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Encyclopedia > Melanoma
Melanoma
Classification & external resources
Melanoma malignum on the left leg of a 60-year-old woman
ICD-10 C43.
ICD-9 172
ICD-O: M8720/3
OMIM 155600
DiseasesDB 7947
MedlinePlus 000850
eMedicine derm/257 

Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). It is one of the rarer types of skin cancer but causes the majority of skin cancer related deaths.[1][2] Despite many years of intensive laboratory and clinical research, the sole effective cure is surgical resection of the primary tumor before it achieves a thickness greater than 1 mm. Image File history File links Melanoma_malignum. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // C00-D48 - Neoplasms (C00-C14) Malignant neoplasms, lip, oral cavity and pharynx (C00) Malignant neoplasm of lip (C01) Malignant neoplasm of base of tongue (C02) Malignant neoplasm of other and unspecified parts of tongue (C03) Malignant neoplasm of gum (C04) Malignant neoplasm of floor of mouth (C05) Malignant neoplasm of... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... For malignant tumors specifically, see cancer. ... This article or section does not cite its references or sources. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... For other uses, see Eye (disambiguation). ... Uveal Melanoma is cancer (melanoma) of the colored part of the eye and the surrounding areas (uvea). ... Skin cancer is a malignant growth on the skin which can have many causes. ...


Around 160,000 new cases of melanoma are diagnosed worldwide each year, and it is more frequent in males and caucasians.[3] It is more common in caucasian populations living in sunny climates than other groups.[4] According to the WHO Report about 48,000 melanoma related deaths occur worldwide per annum.[5] Look up who in Wiktionary, the free dictionary. ...


The treatment includes surgical removal of the tumor; adjuvant treatment; chemo- and immunotherapy, or radiation therapy. In medicine, adjuvants are agents which modify the effect of other agents while having few if any direct effects when given by themselves. ... Chemotherapy is the use of chemical substances to treat disease. ... Cancer Immunotherapy is the use of monoclonal antibodies (-mab) to specifically target cells. ... Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ...


Melanomas also occur in horses, see equine melanoma, below. Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). ...

Contents

History

Although melanoma is not a new disease, evidence for its occurrence in antiquity is rather scarce. However, one example lies in a 1960s examination of nine Peruvian Inca mummies, radiocarbon dated to be approximately 2400 years old, which showed apparent signs of melanoma: melanotic masses in the skin and diffuse metastases to the bones.[6] Capital Cusco 1197-1533 Vilcabamba 1533-1572 Language(s) Quechua, Aymara, Jaqi family, Mochic and scores of smaller languages. ... Carbon-14 is the radioactive isotope of carbon discovered February 27, 1940, by Martin Kamen and Sam Ruben. ...


John Hunter is reported to be the first to operate on metastatic melanoma in 1787. Although not knowing precisely what it was, he described it as a "cancerous fungous excrescence". The excised tumor was preserved in the Hunterian Museum of the Royal College of Surgeons of England. It was not until 1968 that microscopic examination of the specimen revealed it to be an example of metastatic melanoma.[7] Engraving of John Hunter (1728 – 1793) taken from the original portrait by Sir Joshua Reynolds, which is in the Royal College of Surgeons. ... Year 1787 was a common year starting on Monday (see link for calendar). ... The Royal College of Surgeons of England is an independent professional body committed to promoting and advancing the highest standards of surgical care for patients. ... The Royal College of Surgeons of England is an independent professional body committed to promoting and advancing the highest standards of surgical care for patients. ... Year 1968 (MCMLXVIII) was a leap year starting on Monday (link will display full calendar) of the Gregorian calendar. ...


The French physician René Laennec was the first to describe melanoma as a disease entity. His report was initially presented during a lecture for the Faculté de Médecine de Paris in 1804 and then published as a bulletin in 1806.[8] The first English language report of melanoma was presented by an English general practitioner from Stourbridge, William Norris in 1820.[9] In his later work in 1857 he remarked that there is a familial predisposition for development of melanoma (Eight Cases of Melanosis with Pathological and Therapeutical Remarks on That Disease). René Théophile Hyacinthe Laënnec René-Théophile-Hyacinthe Laennec (February 17, 1781- August 13, 1826), French physician; inventor of the stethoscope. ... 1804 was a leap year starting on Sunday (see link for calendar). ... 1806 was a common year starting on Wednesday (see link for calendar). ... 1820 was a leap year starting on Saturday (see link for calendar). ...


The first formal acknowledgement of advanced melanoma as untreatable came from Samuel Cooper in 1840. He stated that the '... only chance for benefit depends upon the early removal of the disease ...'[10] More than one and a half centuries later this situation remains largely unchanged.


