Melanoma Skin Cancer: A Case Study
Type of cancer. Melanoma is a skin cancer that originates in the melanocytes, a type of cell that makes up the skin. Skin is formed by three layers: epidermis, dermis and subcutaneous tissue. Melanocytes, together with keratinocytes, are part of the epidermis and are responsible for producing melanin, a pigment that protects against the damaging effects of sunlight. The formation of melanin - melanogenesis is a biochemical process carried out by melanocytes and is affected by several hormones: α-melanocyte-stimulating hormone (α-MSH), β-MSH, β-LPH (β-lipotropic hormone) ACTH, BFGF (basic fibroblast growing factor), estrogen and testosterone (Anoma, 2011) Furthermore, melanocytes have in their cytoplasm numerous melanosomes and, under normal
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conditions may give rise to dark agglomerations visible on the surface of the skin known as nevus. When a mutation happens in certain genes, a patient may develop this type of skin cancer. The genes involved with melanoma development are CDKN2A, which function as a cancer suppressor gene, CDK4, MC1R (Melanocortin 1 Receptor) and DNA repair genes. Moreover, genetic alteration in BRAF and NRAS, are also tied to melanoma occurrence. An important role is also played by an alteration of cell cycle proteins (cyclin D1, pRb, and p16) which are responsible for transformation and progression in melanoma cancer (Bandarchi, Ma, Navab, Seth, & Rasty, 2010).
Risk factors. The main risk factor for skin melanoma is excessive exposure to ultraviolet light (UVA and UVB rays) by sun rays and sunbeds. Ultraviolet light can damage the DNA of the skin cells and trigger a malignant transformation of melanocytes. Other risk factors are the immune system deficiency and specific hereditary diseases.
Symptoms. The major symptom of melanoma is the change in the appearance of a nevus or the appearance of a new one. Nevi are observed following an ABCDE scale feature: (A) Asymmetry, (B) irregular Border, (C) Colour changes, (D) Diameter greater than 6mm, (E) Evolving (“Melanoma”, n.d). Attention must also be made to a nevus that bleed, scratches or is surrounded by a nodule.
Diagnosis. Diagnosis of melanoma is made through self-examination and visual examination performed by a doctor and with dermatoscopy. The final diagnosis is made with a biopsy while X-ray, TAC, PET, and magnetic resonance imaging are helpful in determining if and where the disease has spread.
Treatment.
There are different treatment options for melanoma: one is surgery where melanoma is removed as well as a portion of healthy tissues around it, to make sure to eliminate all cancer cells. This option neither treat the symptoms nor the genetic nature of the disease but it rather removes it. If the cancer was due to a hereditary disease, the cause is clearly not – and cannot be removed. Usually, after removal immunotherapy with interferon alpha is administered, to stimulate the immune system to fight against eventual cancer cells that may still be present in the body. Another treatment is radiotherapy which is generally used to treat melanoma that occurs after another treatment. At terminal stages, radiotherapy function is to relieve the symptoms. To help alleviate symptoms, chemotherapy may be used, but is generally not very effective in treating the disease. There are undergoing studies about vaccines and targeted therapies. The former exploit parts of melanoma cells to trigger the action of the immune system against the disease while the latter are drugs directed against specific mutations in the DNA of cancer cells (for example vemurafenib, a drug directed against the BRAF V600 mutation) (“Melanoma”,
n.d.).
conditions may give rise to dark agglomerations visible on the surface of the skin known as nevus. When a mutation happens in certain genes, a patient may develop this type of skin cancer. The genes involved with melanoma development are CDKN2A, which function as a cancer suppressor gene, CDK4, MC1R (Melanocortin 1 Receptor) and DNA repair genes. Moreover, genetic alteration in BRAF and NRAS, are also tied to melanoma occurrence. An important role is also played by an alteration of cell cycle proteins (cyclin D1, pRb, and p16) which are responsible for transformation and progression in melanoma cancer (Bandarchi, Ma, Navab, Seth, & Rasty, 2010).
Risk factors. The main risk factor for skin melanoma is excessive exposure to ultraviolet light (UVA and UVB rays) by sun rays and sunbeds. Ultraviolet light can damage the DNA of the skin cells and trigger a malignant transformation of melanocytes. Other risk factors are the immune system deficiency and specific hereditary diseases.
Symptoms. The major symptom of melanoma is the change in the appearance of a nevus or the appearance of a new one. Nevi are observed following an ABCDE scale feature: (A) Asymmetry, (B) irregular Border, (C) Colour changes, (D) Diameter greater than 6mm, (E) Evolving (“Melanoma”, n.d). Attention must also be made to a nevus that bleed, scratches or is surrounded by a nodule.
Diagnosis. Diagnosis of melanoma is made through self-examination and visual examination performed by a doctor and with dermatoscopy. The final diagnosis is made with a biopsy while X-ray, TAC, PET, and magnetic resonance imaging are helpful in determining if and where the disease has spread.
Treatment.
There are different treatment options for melanoma: one is surgery where melanoma is removed as well as a portion of healthy tissues around it, to make sure to eliminate all cancer cells. This option neither treat the symptoms nor the genetic nature of the disease but it rather removes it. If the cancer was due to a hereditary disease, the cause is clearly not – and cannot be removed. Usually, after removal immunotherapy with interferon alpha is administered, to stimulate the immune system to fight against eventual cancer cells that may still be present in the body. Another treatment is radiotherapy which is generally used to treat melanoma that occurs after another treatment. At terminal stages, radiotherapy function is to relieve the symptoms. To help alleviate symptoms, chemotherapy may be used, but is generally not very effective in treating the disease. There are undergoing studies about vaccines and targeted therapies. The former exploit parts of melanoma cells to trigger the action of the immune system against the disease while the latter are drugs directed against specific mutations in the DNA of cancer cells (for example vemurafenib, a drug directed against the BRAF V600 mutation) (“Melanoma”,
n.d.).