Melanoma case

Topic: Melanoma

Order #:32753579

Specifications: 5 Pages, 4 Sources, MLA Style

Description: Preferred language style: English (U.S.)
The paper must include a bibliography with a minimum of four (4) sources. At least 2 sources must be hard copy, non-internet sources other than an encyclopedia or a medical dictionary. Points will be deducted for improper grammar or spelling or for failing to cite references and page numbers in parenthesis when utilizing material that is specific to a source.
A. Define and describe the disease or condition
B. Incidences of the condition:
i. Frequency of occurrences
ii. Is it heredity
iii. What age range, sex, race, nationality, occupations, and geographic locations are most affected
C. Pathophysiology – explain how the condition is contracted
D. Signs and symptoms
E. Means of diagnosis
i. Lab tests
ii. X-ray exams
iii. Other tests
F. Treatment- describe differing approaches
i. Curative or palliative
ii. Conservative approaches
iii. Radical approaches
iv. Controversial approaches
G. Prognosis
i. Degree of expected disability/fatality
H. What does the future hold for the disease
i. Are there cures
ii. Will more or less people become diagnosed and/or die from it
**********All the information above was supplied from my syllabus.************
The paper topic is melanoma skin cancer.
All pages must be numbered.


Melanoma is a type of skin cancer that develops from cells that produce the pigment melanin (known as ‘melanocytes’) (NCI. 2003).  It is one of the most dangerous forms of skin cancer, and is the third most common of all cancers after basal cell carcinoma and squamous cell carcinoma.  It is dangerous because, although 3 % of all cancers are melanoma, about 83 % of all fatalities arising from skin cancers in the US belong to melanomas (William G. Shafer Et al. 1997. 133).  It can occur in almost any part of the body in which melanocytes are present (including the face, neck, scalp, eye – choroids, palms, soles, genitals, underneath the nails, and the oral cavity), and very rarely in the rectum, anus, membrane that cover the brain (meninges) and the lymph nodes.

In the US, about 60, 000 new cases of melanoma are seen every year, and about 8, 000 individuals die from the condition every year (NCI. 2003).  Melanoma is rarely seen in Blacks, and is more common in Whites in the US, UK and Australia (J.A.A. Hunter. 1996. pp. 969).  The incidence of melanoma in these segments of the population is doubling every ten years.  The condition more frequently occurs in people residing in an Equatorial type of climate, than those living in a temperate climate.  The incidences in the Equatorial climate is about 40 per 100, 000 individuals, and in a temperate type of climate is about 5 to 10 per 100, 000 individuals, every year (J.A.A. Hunter. 1996. pp. 969).  One out of every 85 individuals will have melanoma once during their lifetime in the US.  The condition more often occurs in individuals who usually have normal health (William Matsui. 2006).  The risk of melanoma increases with age, but is most common in individuals between the ages of 20 and 30 years.  The condition more often occurs in the fairer sex (that is females).  Melanoma can develop from benign tumors that arise from the melanocytes (nevi) or from apparently normal skin.  The incidence of malignant melanoma developing from nevi (usually junctional nevi, Hutchinson’s nevi or compound nevi) is much higher (about 90 %) than those that arises from apparently healthy skin (10 %) (Somen Das. 1994. pp. 111).  Individuals who tend to work in the outdoors are at a higher risk of developing melanoma.  The other risk factors of melanoma includes fair individuals, people having light-colored hair, presence of moles (nevi), family history of melanoma, previous history of melanoma, presence of sunburns during childhood, defective immune function, exposure to ultraviolet light, etc.  An individual having a close family member who has suffered from the disease is at a higher risk of developing melanoma.  A family history of the disorder is observed in about 10 % of all cases (NCI. 2003).