In 1956, Australian professor Henry Oliver Lancaster discovered that melanomas were directly associated with latitude (ie, intensity of sunlight); and that exposure to the sun was a very high factor in the development of the cancer[citation needed]. This article is about the geographical term. ... Prism splitting light High Resolution Solar Spectrum Sunlight in the broad sense is the total spectrum of the electromagnetic radiation given off by the Sun. ... Sol redirects here. ...


Epidemiology and causes

Nodular melanoma on the leg of an elderly woman.

Generally, an individual's risk for developing melanoma depends on two groups of factors: intrinsic and environmental.[11] "Intrinsic" factors are generally an individual's family history and inherited genotype, while the most relevant environmental factor is sun exposure. Image File history File linksMetadata Malignant_melanoma. ... Image File history File linksMetadata Malignant_melanoma. ... This article does not cite any references or sources. ...


Epidemiologic studies suggest that exposure to ultraviolet radiation (UVA[12] and UVB) is one of the major contributors to the development of melanoma. UV radiation causes damage to the DNA of cells, typically thymine dimerization, which when unrepaired can create mutations in the cell's genes. When the cell divides, these mutations are propagated to new generations of cells. If the mutations occur in oncogenes or tumor suppressor genes, the rate of mitosis in the mutation-bearing cells can become uncontrolled, leading to the formation of a tumor. Occasional extreme sun exposure (resulting in "sunburn") is causally related to melanoma.[13] Those with more chronic long term exposure (outdoor workers) may develop protective mechanisms. Melanoma is most common on the back in men and on legs in women (areas of intermittent sun exposure) and is more common in indoor workers than outdoor workers (in a British study[14]). Other factors are mutations in or total loss of tumor suppressor genes. Use of sunbeds (with deeply penetrating UVA rays) has been linked to the development of skin cancers, including melanoma. Epidemiology (Greek epi = upon, among; demos = people, district; logos = word, discourse), defined literally, is the study of epidemics in humans. ... For other uses, see Ultraviolet (disambiguation). ... DNA damage resulting in multiple broken chromosomes DNA repair is a process constantly operating in each cell of a living being; it is essential to survival because it protects the genome from damage. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... For linguistic mutation, see Apophony. ... For other uses, see Gene (disambiguation). ... This does not adequately cite its references or sources. ... An oncogene is a modified gene that increases the malignancy of a tumor cell. ... A tumor suppressor gene is a gene that reduces the probability that a cell in a multicellular organism will turn into a tumor cell. ... Mitosis divides genetic information during cell division. ... For malignant tumors specifically, see cancer. ... For linguistic mutation, see Apophony. ... A tumor suppressor gene is a gene that reduces the probability that a cell in a multicellular organism will turn into a tumor cell. ... A sunbed, with lights off. ...


Possible significant elements in determining risk include the intensity and duration of sun exposure, the age at which sun exposure occurs, and the degree of skin pigmentation. Exposure during childhood is a more important risk factor than exposure in adulthood. This is seen in migration studies in Australia[15] where people tend to retain the risk profile of their country of birth if they migrate to Australia as an adult. Individuals with blistering or peeling sunburns (especially in the first twenty years of life) have a significantly greater risk for melanoma. Historical data for native populations collected by R. Biasutti prior to 1940. ...


Fair and red-headed people, persons with multiple atypical nevi or dysplastic nevi and persons born with giant congenital melanocytic nevi are at increased risk.[16] It has been suggested that this article or section be merged with Birthmark. ... A dysplastic nevus, (or naevus; pl. ... The congenital melanocytic nevus is a type of melanocytic nevus (or mole) found in infants at birth. ...


A family history of melanoma greatly increases a person's risk because mutations in CDKN2A, CDK4 and several other genes have been found in melanoma-prone families.[17] Patients with a history of one melanoma are at increased risk of developing a second primary tumour.[18] Cyclin-dependent kinase 4 is part of the cyclin-dependent kinase family. ...


The incidence of melanoma has increased in the recent years, but it is not clear to what extent changes in behavior, in the environment, or in early detection are involved.[19]


Genetics

Familial melanoma is genetically heterogeneous,[20] and loci for familial melanoma have been identified on the chromosome arms 1p, 9p and 12q. Multiple genetic events have been related to the pathogenesis of melanoma.[21] The multiple tumor suppressor 1 (CDKN2A/MTS1) gene encodes p16INK4a - a low-molecular weight protein inhibitor of cyclin-dependent protein kinases (CDKs) - which has been localised to the p21 region of human chromosome 9.[22] A tumor suppressor gene is a gene that reduces the probability that a cell in a multicellular organism will turn into a tumor cell. ... Cyclin-dependent kinases (CDK) belong to a group of protein kinases originally discovered as being involved in the regulation of the cell cycle. ... Chromosome 9 is one of the 23 pairs of chromosomes in humans. ...


