The steady increase in the incidence of melanoma and its resistance to chemotherapy, together with its high potential to metastasize have emphasized the importance of its prevention because the key to treating melanoma is early recognition of symptoms. Melanoma is the most devastating form of skin cancer and for patients with melanoma that has spread beyond the skin and nearby lymph nodes, treatment is more difficult and at this point, usually not curable. Melanoma is a rare but very serious type of skin cancer in which the cells lose the ability to divide and grow normally. These abnormal skin cells can grow and from a mass or “tumor”.
These tumors are considered benign of the cancer is limited to a few cell layers and does not invade surrounding tissues or organs. If the tumor spreads to surrounding tissues, it is considered malignant, or cancerous. Most skin growths are benign tumors. However, melanoma is a malignant skin growth because it can metastasize, which means it can spread to other parts of the body. When Melanoma spreads to vital organs like the brain or liver, it can be life-threatening. Fortunately, if diagnosed early and treated promptly, Melanoma can have a very high cure rate. ( Health Information Publications, 2009).
Melanoma starts in the melanocytes, which are pigment-producing cells found mainly in the epidermis (outer layer of skin). They make a dark material, melanin, which gives skin its natural color. Melanoma is serious because the malignant cells tend to spread rapidly from the skin to the internal organs. In 2009, the American Melanoma Foundation released the following statistics:
• About 1. 3 Americans are diagnosed with skin cancer each year and melanoma accounts for 4 percent of those cases. • Each year more than 50,000 people are diagnosed with melanoma • Melanoma is the most common form of cancer for young adults 25 – 29 years old. Melanoma is increasing faster in females than in males in the same age group, which might be due to high-risk tanning behaviors • One American dies of melanoma every 61 minutes • About 75 percent of skin cancer deaths are from melanoma • The five year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent. • Five year survival rates for regional and distal stage melanomas are 65 percent and 15 percent respectively • In 2004, the total direct cost associated with the treatment for melanoma skin cancer was $1. billion.
Many people with melanoma and their caregivers face practical, emotional, and psychological demands in addition to the physical effects of the disease and treatment. (Brandberg, 1995). The challenges of melanoma include the fear of a diagnosis of anyone faced with a life-threatening disease, the pain and discomfort associated with that treatment, and body image changes associated with disfiguring surgery. While most studies have found that patients adjust well to melanoma in the long term, deeply ndented scars, such as occur with skin grafting following removal of skin, subcutaneous and deep fascia, as well as those whose scars are larger than they anticipated, may be particularly distressed. (Cassileth, 1983). It goes without saying that melanoma patients have a lot to cope with, as do all patients with a life-threatening diagnosis.
The diagnosis and treatment of a cancer, such as melanoma, threatens and disrupts life and research has found that different ways of coping with these threats and disruptions are associated with differences in one’s psychological adjustment and emotional well being over time. Heim, 1991). It appears that some ways of coping are generally better than others, in the sense that they are more conducive to a good quality of life (physically and emotionally) when dealing with a serious illness. A positive attitude and behavior when dealing with these situations, however, does help the person to focus on what they are doing to meet the stressfulness of this event instead of all of the troublesome thoughts and emotional upsets of what they are defending against.
The impact on families of those with melanoma is also considerable, as they share in the fears of relapse, the traumas of treatment, and the sadness of a late-stage disease. Some families as well as patients, will react as if it’s all too much to deal with, they deny the realities and in essence say “ I can’t cope with this”. Actually this denial is a type of coping and it protects the patient/family from being overwhelmed. However, it cam also hinder coming to terms with the disease and is therefore associated with a poorer psychological adjustment in the long run. Kneier, 2003). Reaching out for help and emotional support from friends and family can be hard. The patient may feel like they are being an imposition to others and that they should put their own needs and fears aside to help alleviate those of their peers or, they hide their true feelings as a way of protecting their loved ones. Cancer patients are consistently encouraged to “keep a positive attitude”, and this often makes the patient feel that there is something wrong or dangerous about their “negative” emotions. (Rittenberg, 1993).
While a diagnosis of cancer can be an awful experience, it can also bring about positive changes as in response to their illness, many patients step back and re-examine their lives and re-learn their priorities. They live in a positive way and promote good influence and no longer take life for granted. These changes are often called the “enlightenment” or “gift” that comes with cancer. Patients who embrace this aspect of their cancer, have been found to be especially well-adjusted and better able to deal with the many trials and disruptions caused by their illness. Taylor et al, 2000).
