Best Melanoma Treatment in Delhi, India

Melanoma is a type of skin cancer that develops from the pigment-producing cells called melanocytes. It typically appears as an abnormal growth or mole on the skin, which may vary in colour, shape, and size. Melanoma can occur anywhere on the body, but it is most commonly found in areas exposed to the sun, such as the face, neck, arms, and legs. If left untreated, melanoma can spread to other parts of the body and become life-threatening. Early detection and treatment are crucial for a favourable prognosis.

There are several types of melanoma, each characterised by its location on the skin and its appearance under the microscope. The main types of melanoma include:

• Superficial Spreading Melanoma: This is the most common type of melanoma and often appears as flat or slightly raised lesions with irregular borders. It tends to spread along the surface of the skin before penetrating deeper layers.
• Nodular Melanoma: Nodular melanoma typically presents as a raised bump on the skin, which may be pink, red, or dark in colour. It tends to grow more rapidly than other types of melanoma and can be more aggressive.
• Lentigo Maligna Melanoma: This type of melanoma usually develops on areas of the skin that have been exposed to the sun for long periods, such as the face and neck. It initially appears as a flat or slightly raised lesion with irregular borders and may have varying shades of brown or black.
• Acral Lentiginous Melanoma: Acral lentiginous melanoma is most commonly found on the palms of the hands, soles of the feet, or under the nails. It often appears as a dark spot or streak and is more common in people with darker skin tones.
• Desmoplastic melanoma: This is a rare type of melanoma that can be difficult to diagnose. It appears as a firm, white or pink bump on the skin. Desmoplastic melanoma can grow slowly or quickly.

These are the main types of melanoma, but there are also rare subtypes and variations. It's important to recognize the signs of melanoma and seek prompt medical attention if you notice any suspicious changes in your skin. Early detection and treatment can greatly improve outcomes for individuals with melanoma.

• UV Radiation Exposure: One of the primary causes of melanoma is exposure to ultraviolet (UV) radiation from sunlight or artificial sources like tanning beds. UV radiation can damage the DNA within skin cells, leading to mutations that can cause melanocytes to become cancerous.
• Genetic Factors: Certain genetic mutations can predispose individuals to melanoma. For instance, mutations in genes such as CDKN2A, CDK4, and BRAF are associated with an increased risk of melanoma. These mutations can interfere with normal cell growth and division, leading to the development of cancerous melanocytes.
• Immune Suppression: Weakened immune systems, whether due to medical conditions like HIV/AIDS or immunosuppressive medications following organ transplantation, can increase the risk of melanoma. A compromised immune system may not be as effective in detecting and destroying cancerous cells, allowing melanoma to develop and progress.
• Environmental Factors: Other environmental factors besides UV radiation may also contribute to melanoma risk. These may include exposure to certain chemicals or pollutants, although the specific mechanisms by which they may increase melanoma risk are not fully understood.

• Fair Skin, Hair, and Eyes: Individuals with fair skin, light-coloured hair, and blue or green eyes are at a higher risk of developing melanoma. This is because they have less melanin, which provides natural protection against UV radiation.
• Family History: A family history of melanoma increases an individual's risk of developing the disease. Certain genetic mutations associated with melanoma can be inherited, increasing susceptibility within families.
• Personal History of Melanoma or Skin Cancer: Having a previous diagnosis of melanoma or other types of skin cancer increases the risk of developing melanoma again. Additionally, individuals who have had non-melanoma skin cancers, such as basal cell carcinoma or squamous cell carcinoma, also have an elevated risk.
• Presence of Atypical Moles or Large Number of Moles: Individuals with numerous moles or atypical moles (dysplastic nevi) have a higher risk of developing melanoma. Similarly, having large congenital nevi (present at birth) increases the risk.
• Age: While melanoma can occur at any age, it is more commonly diagnosed in older adults. However, it is also one of the most common cancers in younger people, particularly in young women.
• Gender: Melanoma is more prevalent in men than in women, although the gap is narrowing. However, melanoma incidence in women under 50 has been rising in recent years.
• Geographic Location: Living closer to the equator or at higher altitudes increases exposure to UV radiation, thereby increasing the risk of melanoma.
• Certain Medical Conditions: Some medical conditions, such as xeroderma pigmentosum, which reduces the skin's ability to repair DNA damage caused by UV radiation, increase the risk of melanoma.

Understanding these causes and risk factors is crucial for early detection and prevention of melanoma. Regular skin examinations, sun protection measures, and avoidance of tanning beds are important steps in reducing the risk of developing this potentially deadly form of skin cancer.