Today, melanomas are diagnosed only after they become visible on the skin. In the future, however, physicians will hopefully be able detect melanomas based on a patient’s genotype, not just his or her phenotype. Recent genetic advances promise to help doctors to identify people with high-risk genotypes and to determine which of a person’s lesions have the greatest chance of becoming cancerous. This article does not cite any references or sources. ... Individuals in the mollusk species Donax variabilis show diverse coloration and patterning in their phenotypes. ...


A number of rare mutations, which often run in families, are known to greatly increase one’s susceptibility to melanoma. One class of mutations affects the gene CDKN2A. An alternative reading frame mutation in this gene leads to the destabilization of p53, a transcription factor involved in apoptosis and in fifty percent of human cancers. Another mutation in the same gene results in a non-functional inhibitor of CDK4, a [cyclin-dependent kinase] that promotes cell division. Mutations that cause the skin condition Xeroderma Pigmentosum (XP) also seriously predispose one to melanoma. Scattered throughout the genome, these mutations reduce a cell’s ability to repair DNA. Both CDKN2A and XP mutations are highly penetrant. TP53 bound to a short DNA fragment. ... In molecular biology, a transcription factor is a protein that binds DNA at a specific promoter or enhancer region or site, where it regulates transcription. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ... Cyclin-dependent kinase 4 is part of the cyclin-dependent kinase family. ... Xeroderma pigmentosum, or XP, is an autosomal recessive genetic disorder of DNA repair in which the bodys normal ability to remove damage caused by ultraviolet (UV) light is deficient. ...


Other mutations confer lower risk but are more prevalent in the population. People with mutations in the MC1R gene, for example, are two to four times more likely to develop melanoma than those with two wild-type copies of the gene. MC1R mutations are very common; in fact, all people with red hair have a mutated copy of the gene. Two-gene models of melanoma risk have already been created, and in the future, researchers hope to create genome-scale models that will allow them to predict a patient’s risk of developing melanoma based on his or her genotype. The Melanocortin-1 receptor (Mc1r) is one of the key proteins in hair colour production. ...


In addition to identifying high-risk patients, researchers also want to identify high-risk lesions within a given patient. Many new technologies, such as optical coherence tomography (OCT), are being developed to accomplish this. OCT allows pathologists to view 3-D reconstructions of the skin and offers more resolution than past techniques could provide. In vivo confocal microscopy and fluorescently tagged antibodies are also proving to be valuable diagnostic tools. Optical coherence tomography tomogram of a fingertip. ... Confocal microscopy is an imaging technique used to increase micrograph contrast and/or to reconstruct three-dimensional images by using a spatial pinhole to eliminate out-of-focus light or flare in specimens that are thicker than the focal plane. ... Wikipedia does not yet have an article with this exact name. ...

Detection and prevention

Minimizing exposure to sources of ultraviolet radiation (the sun and sunbeds),[23] following sun protection measures and wearing sun protective clothing (long-sleeved shirts, long trousers, and broad-brimmed hats) can offer protection. Using a sunscreen with an SPF rating of 30 or better on exposed areas has been recommended.[24] However, there are severe doubts about the ability of current sunscreen to prevent melanoma.[25] // Sun protective clothing is clothing specifically designed for sun protection and is produced from a fabric rated for its level of ultraviolet (UV) protection. ... Sunscreen (also known as sunblock, suntan lotion) is a lotion, spray or other topical product that helps protect the skin from the suns ultraviolet (UV) radiation, and which reduces sunburn and other skin damage, with the goal lowering your risk of skin cancer. ... Sunscreen (also known as sunblock, suntan lotion) is a lotion, spray or other topical product that helps protect the skin from the suns ultraviolet (UV) radiation, and which reduces sunburn and other skin damage, with the goal lowering your risk of skin cancer. ...

A melanoma showing irregular borders and colour, diameter over 10 mm and asymmetry (ie A, B, C and D.)

To prevent or detect melanomas (and increase survival rates), it is recommended to learn what they look like (see "ABCDE" mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.[26] Image File history File linksMetadata Download high resolution version (3008x2000, 2377 KB) Summary Description: Melanoma left foot Source: self-made Date: created 29. ... Image File history File linksMetadata Download high resolution version (3008x2000, 2377 KB) Summary Description: Melanoma left foot Source: self-made Date: created 29. ...


A popular method for remembering the signs and symptoms of melanoma is the mnemonic "ABCDE":

  • Asymmetrical skin lesion.
  • Border of the lesion is irregular.
  • Color: melanomas usually have multiple colors.
  • Diameter: moles greater than 5 mm are more likely to be melanomas than smaller moles.
  • Evolution: The evolution (ie change) of a mole or lesion may be a hint that the lesion is becoming malignant --or-- Elevation: The mole is raised or elevated above the skin.

