Types of Skin Cancer: Melanoma

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Melanoma is a type of cancer that originates in the epidermis (Winsey et al., 2000). More specifically, it is located in the stratum basale layer, the most deep layer of the epidermis, which contains melanocytes. These melanocytes produce melanin which give our skin pigmentation, and it is also the place where cancer cells being rapidly dividing in those affected by melanoma. Because melanocytes make melanin, melanoma often presents itself in moles on the surface of the skin that are black or brown in color.

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Although they present themselves as moles, as the cancer cells continue to divide, they begin to appear bumpy, odd in shape, or have varying shades of color within the affected mole(s) (Leachman, et al., 2017).

Melanoma is the deadliest type of skin cancer because it has the tendency to spread internally, which is called metastasis (American Cancer Society). Symptom presentation is usually delayed until the metastases have begun compromising vital body organs such as the brain, liver, and kidneys.

This is because, with only the appearance of a mole on the skin, this type of cancer can spread to practically any organ in the body, and often times it is only detected months before death. Once a patient’s vital organs simultaneously begin to shut down, it is almost impossible for chemotherapy or radiation to halt the effects of this type of cancer. Effects of this cancer is often times death because it is most commonly caught in stage IV of the disease, the criteria of which I will discuss later.

A research study done on risk-factors for melanoma has concluded that a genetic pre-disposition, combined with environmental factors such as ethnicity, location in proximity to the equator, and proper skin-care technique, all play a factor in whether someone will develop melanoma or not. In a study done about the genetic factors involved in melanoma pre-disposition, DNA repair genes are being assessed in patients with and without melanoma, studying the structural composition of the DNA comprising these genes (Winsey, et al., 2000). DNA repair genes are essential in repairing DNA mutations that can lead to cancer, and in this study, patients who had been diagnosed with melanoma, had repair genes that were mutated, thus not properly repairing the damaged DNA (Winsey, et al., 2000). A more recent research study looking on the genetic predisposition to melanoma found that not only were the mutated DNA repair genes inherited in the cases they studied, but that the inheritance rate for their study was 45%, a number that scientists saw as a daunting statistic (Leachman et al., 2017). For family members with relatives diagnosed with melanoma, this inheritance rate is scarily high, especially if they live in an environment where they have several environmental risk factors present that are at play with their genetic predisposition. These environmental risk factors could be light skin color (which often times is a familial trait) and UV penetration/sun exposure in the area they live in. The reason that Caucausian and other ethnicities with lighter skin experience a higher risk of sun damage which can lead to melanoma formation, is due to the lack of an “epidermal melanin barrier” (Rivas et al., 2017), which darker skinned people have. More specifically, Caucasian people who have “freckles, red or blonde hair, and tend to burn in the sun” are more likely to develop melanoma than their Caucasian counterparts not expressing these phenotypes (Field et al., 2013).

An interesting up-and-coming topic of research in the study of melanoma, is its relationship with Vitamin D synthesis. There have been conflicting results preventing scientists from coming to a conclusion about whether there is in fact a relationship between Vitamin D levels and the development of melanoma, but it is hypothesized that people with low-Vitamin D levels are more susceptible for developing melanoma. The reason being is because it is thought that patients with a low Vitamin D deficiency are those who also burn easily in the sun. Patients with the genotype that dispose them to burn in the sun are already at a higher risk for melanoma, and often try to stay out of the sun or limit sun exposure, thus not receiving the proper amount of vitamin D. In addition to this, patients who did develop melanoma and had low vitamin D levels had a poorer prognosis than other melanoma patients (Timerman et al., 2016). Another hypothesized explanation is that vitamin D3 “may serve as a marker for adequate immune response”, and patients with metastatic melanoma who are low in vitamin D3 are lacking the full immune response strength (Timerman et al., 2016). For the time being scientists are not confident enough to label this as a causal relationship, and the two appear to be merely confounding variables.

In terms of who is more likely to develop melanoma, as I have stated earlier, Caucasians who burn easily, have light hair and have lots of freckles and moles as a result of sun exposure are more likely than any other group to develop melanoma. Typically, these groups are found in North America and Europe. Statistics on gender prevalence are interesting because women are more likely to develop melanoma before age 50, but white men are more likely to develop melanoma, and white men over the age of 55 is the largest group of patients diagnosed with melanoma (Skin Cancer Foundation, 2018). Men also have a higher mortality rate with melanoma and this is most commonly associated with the tendency of men to not seek as frequent and diligent skin checkups in comparison to women (Swetter, Clarke, Keegan, 2014).

Treatment for melanoma varies by patient and varies due to stage of the disease. As I mentioned earlier, melanoma is a very aggressive and deadly type of skin cancer due to the fact that often times it is not caught until it has metastasized inside the body. According to the American Cancer Society, treatment is broken down by stage. Stage 0 melanoma (which is rarely caught), is when the cancer only resides in the epidermis and can simply be excised from the top layer of skin. Stage 1 is when the melanoma is a little larger, but still remains only in the skin and is excised as well as a larger border around the cancer. It is also recommended to have a “lymph node biopsy” (American Cancer Society), to rule out metastasis inside the body. Stage 2 melanoma is when the cancer has spread to lymph nodes near the site of the melanoma, and can be treated by removal of the local node, as well as the melanoma. Stage 3 is a slight progression of stage 2, except the site where the lymph nodes were removed is often treated with radiation. Stage 4 is the most severe, but often the stage when most melanomas are found. At this stage, the cancer has spread to a large part of the lymph nodes in the body as well as other vital organs. Aggressive chemotherapy and radiation is pursued, but often times all the melanoma is not removed and it continues metastasizing (American Cancer Society).