Melanoma can manifest with various symptoms. Recognizing these symptoms early is crucial for prompt diagnosis and treatment. Here are some common signs and symptoms of melanoma:

• Changes in Existing Moles: Keep an eye on any changes in the size, shape, colour, or texture of existing moles. Melanomas often develop from existing moles or appear as new pigmented growths on the skin.
• Asymmetry: Look for moles or lesions that are asymmetrical, meaning one half does not match the other half in terms of shape or size.
• Irregular Borders: Melanomas may have irregular, jagged, or poorly defined borders. Borders that appear blurred or notched are concerning.
• Varied Colours: Melanomas may display multiple colours or shades within the lesion, such as black, brown, tan, red, white, or blue. This is often referred to as variegated coloration.
• Diameter: Pay attention to the size of moles or lesions. Melanomas are typically larger in diameter than a pencil eraser (about 6 millimetres or larger), although they can be smaller in some cases.
• Evolution or Changes Over Time: Any changes in a mole or lesion over time, such as growth in size, changes in colour, or alterations in shape or texture, should be evaluated by a healthcare professional.
• Itching or Pain: Some melanomas may itch, bleed, or become painful. However, not all melanomas cause symptoms, so it's essential to be vigilant about any changes on the skin.
• Ulceration or Bleeding: Melanomas may develop ulceration, which is the formation of a sore or open wound on the surface of the lesion. Bleeding from a mole or lesion without trauma is also concerning.
• Satellite Lesions: Occasionally, melanomas may develop smaller lesions near the primary tumour, known as satellite lesions or satellites.
• Nodular Growth: Some melanomas may present as raised nodules or bumps on the skin, rather than flat lesions.
• Location: Melanomas can occur anywhere on the body, including areas not exposed to the sun, such as the palms of the hands, soles of the feet, or under the nails.

It's important to note that not all melanomas exhibit these symptoms, and some melanomas may lack characteristic features. Additionally, other skin conditions can mimic the appearance of melanoma. If you notice any suspicious changes on your skin, it's essential to consult a dermatologist or healthcare provider for evaluation and appropriate management. Early detection and treatment significantly improve the prognosis for melanoma. Regular self-examinations and annual skin checks by a healthcare professional are recommended for individuals at increased risk.

• Physical Examination: A dermatologist or healthcare provider will conduct a thorough examination of the skin, including any moles or lesions of concern. They will assess the size, shape, colour, and texture of the lesion and inquire about any changes over time.
• Dermoscopy: Dermoscopy is a non-invasive technique that uses a handheld device with a magnifying lens and light to examine skin lesions more closely. It helps dermatologists visualise the structures within the mole or lesion and assess for features suggestive of melanoma.
• Biopsy: If a mole or lesion appears suspicious, a biopsy will be performed to obtain a tissue sample for laboratory analysis. There are different types of biopsies, including shave biopsy, punch biopsy, or excisional biopsy, depending on the size and location of the lesion. A pathologist will examine the tissue under a microscope to determine if it contains cancerous cells.
• Sentinel Lymph Node Biopsy: If melanoma is diagnosed and appears to have spread beyond the skin, a sentinel lymph node biopsy may be recommended to assess whether cancer has spread to nearby lymph nodes. This procedure involves injecting a dye or radioactive substance near the tumour to identify the sentinel lymph node, which is the first lymph node that cancer cells are likely to spread to from the primary tumour.
• Imaging Studies: In cases where melanoma has spread (metastasized) to other parts of the body, imaging studies such as CT scans, MRI scans, or PET scans may be performed to evaluate the extent of metastasis and plan further treatment.

Melanoma is staged based on the thickness of the tumour, whether it has spread to nearby lymph nodes, and whether it has metastasized (spread) to distant organs. The staging system most commonly used for melanoma is the American Joint Committee on Cancer (AJCC) TNM staging system, which classifies melanoma into stages ranging from 0 to IV. Here's an overview of the stages of melanoma:

Stage 0 (Melanoma in situ)

Melanoma is confined to the epidermis (outer layer of the skin) and has not invaded deeper layers of the skin or spread to nearby lymph nodes or other organs. This stage is also known as melanoma in situ.

Stage I

Stage I melanoma is divided into two subgroups:

• Stage IA: The tumour is ≤1.0 mm thick, with no ulceration and no evidence of spread to nearby lymph nodes or distant organs.
• Stage IB: The tumour is between 1.01 mm and 2.0 mm thick, with or without ulceration, and has not spread to nearby lymph nodes or distant organs.

