Melanoma is the least common form of skin cancer but by far the most deadly. Unfortunately, the incidence of melanoma has been increasing for many decades. In women, for example, only the incidence of lung cancer is rising more quickly and melanoma is the most common cancer diagnosed in women between ages 29 and 34. Melanoma develops from melanocytes, cells located primarily in the skin that produce the dark pigment melanin, which serves to protect the skin from ultraviolet radiation. People with darker skin produce more melanin and generally are at less risk for all skin cancers, including melanoma, than those with pale skin. There is a relationship between sunburn (especially repeated sunburns before age 20) and skin cancers. However, other factors, including family history and skin type, also figure into the equation of who gets skin cancer. Melanomas may develop anywhere on the body. The most common sites are areas intermittently exposed to the sun, such as the trunk and legs.One type of melanoma, however, is associated with chronic sun exposure and occurs most often on the face and arms. (Melanoma in the eye is fortunately uncommon; see Eye Cancers.) Left untreated, melanoma may quickly metastasize, or spread, to other parts of the body.Metastasized melanoma is potentially and frequently fatal, making detection and treatment critical.

Symptoms of Melanoma

• Any change in a mole's appearance. Such changes are characterized by the acronym ABCD: asymmetrical shape; border irregularity; color variation; diameter larger than a pencil eraser.
• An irregularly shaped flat spot or raised bump anywhere on the skin. The spot or bump may be brown, black, blue, tan, red, white, or multicolored; it usually has no symptoms.Only occasionally will it be tender, itchy, or ooze or bleed.
• A black or brown spot on the color portion (iris) or the white (sclera) of the eye; change of color of the iris; gradual loss of vision; pain and redness in the affected eye.

What Causes Melanoma?

• The cause of melanoma is unknown; however, it is likely a combination of genetic factors and environmental sun exposure.
• Exposure to ultraviolet (UV) radiation from the sun or from artificial sources (such as sunlamps) may promote melanoma. Skin damage and melanoma risk increase with cumulative UV exposure.
• Hereditary factors play a role in some forms of melanoma; a family history of melanoma increases the risk.
• Those with pale skin, blue or green eyes, and red or blond hair are most at risk for skin cancer. However, anyone of any age or skin color may develop melanoma.
• The presence of atypical moles (as differentiated by the acronym ABCD; see Symptoms) increases risk.
• Having many moles on the skin is a risk factor.
• A congenital mole (a mole present at birth) has an increased chance of developing a melanoma within it.With very large moles, this may occur before age five; with small moles, this may occur at any time, even in old age.
• The risk of melanoma increases steadily with age.
• People's relatively recent tendency to spend moretime in the sun with less clothing coverage is believed to be a factor in the increasing incidence of skin cancer.

Prevention of Melanoma

• Perform regular skin self-examinations: once every few months for those with a low risk of skin cancer; more often for those in high-risk categories. To perform: Stand in front of a mirror and slowly inspect the entire surface of the skin, checking for changes in existing moles and for the appearance of any new skin lesions or spots. Do not neglect hard-to-see areas; a second mirror may help. Regular self-examination aids in early diagnosis and treatment.
• Whenever possible, avoid exposure to direct sunlight between 10 a.m. and 2 p.m.
• Block the sun's rays by wearing protective clothing, such as hats and long-sleeved shirts.
• Apply a waterproof sunscreen lotion with a sun protection factor (SPF) of 15 or higher before going outside. Reapply often, especially after swimming or perspiring heavily.
• Avoid sunlamps and tanning booths.
• Using yourself as an example, make sure children follow steps for proper sun protection. Sun exposure and sunburn during childhood and adolescence increase the likelihood of skin damage later in life.
• People who have had one episode of melanoma are at greater risk of developing a second melanoma. For this reason, preventive measures are especially important after initial diagnosis.

Diagnosis of Melanoma

• A skin biopsy is done by removing part or all of a suspicious skin growth; the tissue is sent to a pathologist trained in examining skin biopsies.
• If melanoma in the eye is suspected, a complete eye examination is conducted by an ophthalmologist.

How To Treat Melanoma

• Surgery to remove a melanoma (and usually at least half an inch of normal surrounding skin) is required. In some cases, neighboring lymph nodes may be removed to determine whether the melanoma has spread.
• Chemotherapy and radiation therapy may be used in advanced cases of melanoma to forestall cancer growth and thus ease symptoms (although these treatments rarely result in a cure).
• Laser surgery, cryosurgery (in which liquid nitrogen is used to freeze the targeted tissue), or radiation therapy may be used to destroy cancerous cells within the eye.

When To Call A Doctor

• Make an appointment with a dermatologist if you notice a change in the appearance of a mole or a new unidentified growth.Most skin growths are harmless, but if there is any question, a simple skin biopsy may be done to determine the presence or absence of cancer.
• Schedule regular follow-up appointments with a dermatologist after an episode of melanoma, because of the increased likelihood of subsequent episodes.
• Have regular skin cancer screenings with a dermatologist if you have a family history of melanoma or are in a high-risk category for melanoma or other skin cancers. Relatives of high-risk people should also be screened regularly.
• See an ophthalmologist if you develop symptoms of melanoma in the eye.

For more information on Melanoma, click on this link -- Johns Hopkins Health Alerts: Healthy Living

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