About Melanoma

The Skin

Your skin is your body’s largest organ. It has several important roles:

  • To protect your body from injury and keep out infections
  • To control your body temperature and keep in water
  • To protect your body from harmful effects of sunlight – especially Ultraviolet or UV radiation.

Your skin has 2 main layers – the Epidermis and Dermis.  The upper layer, or Epidermis, is made up of different types of cells:

  • Squamous cells – these are the top layer of skin cells
  • Basal cells – these form the base or foundation of your skin
  • Melanocytes – these provide the pigment or colour of your skin, hair and eyes.

The typical number of melanocytes in your skin is between 1000 and 2000 cells per square millimeter of skin. WOW! The difference between fair people and dark people is not the amount of melanocytes, but how active the melanocytes are.

DID YOU KNOW……Albinos lack an enzyme, tyrosinase, that is required for melanocytes to produce melanin.

skin

Information about melanoma

It is a problem with the melanocytes that causes melanoma. They become damaged – mainly by UV radiation or through a faulty gene passed down through families, and grow out of control. A clump of mutated melanocytes (or any cancer cells) are known as a tumour.

Melanoma occurs mainly due to too much exposure to sunlight or UV radiation but it may also occur in places that have never seen the sun.  This may be due to families passing down faulty genes that make moles develop into melanoma or for melanomas to form where there haven’t been any moles.

The most common places for melanomas to occur are the skin of men’s backs and on women’s legs, but melanoma can occur anywhere on the body. Other common places are:

  • The head and neck
  • the skin under the fingernails
  • the soles of the feet or palms of the hands.

Melanoma can be treated successfully if it is caught early but if it spreads to other parts of the body (known as metastatic melanoma) the prognosis or outcome is poor.  This is why early detection is so important (see our ‘prevention and early detection’ tab)

Staging of melanoma

Melanoma is staged or classified according to how thick it is – or how deep through the layers of skin it has spread.  This includes whether it has spread through the skin layers to the lymph nodes (these drain fluid around your body) or to other organs around the body (known as metastatic melanoma)

Medical staff can use different ways to assess your melanoma:

  • physical examination using a dermatoscope to look at the melanoma closely
  • biopsies – taking small amounts of the mole or suspicious skin for a look under a microscope
  • Xray, CT or MRI scans- to see if the melanoma cells have travelled from the original spot to elsewhere in the body

(see our ‘prevention and early detection’ tab)

Medical staff use the following staging method and this will help them plan your treatment and estimate your prognosis (or outlook):

T  = Tumour

Doctors look at how far the melanoma tumour has grown within the skin. This is worked out looking at the thickness of the melanoma using the Breslow measurement (done by a pathologist using your biopsy).  The thinner the melanoma, the better the prognosis.  In general, melanomas less than 1mm thickness have a very small chance of spreading.

The tumour is given a rating of 0-4.  It may also be given a small letter which doctors use to give information to other doctors on whether the surrounding skin has ulcerated as well and how quickly the tumour cells are dividing.  Ask your doctor if you have any questions about the stage of your melanoma.

N = Nodes (spreading to Lymph nodes)

N stands for spread to nearby lymph nodes (bean-sized collections of immune system cells, to which cancers often spread first). The N category is given a number (from 0 to 3) based on whether the melanoma cells have spread to lymph nodes or are found in the lymphatic channels connecting the lymph nodes. It may also be assigned a small letter a, b, or c, depending on how it has spread. Ask your doctor if you have any questions about the stage of your melanoma.

M = Metastasized (or spread to distant organs)

This classification is based on whether the melanoma has spread from the area in which is started or originated (known as the primary tumour). It takes into account which organs it has reached, and may also rely on measurements of a substance called LDH in the blood

One the TNM ratings have been done, they are combined to give an overall score or staging (Clark’s level). These are usually given a number I-IV.

In general, patients with lower stage cancers have a better outlook for a cure or long-term survival.