“An improved understanding as to why people get melanoma can lead to improved interventions to reduce the impact of melanoma to the community, as well as, advances in the detection, treatment, and management of the disease. ” (The Scott Kirkbride Melanoma Research Center. ) One of their research programs involves collecting information from Western Australian teenagers. The Kidskin II study investigates the possible genetic causes of moles and how they might relate to melanoma. This is an area of research that has been given little attention to date.
While it’s known that having a lot of moles is a strong risk factor for melanoma, it is not yet known what genetic factors contribute to the formation of moles. The researchers believe that if they can uncover what causes moles to develop, it may help their quest to more effectively prevent and treat melanoma. Another research program currently being funded at this centre is the WA Melanoma Health Study. They have formed a database aimed to approach all patients in Western Australia that have been diagnosed with malignant melanoma to participate by offering blood samples and information on health, family, and lifestyle.
Once collected, this database will allow the researches to study potential genetic, individual and environmental factors that may contribute to melanoma in adults. This data base will be linked to other data sets from the Washington population, which will further enhance the investigation into melanoma and its causes. This project is one of the most comprehensive studies anywhere in the world and the goal is that an improved understanding of why people get melanoma can lead to improved interventions to reduce the impact of melanoma as well as advances in the detection, treatment, and management of the disease.
Community support of patients with melanoma is very important to the management of this disease. The Yale cancer center offers an entire community of support. The care of melanoma patients is a coordinated effort and a weekly conference is held in which the surgeons, melanoma oncologists, dermatologists, radiologists, and pathologist and treatment of the program members is discussed. This program emphasizes communication with all physicians active in the care of the participants. The program and the patients benefit from the support and extensive experience of its clinical staff in the diagnosis, treatment, and care of melanoma.
There is another support program that I have become very fond of and it’s on the World Wide Web community. The site connects family and friends of people who are facing a significant health challenge. It is a place where the patient can create their own website and blog about their daily journey. Sometimes sharing very personal challenges and fears are a little easier with strangers than they are with family in the next room. Family and friends can log on and read the personal journal to keep up with treatments, good days, bad days, desperate days and funny days.
Melanoma patients can connect with their peer group to learn of their successes and failures in treatment and bond with each other and champion each other. It also reduces the time and emotional energy spent on repeated phone calls and emails. Sometimes we all mean well by calling to check on our ill friend or family member but cancer treatments can be very taxing and this provides a way to get it all said in one quick blog. Also each member of the peer support group is informed with accurate information straight from the patient.
I believe the most important intervention in the melanoma journey is the active participation of the patient. From the first sign of a possible significant mole, to the diagnosis, treatment and management of this horrific cancer, education is tremendously important. Becoming active and engaged in the process gives the patient a self satisfaction that even if they couldn’t stop the disease from affecting them, they do have control over the physician they see and the treatment path they may choose. Patients who take a participatory stance believe they can make a difference.
They put this belief into action and therefore, feel less helpless and vulnerable. (Telch and Telch 1985). This type of engagement also helps the patient to better embrace and stick to the treatments. Preventive practices are, of course, the best intervention for melanoma. Public education and awareness can make all the difference in diagnosis, treatment and cure. Recognizing the signs and symptoms of this disease is the loudest message being heard for those who care to listen. The “ABC” rule teaches us all to find and recognize moles that may be suspicious.
A stands for asymmetry and teaches one that suspicious skin growths will not look the same when comparing one half to the other. B is for border which means that if the border is not smooth but irregular, notched, or scalloped it can likely be cancerous or precancerous. The C stands for color and warns that if the mole is more than one shade, it also needs to be checked by a professional. This message is vital to all of us and I found this source through an application on my iphone which also includes flip cards showing suspicious moles and skin growths.
This technology also brings this information to the population that is so at risk today, young adult females. It also puts this vital information and education in the palm of your hands as I have literally passed my phone around the lunchroom at work so all could view the flip cards and compare these pictures to their own skin growths and check for abnormalities and causes for concern. You can even take pictures of your own moles and keep a mole map to compare year on year. As stated in the beginning of this paper, preventive measures and early treatment are the key to providing a long future to the patient diagnosed with Melanoma.