The incidence of melanoma has been on the rise for decades, maybe due to damage to the ozone layer in atmosphere. Presently, it is the seventh common cancer in the United States. The estimated lifetime risk of developing skin melanoma in Americans was 1 in 1,500 in 1935 and is expected to rise to 1 in 75 by year 2000. Melanoma can affect individuals in their 20's and 30's but the average age at the time of diagnosis is between 55 and 57. This cancer starts in the skin. The most frequent sites in women are the arms and legs, and in men it is the trunk. It is more common in fair-skinned individuals and significantly less common in African-Americans and individuals with dark color skin.
CAUSES OF MELANOMA
Heavy exposure to sun is the most important factor in development of melanoma. It is more common in individuals who develop sunburn or blister from excessive exposure. Certain skin moles can also transform into melanoma.
SIGNS AND SYMPTOMS
Patients do not have any signs at very early stages. Most commonly, a mole is noticed to be getting bigger rapidly, or bleeding. Larger moles with irregular shapes and borders, a deep black color, may represent a melanoma. Such moles must be removed and examined. On occasion, the disease may have spread to other organs and may present with signs of advanced disease: cough, shortness of breath, chest pain or blood in the sputum are among early worrisome signs. Other signs of this illness could be weakness, fatigue, weight loss and bone pain.
TREATMENT
The only effective treatment for this disease is a successful surgical removal of the involved skin. A suspicious lesion is normally removed to establish the diagnosis. If the diagnosis is of a Melanoma, then a second surgery of a wider area of normal skin around the original site must be performed. Curative surgery is incomplete without this wide excision. The role of more aggressive surgery, removing the local lymph glands, is very vague and unclear.
Although one can remove the mole with surgery, however cancer cells may have already spread to other parts of the body. Detection of these cells at these early stages and with our current knowledge and technology is not possible. Clinical trials have shown that adjuvant therapy with Interferon following surgery on high-risk melanomas will reduce the recurrence rate and will prolong survival of patients. Interferon remains the most active adjuvant therapy for Melanoma.
When the disease spreads to other site, i.e. metastatic stage, it becomes a difficult challenge to treat. Most treatment regimens use a combination of various chemotherapy drugs along with Immunotherapy with Interferon, Interleukin 2 or Melanoma Vaccine.
A rather aggressive and established regimen that is used frequently in metastatic melanoma is referred to Dartmouth Regimen and consists of:
• BCNU given every six weeks
• DTIC given daily for three days, every three weeks.
• Cisplatinum given daily for three days, every three weeks.
• Tamoxifen twice daily
Other drugs that may be used are Vinblastine, Bleomycin which may induce a minimal response in some patients.
The one treatment that seems to be more effective is Interleukin 2. This drug has been used in a variety of schedules and doses with almost 20% response rate, however 5-6% of patients have achieved very durable responses lasting over 5 years. Among patients who achieve a complete response to Interleukin 2, almost 80% become long term survivors with no recurrence of melanoma.