The E is sometimes omitted, as in the ABCD guideline. The ABCD guideline refers to a system of criteria for suspecting that a mole (skin marking) is potentially a cancerous melanoma. ...


People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma. A dysplastic nevus, (or naevus; pl. ...


Diagnosis

Moles that are irregular in color or shape are suspicious of a malignant or a premalignant melanoma. Following a visual examination and a dermatoscopic exam (an instrument that illuminates a mole, revealing its underlying pigment and vascular network structure), the doctor may biopsy the suspicious mole. If it is malignant, the mole and an area around it needs excision. This will require a referral to a surgeon or dermatologist. Dermatoscopy (also known as epiluminescence microscopy) is the examination of cutaneous lesions with a dermatoscope, a magnifier with a light and a liquid medium between the instrument and the skin, thus illuminating the lesion without reflected light. ...


The diagnosis of melanoma requires experience, as early stages may look identical to harmless moles or not have any color at all. Where any doubt exists, the patient will be referred to a specialist dermatologist. Beyond this expert knowledge a biopsy performed under local anesthesia is often required to assist in making or confirming the diagnosis and in defining the severity of the melanoma. A mole, technically known as a melanocytic naevus, is a small, dark spot on human skin. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... It has been suggested that this article or section be merged with local anesthetic. ... In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ...


Excisional biopsy is the management of choice; this is where the suspect lesion is totally removed with an adequate ellipse of surrounding skin and tissue.[27] The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin, enabling the histopathologist to determine the depth of penetration of the melanoma by microscopic examination. This is described by Clark's level (involvement of skin structures) and Breslow's depth (measured in millimeters). A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... In medicine, Breslows depth is used as a prognostic factor in predicting the 5-year survival rate in humans who have malignant melanoma of the skin by calculating the risk of metastasis. ...


Malignant melanoma in skin biopsy with H and E stain. This case may represent superficial spreading melanoma. The same case as the last one. Enlargement of the image. Image File history File linksMetadata Malignant_melanoma_(1)_at_thigh_Case_01. ... Image File history File linksMetadata Malignant_melanoma_(2)_at_thigh_Case_01. ... Image File history File linksMetadata Malignant_melanoma_(3)_at_thigh_Case_01. ... Image File history File linksMetadata Malignant_melanoma_(4)_at_thigh_Case_01. ...


If an excisional biopsy is not possible in certain larger pigmented lesions, a punch biopsy may be performed by a specialist hospital doctor, using a surgical punch (an instrument similar to a tiny cookie cutter with a handle, with an opening ranging in size from 1 to 6 mm). The punch is used to remove a plug of skin (down to the subcutaneous layer) from a portion of a large suspicious lesion, for histopathological examination.


Lactate dehydrogenase (LDH) tests are often used to screen for metastases, although many patients with metastases (even end-stage) have a normal LDH; extraordinarily high LDH often indicates metastatic spread of the disease to the liver. It is common for patients diagnosed with melanoma to have chest X-rays and an LDH test, and in some cases CT, MRI, PET and/or PET/CT scans. Although controversial, sentinel lymph node biopsies and examination of the lymph nodes are also performed in patients to assess spread to the lymph nodes. Lactate dehydrogenase (LDH) is an enzyme (EC 1. ... For the musical composition, see Metastasis (Xenakis composition). ... negron305 Cat scan redirects here. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... Lymph nodes are components of the lymphatic system. ...


Sometimes the skin lesion may bleed, itch, or ulcerate, although this is a very late sign. A slow-healing lesion should be watched closely, as that may be a sign of melanoma. Be aware also that in circumstances that are still poorly understood, melanomas may "regress" or spontaneously become smaller or invisible - however the malignancy is still present. Amelanotic (colorless or flesh-colored) melanomas do not have pigment and may not even be visible. Lentigo maligna, a superficial melanoma confined to the topmost layers of the skin (found primarily in older patients) is often described as a "stain" on the skin. Some patients with metastatic melanoma do not have an obvious detectable primary tumor. Lentigo is a type of brown skin lesion. ...


Types of primary melanoma

Superficial spreading melanoma on the right leg of a 63-year-old man. This is an asymmetric black and 2 cm nodule with variable color, texture and well demarcated border.

The most common types of Melanoma in the skin: Image File history File linksMetadata Download high-resolution version (1600x1200, 725 KB)Superficial spreading melanoma from DermAtlas [1] ((http://dermatlas. ... Image File history File linksMetadata Download high-resolution version (1600x1200, 725 KB)Superficial spreading melanoma from DermAtlas [1] ((http://dermatlas. ...