The exact manner in which the disease occurs is still not understood.  Melanoma can develop from pre-existing skin nevi or from apparently normal skin.  Repeated exposure to the sunlight or irritation (of the moles) from the certain external factors can result in the development of the melanomas.  The cells present in the Junctional area of the skin are increased in number and in size.  Several atypical features develop in the cells that are undergoing malignant transformation including an increase in the size of the nucleus, hyperchromatosis, abnormal mitotic figures, presence of melanin granules in the cytoplasm of the cells (of the epidermis), invasion of the dermis by the abnormal cells, etc.  The tumor cells also spread to neighboring lymph nodes leading to enlargement.  The cancerous cells can also spread through the blood or lymph to various parts of the body (such as liver, lungs, bones, brain, intestines and the breast) causing distant metastasis.  The area of the skin below the epidermis is invaded by lymphocytes.  Clark has classified melanoma based on the spread of the tumor cells into five types, namely, level 1 (cancerous cells are present above the basement membrane), level 2 (cancerous cells are present in the papillary layer), level 3 (cancerous cells are present between the junction of the papillary and reticular layer), level 4 (cancerous cells present in the dermis) and level 5 (cancerous cells present in the subcutaneous tissues) (Somen Das. 1994. pp. 111-112).

Based on the clinical features, Melanomas can be classified into 4 types, namely, the superficial spreading type (appears flat and brown to black in color, and the most common), nodular melanoma (appears as a bluish-red or blackish-blue raised lesion), Lentigo maligna melanoma (appears large, flat lesion with areas of brown and present in exposed portions of the body), and Acral lentiginous melanoma (more frequent in Blacks, Chinese and Japanese, and present in the palms and soles) (William Matsui. 2006).  Melanomas are usually seen as a change in color and size or a mole, or the development of a swelling, ulcer or lesion on the skin.  As the tumor tends to spread, it produces a halo, and the borders of the lesion appear irregular.  The regional lymph nodes may be enlarged (due to involvement with the cancer).  The lesion usually does not cause any pain, but an itch may be present, along with scaling.  Very rarely, the individual develops systemic features during the early stages such as low-grade fever, weight loss, breathing problems, anorexia, malaise, etc.  The melanoma are frequently examined under the ABCDE criteria (Asymmetry, Borders appears irregular, Color appears different in various areas, Diameter below or above 6 mm, and Elevation) (J.A.A. Hunter. 1996. pp. 969).

The diagnosis of melanoma is made based on the history (including previous medical history and family history), symptoms, signs, physician examination, dermatoscopy, biopsy, X-rays, blood tests, urine tests, etc.  The diagnosis of melanoma is usually confirmed but taking a biopsy sample of the lesion, along with a portion of the normal tissues.  Different biopsy techniques may be utilized for different lesions.  Small lesions are usually subjected to excisional biopsy, in which the entire lesion along with margins of the surrounding healthy tissues are removed and examined under the microscope (NCI. 2003).  Incisional biopsy is usually performed for big lesions that are present at certain areas in the body, and involves removing a section of the lesion (J.A.A. Hunter. 1996. pp. 969).  Biopsy may also be required of the regional lymph nodes.  X-rays, CT scans and MRI scans are performed to determine if the distant metastasis are present in various parts of the body such as bones, brain, intestines, etc.  Blood tests are required to determine the presence of cancerous cells in the blood, and urine tests are needed to study the presence of abnormal substances in the urine (Mayo Clinic. 2006).

