Melanoma is a type of skin cancer that occurs in cells that produce pigment. This disease may begin with colored (usually black and brown) tissues in the eyes, intestines, or other parts of the body. You can find more information below.

What is melanoma?

Melanoma or black skin cancer is a malignant skin tumor. It is considered the most dangerous form of all skin cancer, because it can lead to malignant tumors in one out of every five affected people. Melanomas mainly develop in places exposed to the sun.

Because melanomas usually consist of birthmarks, they are often difficult to identify for the layman. The main method of treatment is surgical removal of the skin cancer area.

New melanoma diagnoses are increasing worldwide. This makes melanoma the fifth most common cancer. Particularly in childhood, activities such as sunburn and increased sun exposure are cited as the reasons for the increased incidence of melanoma.

What is the incidence?

Thousands of people are diagnosed with this cancer every year in Turkey. This skin cancer is the fifth most common cancer. It mainly affects people between the ages of 45 and 60 , but is also being discovered in more and more younger people. Almost a third of new cases are found in people under 50.

What causes melanoma?

Melanoma occurs when something goes wrong with the melanin-producing cells (melanocytes) that give your skin its color.

Normally, skin cells develop in a controlled and orderly manner, while healthy new cells push old cells to the surface of your skin and die and eventually fall off. But when some cells develop DNA damage, new cells can start to grow out of control and eventually form a series of cancerous cells.

It’s not clear what damages DNA in skin cells and how this leads to melanomas. A combination of factors, including environmental and genetic factors, is likely to cause melanomas.

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Still, doctors believe that exposure to ultraviolet (UV) radiation from the sun, tanning lamps, and beds is the primary cause of melanoma.

UV light does not cause all melanomas, especially melanomas that occur in places on your body that are not exposed to sunlight. This indicates that other factors may contribute to your risk of melanoma.

Is melanoma hereditary?

Melanomas themselves are not transmitted from person to person, but our risk of melanoma is strictly inherited, strongly influenced by our genetic background. Rarely, a specific faulty gene that causes a high risk of melanoma can be passed from one generation to the next.

But for most people, it’s a combination of many genetic differences that pushes our risk up or down. For example, our different skin colors, the way we react to the sun, the number of moles and other invisible effects of our genetic makeup.

Who is at risk?

Besides exposure to UV rays from the sun or tanning beds, several other factors are also thought to cause black skin cancer, these include:

  • Fair skinned, blond and red hair, blue eyes
  • Many and large birthmarks, liver spots and pigment scars
  • childhood burns
  • Someone else in the family has melanoma
  • Previous skin cancers
  • Weak immune system after organ transplant or HIV infection

What are the symptoms of melanoma?

In this case, there are two questions you should ask yourself:

  1. Do you have black mole-like spots on your skin that have no clear boundaries?
  2. Is the spot slightly higher than your skin and has different colors?

These signs indicate melanoma. However, at an early stage, pigment spots are difficult to distinguish from harmless skin changes such as birthmarks, liver spots, and nevi.

Black skin cancer becomes more recognizable when it reaches an advanced stage. It is doubtful if the spots have changed from the previous period or if they look significantly different from other skin spots.

Melanomas can be flat, arched, or nodular and are usually found in areas exposed to UV rays such as the face, neck, hands, forearms, and lower legs. It affects the upper body in men and the arms and legs in women. Occasionally, affected individuals experience itching throughout the body, and in advanced stages, the itchy areas may bleed.

In rare cases, melanomas without pigmentation (amelanotic melanomas) appear later, mostly on the hands and feet. They are also found under the nails, appearing as a dark discoloration. This condition is commonly known as nail melanoma .

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Melanomas in the eye are associated with visual disturbances or a dark spot on the iris. Melanomas on the mucous membranes, genitals, and even the meninges are extremely rare.

When should you see a doctor?

