Melanoma Cancer

MELANOMA IS A CANCER OF THE PIGMENTED CELLS OF THE SKIN Melanoma occurs because the melanin-containing cells of the skin change and become malignant. The ultra-violet rays of the sun initiate this change. Melanomas present as black or brown spots on the sun-exposed areas of the skin. Melanomas can also occur in nevi or moles (These are the brown or black spots on the skin that we are born with). When ever a brown or black spot changes color, shape, size or becomes itchy or bleeds easily, then it may be going through a malignant change and should be examined by a doctor immediately. Melanomas can also occur in the unexposed areas of the body and people who have had severe sunburns when they were young are at a high risk for developing melanomas in later life. Melanomas can also occur in the back of the eye. The Eye doctors usually discover these. They are treated either with radiation or surgery. People who have multiple brown spots on their skin (and where these brown spots are also present in other family members) are at risk for developing melanomas. The Nevus Dysplastic Syndrome is a genetically expressed Disease, where the presence of these brown or black moles are exaggerated, and predispose this group of patients to getting melanoma early in life. Melanomas are very dangerous cancers but if treated early can be easily cured. So its important for everyone to know about them and have them treated early. If melanomas escape from the skin, it is very difficult to cure them after that. Treatment The treatment depends on how deep the melanomas penetrate the skin. If they are superficial, less than 0.75 millimeters, excising the melanoma and the surrounding skin is all that is necessary. If they penetrate beyond 1.0 millimeter, then the local lymph nodes may be involved and they must be examined at the time of surgery. These can be done by using the Sentinel Node Technique ... by using a tracing radioactive agent,  which localizes the involved node. Biopsy of that node will predict whether the tumor has spread or not. If the melanoma has penetrated beyond 2 millimeters, and even if the melanoma has not spread to the surrounding lymph nodes, a wider excision should be done and prophylactic treatments may have to be given to prevent re-occurrence. Interferon is currently the best drug for preventing reoccurrence. Leukine  (GM-CSF) is currently being tested. This may be better and less toxic than Interferon. The deeper the melanomas penetrate the skin, the worse the prognosis. A Medical Oncologist should evaluate all melanomas; these sub-specialists know most about these tumors and know what treatments need to be given. If the melanoma cancer cells penetrate deeply into the skin, they can reach the underlying blood vessels and from there they can spread through out the body, to the local lymph nodes, the lungs, the liver, the bones or the brain. When melanoma leave the primary site, they are very difficult to cure; they can be controlled for a period of time. This is why diagnosing early is important. Chemotherapy is required when melanoma metastasizes outside the lymph nodes. Interferon, Interleukin-2, Decarbazine, Vincristine, Cis-Platinum, and Cytoxan are all useful. Newer experimental drugs are coming down the pike. (See the Page on New Drugs) Sometimes Tamoxifen or Thalidomide are used to control the disease.  Responses are very individualized. This is a complex disease and no treatment decisions should be made on this brief presentation. If you wish to have a Second Opinion or know more about this disease or the drugs used to control it, please call my office for an appointment and I will be happy to discuss, clarify and manage your particular disease.