Stage II

Stage II melanoma is further subdivided based on tumour thickness and ulceration status:

• Stage IIA: The tumour is between 1.01 mm and 2.0 mm thick, with ulceration, or between 2.01 mm and 4.0 mm thick, with no ulceration, and has not spread to nearby lymph nodes or distant organs.
• Stage IIB: The tumour is between 2.01 mm and 4.0 mm thick, with ulceration, or >4.0 mm thick, with or without ulceration, and has not spread to nearby lymph nodes or distant organs.
• Stage IIC: The tumour is >4.0 mm thick, with ulceration, and has not spread to nearby lymph nodes or distant organs.

Stage III

Stage III melanoma indicates regional lymph node involvement or spread to nearby lymph nodes, but no evidence of distant metastasis. It is further categorised into subgroups:

• Stage IIIA: Melanoma has spread to one to three nearby lymph nodes, and the affected lymph nodes are enlarged or clumped together.
• Stage IIIB: Melanoma has spread to four or more nearby lymph nodes or to nearby lymph nodes that are matted together.
• Stage IIIC: Melanoma has spread to nearby lymph nodes and may also involve the presence of in-transit metastases, which are cancer cells that have spread to lymph nodes or skin areas between the primary tumour and regional lymph nodes.

Stage IV

Stage IV melanoma indicates distant metastasis, where cancer has spread to distant organs or tissues beyond the primary site and regional lymph nodes. Stage IV melanoma is further subdivided into:

• Stage IVA: Melanoma has spread to distant skin, soft tissue, or lymph nodes, but not to internal organs or distant lymph nodes.
• Stage IVB: Melanoma has spread to the lungs.
• Stage IVC: Melanoma has spread to other organs or distant lymph nodes, such as the liver, brain, bone, or gastrointestinal tract.

Staging helps determine the prognosis and guide treatment decisions for melanoma. Treatment options may include surgery, immunotherapy, targeted therapy, radiation therapy, and clinical trials, depending on the stage of the disease and individual factors. Early detection and treatment are crucial for improving outcomes in melanoma.

• Surgery: The primary treatment for early-stage melanoma is surgical removal of the tumour and a margin of healthy tissue surrounding it. This may be performed using techniques such as excisional surgery, Mohs micrographic surgery, or wide local excision. In cases where melanoma has spread to nearby lymph nodes, lymph node dissection may be recommended.
• Immunotherapy: Immunotherapy drugs, such as checkpoint inhibitors (e.g., pembrolizumab, nivolumab) and interleukin-2 (IL-2), work by enhancing the body's immune response to target and destroy cancer cells. These drugs may be used alone or in combination with other treatments for advanced or metastatic melanoma.
• Targeted Therapy: Targeted therapy drugs, such as BRAF inhibitors (e.g., vemurafenib, dabrafenib) and MEK inhibitors (e.g., trametinib, cobimetinib), are designed to block specific genetic mutations found in melanoma cells, such as BRAF mutations. These drugs are used for melanomas that have specific genetic alterations.
• Chemotherapy: Traditional chemotherapy drugs may be used to treat advanced or metastatic melanoma, although they are less commonly used than immunotherapy or targeted therapy. Chemotherapy may be administered intravenously or orally and works by killing rapidly dividing cancer cells.
• Radiation Therapy: Radiation therapy uses high-energy X-rays or other forms of radiation to target and destroy cancer cells. It may be used as a primary treatment for melanoma in certain cases or as adjuvant therapy following surgery to reduce the risk of recurrence.
• Clinical Trials: Participation in clinical trials may offer access to novel treatments and investigational therapies for melanoma. Clinical trials evaluate new drugs, treatment combinations, and treatment strategies to improve outcomes for patients with melanoma.

Treatment decisions for melanoma depend on various factors, including the stage of the disease, the location and size of the tumour, the presence of specific genetic mutations, and the individual's overall health and preferences.

Preventing melanoma involves minimising exposure to ultraviolet (UV) radiation and adopting sun-safe behaviours. Here are some strategies for preventing melanoma:

