Melanoma Treatment Options

What is melanoma?

Melanoma is a skin cancer in which cells form in melanocytes, or the cells that give each person their own skin color. There are two layers of the skin, the epidermis and dermis, which house the three types of skin cells, basal cells, squamous cells and melanocytes.

Skin cancer is fairly common and often non-life threatening when it occurs within the basal cells or squamous cells. Melanoma is rarer than either of these two types of skin cancers and can be much more deadly if left untreated.  

Risk Factors for Melanoma

Since the sun causes damage to everyone’s skin, the majority of people who expose their skin to the sun are at some level of risk. However, certain sectors of the population are more at risk of developing melanoma. The following are some of the more common risk factors for melanoma: 

• Older population. Since the sun causes harm over time, individuals who have lived a life exposing their skin to the sun have a greater likelihood of developing some sort of skin cancer, be it basal cell carcinoma, squamous cell carcinoma or melanoma. 
• Those with excess sun exposure. Living in a certain area of the world, working a job that is primary outside or recreating frequently in the outdoors ramps up one’s potential to get melanoma. 
• Family history of melanoma. Certain skin types are more prone and one can examine their family medical history to determine if others in their family have had melanoma. 
• Moles on the body. These can be indicative of skin that changes abnormally when exposed to excess sun. 
• Fair skin. Lighter skin tones don’t have as much added protection against the sun because they contain less of the protective pigment, melanin. 
• Environment in which one lives. Both indoor and outdoor environments can play a factor in your likelihood of experiencing melanoma or other skin cancer down the line. Poor air quality, a compromised ozone, higher elevations, less infrastructure and education to support sun protection and the like can cause certain populations to have greater likelihood of developing melanoma. 

Signs of Melanoma

Warning signs of melanoma are one of the most common ways that this dangerous, malignant cancer is detected early on. It’s crucial to establish a relationship with a trusted dermatologist starting as soon as possible. They will be able to familiarize themselves with your skin type and alert you to any moles, freckles, or patches to keep an eye on. Melanoma is frequently detected because of an unusual mole that may exhibit any of the following signs: 

• Change in shape 
• Change in texture
• Change on color
• Satellite moles- mole or moles growing next to already existing mole
• Oozing mole 
• Itches
• Atypical moles. If you know what the moles on your body normally look like but notice the sudden formation of moles that don’t look like the others, this could be a sign of melanoma. 
• Has irregular borders
• Has multiple colors
• Is ulcerated

Treatments for Melanoma

Since melanoma is a form of cancer, treatments can vary depending on the stage. Before any treatment is prescribed, your dermatologist will biopsy the skin believed to be melanoma and send it to a dermatopathologist for testing. If it is determined that you have basal or squamous cell carcinoma, your dermatologist may choose to go a minimally-invasive route via a procedure called Mohs surgery, which involves the simple, topical removal of cancerous tissues. 

Depending on the thickness of the melanoma tumor, you may visit with an oncologist who can run tests to determine if the cancerous cells have spread to the bloodstream of lymph nodes. From here, your dermatologist and oncologist will create a multidisciplinary team of doctors to formulate and execute a treatment plan.

• Surgery. Regardless of the severity of melanoma, surgery is pretty much always a first step. 
  • Wide excision. Your surgical oncologist will remove the portion of the skin affected by melanoma and a margin of skin surrounding it. If the tumor was shallow, further surgeries may not be necessary. 
  • Lymph node dissection. If melanoma cells were detected in the lymphatic system, the surgical oncologist may also choose to remove infected lymph nodes. 
• Chemotherapy. Used when melanoma is extensive throughout the skin and body, chemotherapy drugs work to destroy the cancerous cells. Because other therapies are proven to be more effective in combating melanoma, chemotherapy isn’t frequently used.
• Radiation. Radiation therapy to fight melanoma through the use of high energy x-rays. Most typically, radiation treatment uses an external beam which emits radiation via a machine outside the body. 
• Immunotherapy. This type of treatment is used to boost the immune system’s own ability to fight cancer. Natural and synthetic (made in a lab) medications and supplements are used to improve immune function. Stage III and stage IV melanoma can be treated with immunotherapy.
• Targeted therapy. Various types of treatment fall under the umbrella term ‘targeted therapies’. In short, targeted therapy works to undermine the cancer’s specific genes, proteins or the tissue in which it has manifested. Targeted treatments can include the following: 
  • BRAF inhibitors. BRAF refers to a gene in which some instances of melanoma mutate. BRAF inhibitors include FDA-approved, oral medications that attack the mutated gene. 
  • MEK inhibitors. Similarly to BRAF inhibitors, MEK inhibitors are used as a course of treatment to target the MEK protein, which cancerous cells need to survive and grow. 

Vigilance is Key

Melanoma, when detected early, is often successfully treated. However, those who have already had melanoma need to remain vigilant about their skin health and closely monitor any mysterious patches or moles for the rest of their lives. 

Healthy lifestyle practices can be tremendously helpful in mitigating risks of melanoma.  Scheduling routine appointments with your Orlando dermatologist, staying out of the sun when possible, and wearing sunscreen each day minimizes the risk of all types of skin cancers. To begin your journey back to skin health and wellness, visit our patient portal to find a doctor near you, schedule online, or stay up to date on COVID-19 updates for patients.