Melanoma
What is Melanoma?
Melanoma is a dangerous variant of tumor that starts in melanocytes. Melanocytes are the cells in the skin that create melanin and give the skin its pigmentation. It's a really aggressive type of skin cancer because it can spread quickly to other parts of the body, e.g. lymph nodes, lungs, liver, and brain.
Melanoma is seen more in countries where people are lighter skin toned. But there has been a rise in infections in India, especially for people with frequent sun exposure, who suffer from immune deficiencies, or carry genes that elevate their vulnerability.
Statistics and Extent
In India, about 0.3–0.5 people out of 100,000 get it each year. It's more common in the south and northeast of India, and it affects people who work outside, like farmers and fishermen. In India, it usually shows up on the sole of the foot, under the nails, or on the inside surfaces of the mouth and genitals. This is different from Western countries, where it’s usually on skin that gets a lot of sun. Data from AIIMS Delhi and Tata Memorial Hospital says that about 70–80% of all cases in India are acral and mucosal melanomas.
Types of Melanomas
- Acral Lentiginous Melanoma: Appears on palms, soles, or under nails.
- Lentigo Maligna Melanoma: It develop in the face, scalp or neck usually in older people, or people with very sun-damaged skin
- Mucosal Melanoma: Affects mucous membranes (oral cavity, genital tract)
- Superficial Spreading Melanoma: Involves sun-exposed skin
- Nodular Melanoma: Aggressive, may appear anywhere on the body.
Common Sites (Location)
- Soles and palms
- Nail beds (subungual region)
- Oral cavity and mucosal surfaces
- Genital mucosa
- Occasionally face, trunk, or limbs
Stages
Melanoma staging is based on:
- T (Tumor thickness and ulceration)
- N (Lymph node involvement)
- M (Metastasis to distant organs)
- Stages range from Stage 0 (in situ) to Stage IV (metastatic).
Symptoms
- Dark or irregular skin lesion or mole that changes in size, color, or shape
- Bleeding, itching, or ulceration in a pigmented area
- Lesions on soles, palms, or under nails
- Bleeding, pain, or swelling in oral/genital areas
- Lymph node swelling in the groin, armpit, or neck
Risk Factors and Causes
- Chronic sun exposure and UV radiation
- Genetic predisposition or family history of melanoma
- Repeated trauma or irritation to a mole or sole region
- Immunosuppression, especially in transplant or HIV-positive patients
- Previous history of other skin conditions or cancers
Prevention
- Using broad-spectrum sunscreen (SPF more than 30), especially in high UV regions.
- Wearing protective clothing and hats when outdoors.
- Regular self-examination of skin, soles, and nails.
- Awareness programs in rural areas can help detect cases earlier.
Diagnosis
- Diagnosis involves a combination of clinical evaluation and tissue testing:
- Thermoscopic examination: Detects characteristic pigmentation patterns.
- Biopsy: Confirms diagnosis and determines thickness (Breslow depth).
- Sentinel lymph node biopsy: Checks early spread.
- CT, MRI, or PET-CT scans: Detect metastasis in advanced cases.
Treatment
- Surgery: Complete excision with clear margins.
- Lymph node dissection: If regional nodes are involved.
- Immunotherapy: Drugs like pembrolizumab and nivolumab
- Targeted therapy: For patients with BRAF or NRAS gene mutations.
- Radiotherapy: Used in mucosal or metastatic cases.
- Chemotherapy: For advanced or refractory disease.
Side Effects and Maintenance
Short-term effects: Fatigue, pain, nausea, skin irritation, and immune-related reactions.
Long-term effects: Recurrence risk, lymphedema, and pigment changes at the site.
FAQs
Q: Is Melanoma common in India? A: No, it is relatively rare but rising slowly, especially acral and mucosal types.
Q: Is Melanoma curable? A: Yes, . Localized melanoma has high survival rates.
Q: Can dark-skinned people get melanoma? A: Yes. While less common, it occurs in non-sun-exposed areas.
Q: Are there any screening tests?
A: Self-examination and early reporting are key. Population wide screening usually does not take place.
Q: What happens if a mole biopsy is positive? A: If a patient receives positive melanoma results after a mole biopsy, his or her doctor will need to determine the extent of the cancer and develop a treatment plan based on how far the cancer has progressed.