Melanoma: An Overview | Jotted Lines

Over the course of the last century, incidents of melanoma have steadily increased. There are various factors behind this trend, but chief among them is radical lifestyle changes adopted by people. As societies became more and more industrialized, activities involving sun-exposure had correspondingly declined. No more do a majority of people spend hours in the farm or participate in communal outdoor activities. With our bodies and skin thus conditioned to minimal sunlight, sudden bursts of exposure could prove dangerous. With tanning of skin becoming an obsession among fair-skinned women, young white women are particularly at high risk for developing melanoma. There is also an environmental dimension to the steady rise of skin cancer cases across the world. This has to do with the depletion of the earth’s ozone layer. This allows an excessive amount of Ultra Violet radiation to filter through the atmosphere. Although application of sunscreen and protective clothing somewhat mitigates the harmful effects, one cannot be on the guard at all times. The bio-pathology of melanoma is described thus: “Melanoma is a malignancy of melanocytes--the cells in the upper part of our skin (the epidermis) that are responsible for pigmentation of the skin. These cells can become malignant because of exposure to ultraviolet light--a condition called malignant melanoma.” There are three types of malignant tumours of the skin - melanoma being one of them. Basal cell carcinoma and Squamous cell carcinoma are the other two varieties. Rarer forms of skin cancer include “mycosis fungoides (a type of lymphoma) and Kaposi's sarcoma.” ("Skin cancer," 2014) Statistically, melanoma has far lesser occurrence than basal or squamous cell carcinomas. The latter two are caused by disruptions to epithelial tissue DNA. These two types of skin cancer are seldom witnessed in dark-skinned people. Those at high risk for acquisition are light-skinned, blue-eyed people whose are disposed to tan poorly. Face and limbs are the most likely areas of onset of cancer. A saving grace for these two variants of skin cancer is that the rate of fatalities linked to them is quite low. But in the case of melanoma, the statistics paint a dark picture. Even within the broad classification of melanoma there are varieties. For example, one variety, called lentigo maligna accounts for 5% of all occurrences. It is manifest in the face or neck of people above 50 years. Since the cancer can lie in a dormant state for many years, identifying it early and treating it can be relatively easy. Likewise, we have a variety called acral lentiginous melanoma. It afflicts fingers of toes and brown-skinned people are at high risk. Between 2-8% of all melanomas are of this type. Another variety is the Amelanotic melanoma, which is very deadly. Fortunately it is also quite rare. It is “not a typical dark mole that you can see on the skin. It appears like a tan, benign lesion. Eventually, it will bleed, ulcerate, grow rapidly or itch, which would be an indication for a biopsy. The doctor can perform a biopsy and make the diagnosis, but often by that time the melanoma has invaded deeply, so the prognosis may not be good.” (Begg, Huang, & Berwick, 2006) Doctors will also have to probe for the presence of dysplastic or atypical nevi are markers for melanoma. So when dermatologists see a person with multiple dysplastic nevi, they “monitor them much more carefully for the development of melanoma. However, patients with certain genetic diseases, such as xeroderma pigmentosum--a rare disease in which patients cannot repair ultraviolet-damaged DNA--are at increased risk. The DNA within the melanocytes becomes damaged and may develop into melanoma.” (SerVaas, 2013) Melanoma is the most potent type of skin cancer with high incidence of death caused by it. The risk factors that cause melanoma are the same as for any variant of skin cancer. Besides, there also appears to be a genetic component that predicts likelihood of occurrence. While light-skin increases the chance of incidence, dark-skinned people can also acquire the cancer. Melanomas arise “in melanocytes, the melanin-containing cells of the epidermal layer of the skin. Melanin is the pigment that gives skin colour and that helps to protect the skin from sun damage. In light-skinned people, melanomas appear most frequently on the trunk in men and on the arms or legs in women. In blacks melanomas appear most frequently on the hands and feet.” ("Skin cancer," 2014) Over the years, the instances of melanoma have steadily increased. So much so that, various national governments have launched public-health campaigns. In the United States, for example, more than a million people are diagnosed with skin cancer annually. Of these, 50,000 are diagnosed with melanoma, the most virulent variety of skin cancer. But if we were to take necessary precautions, the risk could be substantially reduced. The ingeniously named ‘slip-slap-slop principle’ seems to work very well. Public health professionals urge the general public to “slip on a shirt, slap on a wide-brimmed hat, and slop on some sunscreen.” (Durkee, 2006) There are some point to keep in mind while selecting the clothing as well. A particular attention needs to be given to the weaving of the cloth. While tightly woven material prevents UV rays from reaching the skin, a light weave does not prevent exposure. Even then, there are certain parts of the body which are more vulnerable than others for melanoma. So knowledge of the history of anatomical affliction of the cancer and recorded statistics are of help. As a noted dermatologist observes, “ultraviolet light can get through the hair, depending upon the thickness of the hair...the sun could penetrate the hair and damage the scalp. Hair is there for a reason--to protect the skin. Some of the worst skin cancer problems have been in men with hereditary baldness who received a great deal of sun exposure to the scalp.” (SerVaas, 2013) But one must not over-do prevention efforts, for an optimal exposure to sunlight helps the body build Vitamin D and Vitamin A. So, one has to make a distinction between harmful and benevolent sun rays. It is commonly advised by doctors to avoid exposure during noon. The period between 11 and 4 is when the heat and UV radiation are at their most potent. The sunlight during dawn and dusk is by and large safe. One also has to consider the geographic latitude and longitude of a particular locality. Prevention methods also include a regular check-up with a physician. People can also check themselves by scrutinizing their naked bodies in front of a well lit mirror. This is also one of the recommendations by the Skin Cancer Foundation. “The prognosis and survival of a patient with melanoma depends on how deeply the cancer has invaded. With early diagnosis of melanoma, we are able to cure the melanoma 93 percent of the time or better. If melanoma invades deeply, however, the five-year survival can be less than 20 percent.” (Durkee, 2006) References Begg, C. B., Huang, Y., & Berwick, M. (2006). Separate Estimation of Primary and Secondary Cancer Preventive Impact: Analysis of a Case-Control Study of Skin Self-Examination and Melanoma. Journal of the American Statistical Association, 91(436), 1381+. Di Quinzio, M. L., Dewar, R. A., Burge, F. I., & Veugelers, P. J. (2005). Family Physician Visits and Early Recognition of Melanoma. Canadian Journal of Public Health, 96(2), 136+. Durkee, M. (2006, September). Life after Melanoma; after the Physical Part of Conquering Cancer Was over, the Emotional Part Remained - and Proved Even More Difficult. The Saturday Evening Post, 258, 58+. SerVaas, J. (2013, May-June). Saving Your Skin: Despite Public-Health Campaigns, Skin Cancer Is on the Rise in the U.S., with More Than One Million Cases Diagnosed Each Year. A Noted Dermatologist Gives Advice on How Best to Avoid Harmful Exposure to the Sun. The Saturday Evening Post, 275(3), 32+. Skin cancer. (2014). In The Columbia Encyclopedia (6th ed.). The Columbia University Press.

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