Melanoma develops in the melanocytes, the cells that produce melanin (the pigment that gives the skin its color).
The most typical signs of melanoma are either a new pigmented or unusual-looking blemish on the skin (not necessarily a mole), or a change in the shape, size, or color of an existing mole. Melanomas usually develop on the skin, and occasionally on surfaces that don’t receive significant sun exposure, such as the soles of the feet, scalp, palms of the hands, and fingernail beds. It can also develop in other parts of the body, such as the genitals, anal area, mouth, and eyes. As a primary, it rarely develops inside the body.
To diagnose melanoma, patients usually undergo a series of tests and procedures:
- Skin exam-a dermatologist examines the suspicious mole or skin suspicious area and the rest of the skin using a dermatoscope, a magnifying lens, and light source device.
- Skin biopsy- the surgeon (cosmetic or general) performs a biopsy, and the pathologist checks the tissue sample for cancerous cells. The pathologist generates a report detailing the type of cells in the tumor, the thickness of the melanoma, and the cancer aggressiveness. Special lab tests might also specify whether the tumor cells have specific mutations, such as mutations of the BRAF or C-KIT genes. This information assists the medical team to plan the appropriate treatment.
- Sentinel lymph node biopsy- a procedure to check whether cancer has spread to the lymph nodes. A specialist injects a blue dye and/or radioactive material into the melanoma area and checks for accumulation in one or more sentinel lymph nodes near the tumor. The surgeon removes the sentinel node for further pathological examination.
Melanoma can spread locally, regionally to the skin around the primary tumor or nearby lymph nodes, and systemically to other organs. Common systemic spreading might occur to the lungs, liver, and brain. It can also spread to the bones and other tissues. To learn whether cancer has spread, the doctor might recommend imaging tests. They may include ultrasound, CT, MRI, chest X-ray, or a PET CT scan.
Some patients with advanced or metastatic melanoma, and with a specific cancer mutation might benefit from immunotherapy such as PD-1 inhibitors. Examples include pembrolizumab (Keytruda) and nivolumab (Opdivo). Another immunotherapy drug is Ipilimumab (Yervoy)- a CTLA-4 inhibitor. Some patients can benefit from targeted therapy according to particular factors in the patient’s tumor, such as drugs that target cells with BRAF gene changes, or MEK inhibitors. For some patients, the medical team might recommend chemotherapy or radiation therapy. For most patients, there is also the option of clinical trials with new medications and combination treatments.
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