Any of the above types may produce melanin (and be dark in colour) or not (and be amelanotic - not dark). Similarly any subtype may show desmoplasia (dense fibrous reaction with neurotropism) which is a marker of aggressive behaviour and a tendency to local recurrence. Superficial spreading melanoma (SSM) is the most common form of cutaneous melanoma in Caucasians. ... Nodular melanoma (NM) is the most aggressive form of melanoma. ... Acral lentiginous melanoma is a kind of skin melanoma. ... Lentigo maligna is a melanoma in situ, meaning it consists of malignant cells but does not show invasive growth. ...


Elsewhere:

Clear cell tumors are part of the surface epithelial-stromal tumor group of ovarian neoplasms, accounting for 6% of all neoplastic cases. ... Uveal Melanoma is cancer (melanoma) of the colored part of the eye and the surrounding areas (uvea). ...

Prognostic factors

See also: Breslow's depth
Black, irregularly shaped, uniformly brown pigmented nevus on a 19-year-old man's right cheek. The Breslow index measured 2.88 mm, and a thorough medical evaluation revealed no evidence of metastases. The scar was reexcised with a 2-cm margin, and the skin was repaired with a graft.

Features that affect prognosis are tumor thickness in millimeters (Breslow's depth), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis.[28] In medicine, Breslows depth is used as a prognostic factor in predicting the 5-year survival rate in humans who have malignant melanoma of the skin by calculating the risk of metastasis. ... Image File history File linksMetadata Download high-resolution version (2048x1536, 691 KB)Melanoma from DermAtlas [1] Website allows fair use of unedited images [2] for fair use in articles. ... Image File history File linksMetadata Download high-resolution version (2048x1536, 691 KB)Melanoma from DermAtlas [1] Website allows fair use of unedited images [2] for fair use in articles. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... For malignant tumors specifically, see cancer. ... In medicine, Breslows depth is used as a prognostic factor in predicting the 5-year survival rate in humans who have malignant melanoma of the skin by calculating the risk of metastasis. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... For the musical composition, see Metastasis (Xenakis composition). ...


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 (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion. In medicine, Breslows depth is used as a prognostic factor in predicting the 5-year survival rate in humans who have malignant melanoma of the skin by calculating the risk of metastasis. ... This article or section does not cite its references or sources. ...


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 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. Lymph nodes are components of the lymphatic system. ... “PCR” redirects here. ...


When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.[29] 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. Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure. ... The well-being or quality of life of a population is an important concern in economics and political science. ...


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 (e.g. rectal 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. A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ...


Staging

Further context on cancer staging is available at TNM. The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...


Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.[30]


Melanoma stages:[29]


Stage 0: Melanoma in Situ (Clark Level I), 100% Survival


Stage I/II: Invasive Melanoma, 85-95% Survival

  • T1a: Less than 1.00 mm primary, w/o Ulceration, Clark Level II-III
  • T1b: Less than 1.00 mm primary, w/Ulceration or Clark Level IV-V
  • T2a: 1.00-2.00 mm primary, w/o Ulceration

Stage II: High Risk Melanoma, 40-85% Survival

  • T2b: 1.00-2.00 mm primary, w/ Ulceration
  • T3a: 2.00-4.00 mm primary, w/o Ulceration
  • T3b: 2.00-4.00 mm primary, w/ Ulceration
  • T4a: 4.00 mm or greater primary w/o Ulceration
  • T4b: 4.00 mm or greater primary w/ Ulceration

Stage III: Regional Metastasis, 25-60% Survival

  • N1: Single Positive Lymph Node
  • N2: 2-3 Positive Lymph Nodes OR Regional Skin/In-Transit Metastasis
  • N3: 4 Positive Lymph Nodes OR Lymph Node and Regional Skin/In Transit Metastases

Stage IV: Distant Metastasis, 9-15% Survival

  • M1a: Distant Skin Metastasis, Normal LDH
  • M1b: Lung Metastasis, Normal LDH
  • M1c: Other Distant Metastasis OR Any Distant Metastasis with Elevated LDH

