What is melanoma?
Melanoma is a very serious skin cancer that arises from normal pigment cells called melanocytes. If caught early, melanoma is one of the most curable of all cancers; however, left untreated it can be fatal.
Where does melanoma arise?
Melanoma usually starts in moles or normal-looking skin. The most common site in women is on the legs, while in men it is more common on the trunk, particularly the back. Melanoma may also start in the eyes, mouth, or vagina, under the fingernails or internally.
How common is melanoma?
Approximately 91,900 new cases and 7,600 deaths due to melanoma are expected for 2003. At current rates one in 39 Americans has a lifetime risk of developing melanoma. Its increasing incidence in North America in the last 50 years is exceeded only by the incidence of lung cancer in women and prostate cancer.
Who is at risk?
Established risk factors include
- Severe, blistering sunburns as a child,
- More than 50 moles,
- History of dysplastic nevi (noncancerous, but unusual-looking moles),
- Many freckles,
- Fair skin and light eyes,
- Immunosuppressive therapy,
- Previous diagnosis of melanoma,
- Family history of melanoma,
- Living in the Southwestern United States,
- Spending time in the sun between 10 AM and 4 PM.
How is melanoma diagnosed?
Characteristics of a melanoma developing from a mole often include (but are occasionally not present) asymmetry, irregularity of borders and variability in color. Itching, crusting, or bleeding are less common signs. Examination under the microscope must be used to establish a diagnosis. If the cells are malignant further surgery will usually be carried out to ensure that all the melanoma cells have been removed.
What is Sentinel Node Biopsy?
This is the use of dyes and radioactive substances to identify the first lymph node to which the melanoma is likely to spread from the primary tumor. If the sentinel node does not contain melanoma cells it is unlikely that the other lymph nodes in the area have been affected.
What are the treatment options?
Noninvasive melanoma that has not spread to other parts of the body and is usually cured via surgery. Therapy for advanced melanoma is only marginally effective and includes
What is JOHNS HOPKINS doing?
- PATIENT CARE: Johns Hopkins has a unique group of physicians that form The Melanoma and Cutaneous Oncology Group. It is a multidisciplinary group that offers a comprehensive approach to melanoma and other skin cancers. We are a team of specialists from many disciplines including dermatology, surgical oncology, medical oncology, pathology, plastic surgery, otolaryngology, radiology, and ophthalmology. The group meets weekly to discuss treatment plans for patients in a multidisciplinary fashion, and is actively interested in the development of new treatment strategies for our patients. The Pigmented Lesion Clinic is a specialty dermatologic clinic devoted to patients who are at a higher than average risk of melanoma because of a personal or family history of melanoma or a large number of atypical (“dysplastic”) moles. Several dermatologists who have a special interest in this area participate in this clinic which also offers photographic imaging of a patient’s skin so that changes in moles can be verified by comparison to previously taken photos.
- PATIENT EDUCATION: The Department of Dermatology is actively involved in promoting public awareness of the risks of skin cancer and ways of prevention. Many of our dermatologists volunteer time for advancing this goal on a regular basis which includes projects such as free skin cancer screening, which has always identified people with skin cancers at an early stage that they were completely unaware of.
- RESEARCH: The Johns Hopkins Department of Dermatology is actively involved in crucial research necessary to improving our knowledge of melanoma that will contribute to better treatment options and helping to move closer to a cure. Several current research projects include clinical trials, such as with dendritic cells that is very promising. This new treatment is promising, but unproven,and will therefore be tested in a clinical trial. Dendritic cells pick up “non-self” particles including cancer cell components in order to initiate anti-cancer immune responses. We have recently established that melanoma eliminates dendritic cells (DCs). This results in an unfavorable prognosis since low numbers of DCs correlate with poor patient survival. We therefore believe that DC infiltration into primary melanoma will be associated with reduction of metastatic disease and ultimately with prolonged patient survival. This hypothesis will be tested in a clinical trial that will be conducted in the dermatology department. Other projects include: Identification of genes predicting the outcome of immunotherapy. Around 25% of melanoma patients respond clinically to immunotherapy. The other 75% do not benefit but currently cannot be identified in advance. We will therefore compare responders and non-responders to immunotherapy via gene expression profiling. Identification of genes predicting the metastatic potential of primary melanoma. Prognostic tests are being developed for patients who have had their melanoma surgically excised and who have no evident metastasis at the time of surgery. There is currently no way for such patients to know whether the surgery was curative or whether their melanoma will recur. We will therefore compare primary melanoma tissue from patients who developed systemic disease with melanoma tissue from patients who did not develop metastases via gene expression profiling. Identification of the genes that cause melanoma. We hope that these studies will allow novel approaches to prevention of melanoma.
What can I do?
- Never allow your skin to burn. Always use a sunscreen with a sun protection factor of 15 or higher on all exposed skin.
- Have a skin check-up every 3 years if you are age 20-40 or every year if you are older.
- Supporting research at Hopkins has saved the life of millions of people. The dermatology department continues its commitment to investing in the most talented physicians and researchers. Your support could provide them with the tools of discovery. Your support will make a difference. http://www.hopkinsdermatology.org