DID YOU KNOW…..Clark's level is a staging system, used in conjunction with Breslow's depth, which describes the level of anatomical invasion of the melanoma in the skin. It was developed by Wallace H. Clark, Jr. at Harvard University and Massachusetts General Hospital in the 1960s.

clark_level

Causes of melanoma and your risk

Anyone can develop skin cancer, but if you’re in the following groups then you’re at higher risk then the rest of us:

  • Skin type – those with a family history of the following: (whether you sunbake or not)
    • a light complexion
    • red or fair hair
    • blue or green eyes
    • skin that burns easily
    • skin that freckles and doesn’t tan
  • Sunburns including, but not always, blistering - especially in childhood and adolescence
  • Other close family members who have had melanoma
  • Having a large number of moles (naevi)

Fitzpatrick Skin Type Classification

In 1975 Dr. Thomas Fitzpatrick, a dermatologist at Harvard Medical School, developed a scale to classify a person’s complexion based on tolerance to sunlight.

Have a look at some of your skin that has never seen the sunlight and match it to one of the pictures and descriptions below. The lower your skin type, the higher the risk of melanoma.

  • Type I burns easily and never tans
  • Type II burns easily and tans minimally
  • Type III burns moderately and tans gradually
  • Type IV burns minimally and tans easily
  • Type V rarely burns and tans easily
  • Type VI deeply pigmented skin that never burns

 

Fitzpatrick_Skin_Type_Classification

Statistics and facts

Facts about Melanoma:

  1. 1 in 18 lifetime risk (breast cancer 1 in 8 - Cancer Australia)
  2. 1 in 14 (males); 1 in 24 (females)
  3. Most common cancer 20-40yo
  4. Death rates increasing by 0.5% pa (males, especially those aged over 60).
  5. In Tasmania, melanoma is the third most common cancer in women and the fourth most common in men. 
  6. In Tasmania, we lose on average 30-50 people a year to melanoma.
  7. If diagnosed and treated early melanoma is nearly 100% curable.
  8. Melanoma can spread rapidly and can be life threatening if left untreated.
  9. Melanoma rarely occurs in children.
  10. Melanoma is projected to become the third most common cancer in Australians by the year 2020, replacing lung cancer and behind prostate and bowel cancer in men and breast and bowel cancer in women. (AIHW incidence projections)

Treatment

Please click here for treatment options if you are diagnosed with melanoma

http://www.melanomapatients.org.au/treatment/treatment-options

If you have any questions about your treatment you should of course be guided by your medical practitioner.

Clinical Trials

Clinical trials are very important as they help develop a greater understanding of melanoma to improve the ways we can prevent, screen, diagnose or treat it. They aim to ultimately improve the quality of life of those who have the disease.

Clinical trials take place all over the world and vary in size. They are conducted by doctors, nurses, scientists, research assistants, data managers, pharmacists and other health professions; teams who work together to look after patients during the course of the trial. Each trial follows a Human Research Ethics Committee-approved – a carefully controlled protocol. The protocol is also a detailed plan for the aims of the research.

Trials are strictly voluntary and you have the option of withdrawing at any time.

There are a number of reasons why participants tell researchers that they like being involved in clinical trials. These include:

  • An empowering feeling of being involved in your healthcare,
  • potential health benefits,
  • being a part of something that an change the lives of others for the better,
  • experiencing a feeling of more care and attention, and
  • learning about melanoma.

There may also be risks or downsides involved in participating in an experimental treatment, such as:

  • Receiving no positive effect,
  • experiencing potentially negative side effects,
  • risk of randomisation to placebo (non-active)/observation group and
  • devoting your personal time to the research and study visits.

You may be able to participate in some clinical trials in Tasmania but the majority of trials involved in the melanoma space at the moment require interstate travel – usually to Melbourne or Sydney. Some of this cost is paid for by the companies involved in the trial.

Please speak to your Specialist if you would like more information about clinical trials that may be appropriate for you.

You can also find out more information about clinical trials being undertaken in Australia and New Zealand via the Australia and New Zealand Melanoma Trials Group (ANZMTG).  Membership is free.

https://www.anzmtg.org/content.aspx?page=about