Based Upon AJCC 5-Year Survival With Proper Treatment


Treatment

Treatment of advanced malignant melanoma is performed from a multidisciplinary approach including dermatologists, medical oncologists, radiation oncologists, surgical oncologists, general surgeons, plastic surgeons, neurologists, neurosurgeons, otorhinolaryngologists, radiologists, pathologists/dermatopathologists, research scientists, nurse practitioners and physician assistants, and palliative care experts. Nurse practitioners (NPs) and physician assistants (PAs) are qualified to evaluate and treat patients on behalf of their supervising physicians. Treatment guidelines can be found through many resources available to health care professionals around the world. Inspired by melanoma’s increasing prevalence, researchers are seeking to understand the pathways that regulate melanin production. Dermatology (from Greek δερμα, skin) is a branch of medicine dealing with the skin and its appendages (hair, sweat glands, etc). ... Oncology is the medical subspecialty dealing with the study and treatment of cancer. ... For the album by The Huntingtons, see Plastic Surgery (album). ... A neurologist is a physician who is specialized in the diagnosis and treatment of neurologic diseases. ... Old German engraving depicting a trepanation, an ancient and still performed neurosurgical procedure Neurosurgery is the surgical discipline focused on treating those central and peripheral nervous system diseases amenable to mechanical intervention. ... Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices for the purpose of obtaining visual information as part of medical imaging. ... Max Bielschowsky Paul Ehrlich - (1854 - 1915) Gustav Giemsa - (1867 - 1948) (see Giemsa stain) Ludwig Grünwald William Boog Leishman - (1865 - 1926) (see leishmaniasis) Richard May Frank Burr Mallory (1862 - 1941) (see Mallory bodies) George Nicolas Papanicolaou (1883 - 1962) (see Pap smear) Artur Pappenheim Carl von Rokitansky Dmitri Leonidovich Romanowsky - (1861... A nurse practitioner is a registered nurse who has completed specific advanced nursing education (generally a masters degree) and training in the diagnosis and management of common medical conditions. ... In the United States, a Physician Assistant (PA) is a health care professional licensed to practice medicine with the supervision of a licensed physician (either an M.D. or D.O.) [1] PAs are not to be confused with medical assistants, who perform administrative and clinical tasks in hospitals and... Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure. ... Broadly, melanin is any of the polyacetylene, polyaniline, and polypyrrole blacks and browns or their mixed copolymers. ...


Surgery

A blue stained sentinel lymph node in the axilla.
A blue stained sentinel lymph node in the axilla.

Diagnostic punch or excisional biopsies may appear to excise (and in some cases may indeed actually remove) the tumor, but further surgery is often necessary to reduce the risk of recurrence. Image File history File linksMetadata Size of this preview: 800 × 532 pixel Image in higher resolution (3008 × 2000 pixel, file size: 2. ... Image File history File linksMetadata Size of this preview: 800 × 532 pixel Image in higher resolution (3008 × 2000 pixel, file size: 2. ... The armpit (or axilla) is the area on the human body directly under the area where the arm connects to the shoulder. ...


Complete surgical excision with adequate margins and assessment for the presence of detectable metastatic disease along with short and long term follow up is standard. Often this is done by a "wide local excision" (WLE) with 1 to 2 cm margins. 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. There seems to be no advantage to taking in excess of 2 cm margins for even the thickest tumors.[31]


Mohs micrographic surgery is not well accepted in the treatment of melanoma. In this surgery, performed by specially-trained dermatologists, a small layer of tissue is excised and prepared as a frozen tissue section. This section can be prepared and examined by the dermatologist/dermatopathologist within one hour, and the patient will return for further stages of excision as needed, with each excised tissue layer being examined until clear margins are obtained.[32] However, the usefulness of Moh's surgery in melanoma is limited because of the difficulty of identifying melanocytic atypia on a frozen section, which may lead to incomplete resection of the melanoma.[32][33] It has been suggested that this article or section be merged into Mohs surgery. ...


Other issues to consider with Moh's technique are risks of tumor implantation and possible false negative margins due to suboptimal melanocytic staining.[34] Deviation from recommended 1-2 cm margins of excision should thus be approached carefully.


Melanomas which spread usually do so to the lymph nodes in the region of the tumour before spreading elsewhere. Attempts to improve survival by removing lymph nodes surgically (lymphadenectomy) were associated with many complications but unfortunately no overall survival benefit. 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 tumour.[citation needed] Lymph nodes are components of the lymphatic system. ... Lymphadenectomy consists on the surgical removal of one or more groups of lymph nodes. ... The sentinel lymph node is the hypothetical first lymph node reached by metastasizing cancer cells from a tumor. ...


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 node(s)". Further precision is provided using a blue tracer dye and surgery is performed to biopsy the node(s). Routine H&E staining, and immunoperoxidase staining will be adequate to rule out node involvement. PCR (Polymerase Chain Reaction) tests on nodes, usually performed to test for entry into clinical trials, now demonstrate that many patients with a negative SLN actually had a small number of positive cells in their nodes. Alternatively, a fine-needle aspiration may be performed, and is often used to test masses. The sentinel lymph node is the hypothetical first lymph node or group of nodes reached by metastasizing cancer cells from a tumor. ... Look up dye in Wiktionary, the free dictionary. ... Immunoperoxidase stains are used in the microscopic examination of tissues. ... Wikipedia does not yet have an article with this exact name. ...