You should see your family doctor or a dermatologist for all suspicious-looking skin changes and changes in pigment areas. Sudden changes in the shape or color of moles on the skin are suspicious. There may be signs of irritation degeneration in the peripheral area, such as itching, spontaneous bleeding, and redness.

How is melanoma diagnosed?

If your doctor suspects that a spot on the skin is melanoma, you will need a biopsy, which is the only way to make a definitive diagnosis. In this procedure, your doctor tries to remove any growth that looks suspicious. If the growth is too large to be removed completely, your doctor may remove a tissue sample.

The biopsy can usually be done during the examination using local anesthesia. Next, a pathologist examines the tissue under a microscope to check for cancer cells.

Usually, the pathologist can easily tell whether these cells are melanoma or a non-cancerous mole. However, sometimes the distinction can be difficult and special stains or further diagnostic tests must be done to make the diagnosis.

Distinguishing between cancerous and noncancerous tumors can make all the difference for a patient as treatment and outcomes can be very different.

Staging of melanoma

  • Stage 0: These melanomas are limited to the topmost layer of skin called the epidermis. In most cases, patients can be treated with surgery to remove the cancer.
  • Stage 1: Unlike stage 0 melanoma, these melanomas have invaded through the epidermis.
  • Stage 2: These are thicker melanomas that invade deeper into the skin. The deeper a melanoma gets, the more likely it is to spread to other parts of the body.
  • Stage 3: These include melanomas that have spread to local lymph nodes. These melanomas have a risk of recurrence or manifestation in distant organs.
  • Stage 4: At this stage, the cancer has spread to distant organs. Generally, patients are treated with systemic therapy or approaches that target the whole body.

How is melanoma treated?

Which treatment is appropriate for melanoma mainly depends on where the tumor is located, how large it is, how deeply it has penetrated the tissue, and whether it has spread. The general health status, personal attitudes and age of the person concerned are taken into account in the selection of treatment.

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Detailed treatment options include:

  • Melanoma surgery: Even with the slightest suspicion of melanoma, the dermatologist will completely remove the skin change. This is done under local anaesthesia. The tissue is then pathologically examined. If the suspicion is confirmed, the further procedure depends on the depth of penetration of the melanoma. The doctor cuts off healthy skin and subcutaneous fat with a safety distance of one to two centimeters.
  • Lymph node surgery: If micrometastases are found in the sentinel lymph node, experts recommend surgical removal of adjacent lymph nodes to improve the prognosis of those affected.
  • Functioning of organ metastases: If tumors are found in organs such as the lungs, they can also be surgically removed depending on the location.
  • Radiation therapy: For metastases that cannot be surgically removed, tissue-friendly attempts can be made to destroy the tumor with radiation.
  • Immunotherapy: Immunological treatments are designed to strengthen the body’s immune system so that it can better cope with cancer. Interferon-alpha can be used as a supportive (adjuvant) therapy at different doses and for different durations. For example, for high-risk melanoma, it is used to fight the smallest tumors that have not yet been detected.
  • Targeted therapy: This is aimed at melanoma cells with certain mutations.
  • Chemotherapy: Currently, chemotherapy is the second-choice therapy after targeted and immuno-oncological treatments. Depending on the tumor stage and metastases, chemotherapy treatment may vary.

These treatments can be used individually or in combination. If they are combined, this can be done simultaneously or one after the other. The main goal is to remove the tumor completely, or at least as much as possible.

Can melanoma be prevented?

Because the causes of black skin cancer are usually in childhood, melanoma can only be prevented to a limited extent. However, it is recommended to avoid the sun, solarium, intense UV rays.

As a precaution you can apply the following:

  • Avoid direct sun exposure in the middle of the day (between 11:00 and 15:00).
  • Avoid tanning in solariums.
  • Look for shade in sunlight and outdoors, wear sun protection clothing and a sun hat.
  • Use sunscreen.
  • Pay special attention to sun protection for children.
  • Wear protective clothing if you work outdoors.
  • Get screened for cancer every six months.

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