by Scott Graupner, DO, Lexington Oncology

Melanoma is a type of cancer that typically starts in the skin, but rare forms can start in the eyes and mucous membranes, such as inside the nose. It is the deadliest type of skin cancer and is the focus of much effort on prevention, screening and therapeutic developments for treatment. The incidence of melanoma has been rising in the U.S and around the world.

Risk Factors

• Exposures: The most significant risk factor for melanoma is exposure to ultraviolet light. UV light is present in both sunlight and lamps commonly used at tanning beds. Melanoma is highly associated with heavy, intermittent exposures to sunlight and especially with developing sunburns.  
• Age and Gender: Melanoma is more common in men, but the rates in women and in people under 40 years of age have increased drastically in recent years. The median age at diagnosis is 63, but melanoma has become the most common cause of cancer in people age 25-29. The increased usage of tanning beds in younger women has been linked to a sharp rise in cases of melanoma.
• Ethnicity: Melanomas have higher frequency in Caucasians and those with fairer skin colors. Those who get freckles are twice as likely to develop melanoma than those without. A common misconception is that people with dark skin tones cannot get melanoma, which is not true. Melanomas, while rarer in those with darker skin tones, tend to be more aggressive in these patients and are more prone to start in unusual places, such as the feet.
• Family History: Some families are more prone to develop melanoma through genetics, but the majority of cases are more related to UV light exposure than genetics.
• Immunosuppression: Those who have suppressed immune systems from things such as blood cancers, viral infections (e.g., HIV), or organ transplants have a higher risk of developing melanomas and need to be particular about limiting sun exposure.

Prevention and Screening

Regular use of sunscreen when in the sun for work or fun activities is the most scientifically backed way to reduce the risk of developing melanoma. It is recommended to use sunscreen with at least 15 sun protection factor (SPF), while those with fairer skin and longer planned time in the sun should use sunscreen with 30 to 50 SPF. Avoiding prolonged time in the sun and taking breaks from sun can help as well. Wearing lightweight, long sleeve, sun-blocking clothing is also recommended to reduce risk during periods of longer sun exposure.  

Melanoma is curable if caught early. Performing regular skin self-exams monthly in front a mirror is recommended to detect changes in the skin. New moles or skin growths, or changes in size or color of moles, can be concerning signs that should be brought up with your doctor. The American Cancer Society website (https://www.cancer.org/cancer/skin-cancer.html) is a good resource about skin cancer and what you should look for when performing a skin self-exam. Those with a higher risk for developing melanoma should have regular checkups with a dermatologist for a full-body skin exam.

Treatment

Local melanomas, which are melanoma tumors located in a small area on the surface of skin, are usually managed by a dermatologist by surgical excision. More advanced melanomas may involve the care of a medical oncologist, surgeon and radiation oncologist. We are learning more about which local melanomas are more likely to develop into aggressive disease and need closer monitoring or even preventive treatment. 

Treatment of more advanced melanomas has revolutionized over the past decade. Melanoma that has spread beyond the skin to lymph nodes or other organs has been very aggressive and difficult to treat. Melanomas do not respond well to the classical chemotherapy drugs used to treat other types of cancers. One recent important discovery, which led to the Nobel Peace Prize in Medicine, has been immunotherapy — drugs that both re-energize your immune system to attack the cancer and take away some of the camouflaging features cancer uses to hide from the immune system. Melanoma was the first type of cancer in which immunotherapy was successfully used. Patients with advanced melanoma who respond well to immunotherapy are living much longer and with better quality of life. Some respond so well that many researchers and physicians believe they may be cured from a disease that was once considered non-curable, though time will tell if this theory proves to be true. 

Other treatment advances in recent years include the development of targeted agents to specific mutations that caused the cancer and injectable medications that treat individual areas of melanoma on skin and lymph nodes. It is an exciting time in oncology with the innovations in care for advanced melanoma. Lexington Medical Cancer Center, an affiliate of Duke Health, offers these innovative treatment strategies and uses a team approach through our medical oncology, radiation oncology and surgical oncology providers to provide the best care for patients.