related deaths due to its high potential to metastasize (spread to other parts of the body).

Causes and Risk Factors

The development of melanoma is influenced by multiple factors. Key risk factors include:

UV radiation: Excessive sun exposure and the use of tanning beds significantly increase melanoma risk.
Fair skin type: Individuals with fair skin, light eyes, and red or blond hair are at higher risk.
Numerous or atypical moles: Having many moles or dysplastic (atypical) nevi increases risk.
Genetic predisposition: A family history of melanoma and mutations in genes such as CDKN2A or BRAF can elevate risk.
Weakened immune system: Immunosuppressed individuals face a higher risk of developing melanoma.
Personal history of melanoma or other skin cancers

Symptoms

Melanoma typically presents as a new or changing pigmented lesion on the skin. The ABCDE rule is widely used to identify suspicious skin changes:

A – Asymmetry: One half of the mole does not match the other.
B – Border: Irregular, ragged, or blurred edges.
C – Color: Variation in color within the same lesion (shades of brown, black, red, white, or blue).
D – Diameter: Larger than 6 mm in diameter.
E – Evolution: Any change in size, shape, color, or any new symptom such as bleeding or itching.

Additional warning signs include persistent itching, bleeding, or oozing of a skin lesion, and the appearance of new dark spots on the skin.

Types of Melanoma

Melanoma presents in several distinct subtypes with different growth patterns and frequencies:

Superficial spreading melanoma (SSM): The most common type, initially grows horizontally within the skin layers.
Nodular melanoma: Grows rapidly and vertically into deeper skin layers; considered the most aggressive subtype.
Lentigo maligna melanoma: Develops mainly in older individuals on chronically sun-damaged skin, especially the face.
Acral lentiginous melanoma: A rare form occurring on the palms, soles, or under the nails; more common in people with darker skin.

Diagnosis

Diagnosing melanoma involves several steps:

Clinical examination: Visual inspection of the skin, guided by the ABCDE criteria.
Dermoscopy: Non-invasive examination using a dermatoscope to visualize deeper skin structures.
Excisional biopsy: Surgical removal of the suspicious lesion followed by histopathological analysis – this is the gold standard for diagnosis confirmation.
Staging workup: Once melanoma is confirmed, imaging studies (e.g., ultrasound, CT scan, PET-CT) are performed to detect possible metastases.

Staging follows the international TNM classification (Tumor, Nodes, Metastases) as defined by the AJCC (American Joint Committee on Cancer).

Treatment

Surgery

Surgical excision of the melanoma with appropriate safety margins is the primary and most important treatment. The required margin is determined by tumor thickness, measured using the Breslow index.

Immunotherapy

Modern immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab) work by reactivating the immune system to recognize and destroy tumor cells. These therapies have transformed the treatment of advanced-stage melanoma and significantly improved survival rates.

Targeted Therapy

In approximately 50% of melanomas, a mutation in the BRAF gene is present. These tumors can be treated with BRAF inhibitors and MEK inhibitors (e.g., vemurafenib, dabrafenib, trametinib), which interfere with specific signaling pathways that drive tumor growth.

Radiation Therapy and Chemotherapy

Radiation therapy is used primarily for brain metastases or local tumor control. Conventional chemotherapy plays a limited role in modern melanoma treatment, as more effective therapies are now available.

Prevention and Early Detection

Regular skin examinations by a dermatologist and consistent use of sunscreen (SPF 30 or higher), along with avoiding midday sun exposure and tanning beds, are the most effective preventive measures. Early detection dramatically improves outcomes, making routine skin cancer screening essential for at-risk individuals.

References

World Health Organization (WHO): Skin cancers. Available at: https://www.who.int/news-room/fact-sheets/detail/skin-cancers
American Cancer Society: Melanoma Skin Cancer. Available at: https://www.cancer.org/cancer/melanoma-skin-cancer.html
Garbe C et al. - European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics. European Journal of Cancer, 2022.

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