The treatment of melanoma varies depending on the size and depth of the lesion, involvement of other structures in the body, and the individual factors (such as age, health, etc).  Various methods of treatment may be utilized including surgery, chemotherapy, radiotherapy, and immunotherapy.  Besides, the symptoms have to be managed appropriately through supportive care or palliative care (NCI. 2003).  For tumors less than 1 mm in size, the lesion along with 1 cm of the surrounding tissues is removed.  For lesions greater than 1 mm in size, the lesion along with 3 cm of surrounding tissues is removed.  As a precautionary measure, the regional lymph nodes are also removed.  Large tumors usually require skin grafts to compensate for the tissue loss.  If the disorder tends to involve the lymph nodes, a block dissection of all the lymph nodes in the area is performed (J.A.A. Hunter. 1996. pp. 970).  However, block dissection of lymph nodes does not increase the survival rate, but may be beneficial for those individuals who cannot be monitored following the treatment (a lot of controversy exists with regard to this method of treatment) (Somen Das. 1994. pp. 114-115).  If the tumor tends to spread to the distant sites of the body, then tumor excision, block dissection and administration of certain drugs (chemotherapy) may be required (J.A.A. Hunter. 1996. pp. 970).  Chemotherapy works by destroying the cancerous cells present in the body.  However, a certain amount of normal body cells are also destroyed.  The chances of the normal body cells recovering are greater because the genetic material of these cells are seemingly normal, compared to the cancerous cells (NCI. 2003).  Several other procedures such as immunotherapy and/or radiation therapy may also be required (NCI. 2003).  Immunotherapy (a treatment procedure that helps strengthen the immune system in fighting the cancer cells) is required if the lesions spread to a depth of more than 4 mm and if the regional lymph nodes are involved (William Matsui. 2006).  Such individuals are at the higher risk of developing distant metastasis, and to control this immunotherapy is required (NCI. 2003).  Immunotherapy improves the cure rate by about 10 % and can also help to prevent the cancer from occurring (William Matsui. 2006).  Radiotherapy (use of high-energy waves) is utilized to treat the distant metastasis that has spread to the brain or the bones (works by destroying the tumor, shrinking the size of the tumor and/or reducing the symptoms) (NCI. 2003).  If the tumor is large in size, involves the lymph nodes, and spreads to various structures present in the body, the cure rate may be very poor, and multiple modalities are utilized in treating the patient (William Matsui. 2006).

The outcome of melanoma usually depends on how promptly the condition is diagnosed and treated.  Individuals in stage 1 (consisting of a small tumor) have a 70 % chances of a 5-year survival.  Those of the stage 2 (spread to the regional lymph nodes) have 20 to 30 % chances of a 5-year survival, and those with stage 3 (spread to various parts of the body) have less than 10 % chances of a 5-year survival (J.A.A. Hunter. 1996. pp. 970).  After the individual has been treated for the condition, a close follow-up should be maintained to ensure that recurrences are promptly detected and treated.  The individual should regularly conduct self-examination of the skin (NCI. 2003).

The future seem to be good for people suffering from melanoma, as new diagnostic approaches (to detect the disease in the early stages) and treatment interventions are being developed.  Gene therapy seems to be promising to offer a cure in the treatment of melanoma.  Certain genes are created with attach themselves to the cancerous cells, and make them more susceptible to destruction from chemotherapeutic drugs.  The cancerous cells could be treated with certain genes, and this could be utilized as a vaccine in the treatment of melanoma (Mayo Clinic. 2006).  New chemotherapeutic agents are being researched currently which could seem to be more effective in treating the cancer and reducing the side-effects (NCI. 2003).


J. A. A. Hunter. “The Skin and Systemic Disease.” Davidson’s Principles and Practice of Medicine. Ed. Edwards, C. R. W., Bouchier, I. A. D., and Chilvers, E. R. Edinburgh: Churchill Livingstone, 1996. 969-970.


Mayo Clinic Staff. “Melanoma.” Infectious Disease. 2006. Mayo Clinic. 1 Apr 2007


National Cancer Institute. “What You Need to Know About Melanoma.” Cancer Topic. 2003. NCI. 1 Apr 2007


Somen Das. A Concise Textbook of Surgery Calcutta: Dr. S. Das, 1994, pp. 111-115.


William G. Shafer, Mayard K. Hine, Barnet M. Levy, and Charles E. Tomich. A Textbook of Oral Pathology Philadelphia: W. B. Saunders, 1997, pp. 133-134.


William Matsui. “Melanoma.” Medical Encyclopedia. 2006. Medline Plus. 1 Apr 2007




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