Melanoma: Current Detection and Management Strategies

J. Andrew Skirvin, Pharm.D., BCOP

While melanoma is less common than other skin cancers such as basal cell carcinomas and squamous cell carcinomas, it is the most common malignant form. And the incidence of this form of cancer has been growing by as much as 3 percent a year since 1981. In this article, the author provides an in-depth look at detecting and treating this malignant form of skin cancer. Risk Factors As with other forms of cancer, there are certain characteristics that may make an individual more vulnerable to melanoma. Some traits that may put patients more at risk are fair skin, numerous freckles, red or blond hair, and blue eyes. Also, a patient's medical history can affect the chances of developing melanoma. Screening and Prevention Patient awareness, education, and early referral are key to prevention. The use of effective sun screen products are important, but there are many other factors that pose a risk to skin. These include time of day, continuous and intermittent exposure, history of sun exposure as an adolescent, and more. In assessing trouble spots on the skin, clinicians often look for the following changes they consider suspicious: asymmetry of the lesion, border irregularity, color variation, diameter, and elevation. Pathophysiology Although UV exposure is a risk factor for melanoma, the disease is not restricted to the skin. Ninety percent of cases arise in the skin, but melanoma can occur inside the eye, in mucous membranes, lungs, or bowels. Melanomas are categorized by clinical and pathologic cellular subtypes. The most common subtype is superficial spreading. Deaths from melanoma can be prevented through early detection and treatment. Staging The author details the three staging systems used to classify melanoma. The two older systems are based on pathologic information on tumor thickness. The modern staging system, which has been proposed but not adopted, is based on TNM (primary tumor, regional lymph nodes, distant metastasis) staging. Staging is an important step in determining treatment and for gathering prognostic information. Treatment As with other solid malignancies, the basis of melanoma therapy is surgical resection. Not only is the primary tumor removed, lymph nodes are usually examined for signs that the melanoma has spread. The author discusses other forms of treatment in detail. Chemotherapy While chemotherapy is used to treat numerous forms of cancer, response rates to this therapy for melanoma have not been encouraging. The use of single-agent as opposed to multiple-agent chemotherapy is a current topic of debate among clinicians. The author describes seemingly appropriate times for the use of each, along with other chemotherapy options. Conclusion Treatment of recurrent melanoma can be successful. Because of the poor response to chemotherapy in patients with melanoma, the best options are early screening, detection, surgical excision, and follow-up. Education, awareness, prevention campaigns, and vigilance are crucial to impacting the outcome of melanoma. To view the entire article, go to: http://www.uspharmacist.com/newlook/ce/supplement/oncology_september.cfm#melanoma Return to Top