If a lymph node is positive, depending on the extent of lymph node spread, a radical lymph node dissection will often be performed. If the disease is completely resected the patient will be considered for adjuvant therapy.


Adjuvant treatment

High risk melanomas may require referral to a medical or surgical oncologist for adjuvant treatment. In the United States most patients in otherwise good health will begin up to a year of high-dose interferon treatment, which has severe side effects, but may improve the patients' prognosis.[35] This claim is not supported by all research at this time and in Europe interferon is usually not used outside the scope of clinical trials.[36][37] Interferons (IFNs) are natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. ...


Metastatic melanomas can be detected by X-rays, CT scans, MRIs, PET and PET/CTs, ultrasound, LDH testing and photoacoustic detection.[38]


Chemotherapy and immunotherapy

Various chemotherapy agents are used, including dacarbazine (also termed DTIC), immunotherapy (with interleukin-2 (IL-2) or interferon (IFN)) as well as local perfusion are used by different centers. They can occasionally show dramatic success, but the overall success in metastatic melanoma is quite limited.[39] IL-2 (Proleukin®) is the first new therapy approved for the treatment of metastatic melanoma in 20 years. Studies have demonstrated that IL-2 offers the possibility of a complete and long-lasting remission in this disease, although only in a small percentage of patients.[40] A number of new agents and novel approaches are under evaluation and show promise.[41] Chemotherapy is the use of chemical substances to treat disease. ... Dacarbazine (da-KAR-ba-zeen) (brand names DTIC, DTIC-Dome; also known as DIC or Imidazole Carboxamide) is an antineoplastic chemotherapy drug used in the treatment of various cancers, among them malignant melanoma (a form of skin cancer which can spread to other parts of the body). ... Cancer Immunotherapy is the use of monoclonal antibodies (-mab) to specifically target cells. ... Interleukin-2 (IL2) is an interleukin, a type of biological response modifier that can improve the bodys natural response to disease. ... Interferons (IFNs) are natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. ...


Lentigo maligna treatment

Some superficial melanomas (lentigo maligna) have resolved with an experimental treatment, imiquimod (Aldara®) topical cream, an immune enhancing agent. Application of this cream has been shown to decrease tumor size prior to surgery, reducing the invasiveness of the procedure. This treatment is used especially for smaller melanoma in situ lesions located in cosmetically sensitive regions. Several published studies demonstrate a 70% cure rate with this topical treatment. With lentigo maligna, surgical cure rates are no higher. Some dermasurgeons are combining the 2 methods: surgically excise the cancer, then treat the area with Aldara® cream post-operatively for 3 months. Imiquimod (INN, marketed by 3M under the trade name Aldara) is a prescription medication that acts as an immune response modifier. ...


Radiation and other therapies

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.[42] Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ...


In research setting other therapies, such as gene therapy, may be tested.[43] Radioimmunotherapy of metastatic melanoma is currently under investigation. Gene therapy is the insertion of genes into an individuals cells and tissues to treat a disease, and hereditary diseases in which a defective mutant allele is replaced with a functional one. ... Radioimmunotherapy (RIT) utilizes an antibody labeled with a radionuclide to deliver cytotoxic radiation to a target cell (1). ...


Experimental treatment developed at the National Cancer Institute (NCI), part of the National Institutes of Health in the US was used in advanced (metastatic) melanoma with moderate success. The treatment, adoptive transfer of genetically altered autologous lymphocytes, depends on delivering genes that encode so called T cell receptors (TCRs), into patient's lymphocytes. After that manipulation lymphocytes recognize and bind to certain molecules found on the surface of melanoma cells and kill them.[44]

Equine melanoma

Melanomas are also not uncommon in horses, being largely confined to grey (or white) animals - 80% of such pale horses will develop melanomata by 15 years of age[45]; of these, 66% are slow growing but all may be classified as malignant[45]. Surgical excision may be attempted in some cases, if the tumours are limited in extent and number. However, they are often multiple (especially in older animals) and perineal tumours are notoriously difficult to excise. Often, a position of "benign neglect" is assumed, especially if the tumours are not causing any clinical problems. Medical therapy with cimetidine (2.5-4.0mg/kg three times daily for 2 months or more)[46] is also an option, although it has a lower success rate than surgery and cryosurgery[47]. Who ever deleted my page is a prat and i wil hunt them down on lucy and shout at them loudly! RAAAAARRR! connie sansom ... Surgery Surgery is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. ... The muscles of the male perineum In anatomy, the perineum is the region between the genital area and the anus in both sexes. ... See drugs, medication, and pharmacology for substances that treat patients. ... See drugs, medication, and pharmacology for substances that are used to treat patients. ... Cimetidine is a histamine H2-receptor antagonist that inhibits the production of acid in the stomach. ... “Surgeon” redirects here. ... Cryosurgery (cryotherapy) is the application of extreme cold to destroy abnormal or diseased tissue. ...


Future thought

One important pathway in melanin synthesis involves the transcription factor MITF. The MITF gene is highly conserved and is found in people, mice, birds, and even fish. MITF production is regulated via a fairly straightforward pathway. UV radiation causes increased expression of transcription factor p53 in keratinocytes, and p53 causes these cells to produce melanoctye stimulating hormone (MSH), which binds to MC1R receptors on melanocytes. Ligand-binding at MC1R receptors activates adenyl cyclases, which produce cAMP, which activates CREB, which promotes MITF expression. The targets of MITF include p16 (a CDK inhibitor) and Bcl2, a gene essential to melanocyte survival. It is often difficult to design drugs that interfere with transcription factors, but perhaps new drugs will be discovered that can impede some reaction in the pathway upstream of MITF. Broadly, melanin is any of the polyacetylene, polyaniline, and polypyrrole blacks and browns or their mixed copolymers. ... Note: Ultraviolet is also the name of a 1998 UK television miniseries about vampires. ... TP53 bound to a short DNA fragment. ... The keratinocyte is the major cell type of the epidermis, making up about 90% of epidermal cells. ... The acronym MSH may stand for one of several things, including: Melanocyte-stimulating hormone - a hormone produced in the pituitary gland, and related to skin pigmentation. ... The Melanocortin-1 receptor (Mc1r) is one of the key proteins in hair colour production. ... Melanocytes are cells located in the bottom layer of the skins epidermis. ... Camp may mean: Gatherings of people: Campsite Temporary settlement of a band of foragers. ... CREB (top) is a transcription factor capable of binding DNA (bottom) and regulating gene expression. ... P16 may refer to: The US Federal Aviation Administration identifier for Palmyra (Cooper) Airport, on Palmyra Atoll. ... Bcl-2 is the prototype for a family of mammalian genes and the proteins they produce. ... This article or section does not cite its references or sources. ...


Studies of chromatin structure also promise to shed light on transcriptional regulation in melanoma cells. It has long been assumed that nucleosomes are positioned randomly on DNA, but murine studies of genes involved in melanin production now suggest that nucleosomes are stereotypically positioned on DNA. When a gene is undergoing transcription, its transcription start site is almost always nucleosome-free. When the gene is silent, however, nucleosomes often block the transcriptional start site, suggesting the nucleosome position may play a role in gene regulation. Chromatin is the complex of DNA and protein found inside the nuclei of eukaryotic cells. ... A nucleosome is a unit made of DNA and histones. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... Species 50 species; see text *Several subfamilies of Muroids include animals called rats. ...


Finally, given the fact that tanning helps protect skin cells from UV-induced damage, new melanoma prevention strategies could involve attempts to induce tanning in individuals who would otherwise get sunburns. Redheads, for example, do not tan because they have MC1R mutations. In mice, it has been shown that the melanin-production pathway can be rescued downstream of MC1R. Perhaps such a strategy will eventually be used to protect humans from melanoma.

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External links

Wikimedia Commons has media related to:

Image File history File links Commons-logo. ...

Websites

Logo of the GreenFacts website GreenFacts, formerly the GreenFacts Foundation, is an international non-profit organization founded in 2001 in Brussels, Belgium. ...

Patient information

  • What You Need To Know About Moles and Dysplastic Nevi - patient information booklet from cancer.gov (PDF)
  • MPIP: Melanoma patients information page
  • Melanoma Support Organisation (Victoria, Australia) - Ran by Melanoma Sufferers with strong links to Cancer Institutes in Victoria, Australia
  • Melanoma Patients Australia
  • Mikes Page - The Melanoma Resource Center
  • MEL-L - Melanoma e-mail list for patients, caregivers and healthcare professionals - Supporting the Melanoma Patient since 1996

Images, photographs

  • Melanoma photo library at Dermnet
  • DermAtlas: Melanoma images
  • Photographs of melanoma
  • Skin imaging methods for melanoma diagnosis(commercial advertising)
  • Pictures of melanomas
  • Pictures of amelanotic melanomas

Videos

  • Health Video: Melanoma and Non-Melanoma Skin Cancers - Overview, Prevention, and Treatment
  • Health Video: How to Perform a Skin Self Exam

  Results from FactBites:
 
MedlinePlus: Melanoma (468 words)
Melanoma is the most serious type of skin cancer.
Often the first sign of melanoma is a change in the size, shape, color or feel of a mole.
If melanoma is not removed in its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue.
Melanoma (3354 words)
Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).
Melanoma may also occur in the eye and is called intraocular or ocular melanoma.
In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck.
  More results at FactBites »

 
 

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