• Use Sunscreen: Apply a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to all exposed skin, including the face, neck, ears, and hands. Reapply sunscreen every two hours, or more frequently if swimming or sweating.
• Seek Shade: Limit time spent in direct sunlight, especially during peak UV hours (10 a.m. to 4 p.m.). Seek shade under umbrellas, trees, or other shelters when outdoors.
• Protective Clothing: Wear protective clothing, such as lightweight long-sleeve shirts, pants, wide-brimmed hats, and sunglasses with UV protection, to shield the skin from UV radiation.
• Avoid Tanning Beds: Avoid the use of tanning beds and sunlamps, as they emit harmful UV radiation that increases the risk of melanoma and other types of skin cancer.
• Stay Indoors When Possible: Try to schedule outdoor activities earlier or later in the day when UV radiation is less intense. If possible, stay indoors during midday hours when the sun's rays are strongest.
• Check the UV Index: Check the UV index forecast before going outside. The UV index indicates the strength of UV radiation in your area and can help you plan outdoor activities accordingly.
• Perform Self-Examinations: Regularly examine your skin for any changes, including new moles, changes in existing moles, or other skin abnormalities. Use the ABCDE rule to identify suspicious moles: Asymmetry, Border irregularity, Color variation, Diameter larger than 6 millimetres, and Evolving or changing over time.
• Annual Skin Checks: Schedule annual skin examinations with a dermatologist or healthcare provider, especially if you have a history of melanoma or other skin cancers, numerous moles, or other risk factors.
• Protect Children: Protect children from excessive sun exposure by applying sunscreen regularly, dressing them in protective clothing, and encouraging them to seek shade when outdoors.
• Be Mindful of Reflective Surfaces: Remember that water, sand, snow, and concrete can reflect and amplify UV radiation, increasing the risk of sunburn and skin damage.
• Avoid Sunburns: Prevent sunburns by taking proactive measures to protect your skin from UV radiation. Sunburns increase the risk of melanoma and other skin cancers.
• Educate Others: Spread awareness about sun safety and melanoma prevention strategies among family, friends, and community members.

By adopting these sun-safe behaviours and minimising exposure to UV radiation, you can reduce the risk of developing melanoma and other types of skin cancer. Prevention is key to maintaining healthy skin and reducing the incidence of melanoma.

What is a melanocyte?

Melanocytes are cells in your skin that produce melanin, the pigment that gives your skin its colour. Melanin also helps protect your skin from the harmful effects of ultraviolet (UV) radiation from the sun.

What does melanoma look like?

Melanoma can appear in various forms, but the ABCDE rule can help you identify potential warning signs:

• Asymmetry: One half of the mole or spot doesn't match the other half in size or shape.
• Border: The edges of the mole are irregular, ragged, notched, or blurred.
• Colour: The mole has uneven coloration, with shades of brown, black, tan, red, white, or blue.
• Diameter: The mole is larger than the eraser tip of a pencil (around 6 millimetres).
• Evolving: The mole changes in size, shape, or colour over time.

How common is melanoma?

Melanoma accounts for only about 1% of all skin cancers, but it causes the vast majority of skin cancer-related deaths. It's important to be aware of the signs and symptoms for early detection.

How dangerous is melanoma?

Melanoma is the most dangerous type of skin cancer because it can spread to other parts of the body if not detected and treated early. Early detection significantly improves the prognosis.

How widespread is melanoma?

Melanoma can occur anywhere on the body, but it most commonly develops on areas exposed to the sun, such as the face, back, legs, and arms.

Is melanoma painful?

Melanoma typically doesn't cause pain in the early stages. However, as the cancer progresses, it may cause pain or discomfort in the affected area.

At what age does melanoma typically occur?

Melanoma can occur at any age, but it's most common in adults over 50. However, it's crucial to be vigilant at any age and practice sun safety measures.

Where can I get melanoma on my body?

Melanoma can develop anywhere on your body, including the palms of your hands, soles of your feet, and even under your fingernails or toenails. Regularly examine your entire body for any suspicious changes.

What is Breslow depth?

Breslow depth is a measurement used to determine the thickness of a melanoma. Generally, the thicker the melanoma, the more advanced the stage and the higher the risk of it spreading.

What is the ABCDE rule for detecting melanoma?

As mentioned earlier, the ABCDE rule is a helpful memory tool to identify potential melanoma signs: Asymmetry, Border, Color, Diameter, and Evolving.

Should I have regular checkups for skin cancer?

Yes, regular skin cancer screenings by a dermatologist are recommended, especially for those with risk factors. The frequency depends on your individual risk profile. Discuss this with your doctor.

Can tattoos increase the risk of melanoma?

In rare cases, a tattoo can irritate an existing mole, which might make it difficult to monitor for changes. However, tattoos themselves don't directly cause melanoma. If you have a tattoo and notice a suspicious mole developing within it, consult a doctor.

What are the potential complications of untreated melanoma?

If left untreated, melanoma can spread to other organs, such as the lymph nodes, lungs, liver, and brain. This can lead to serious health problems and even death.

How is melanoma different from other types of skin cancer?

Melanoma arises from melanocytes, while other skin cancers like basal cell carcinoma and squamous cell carcinoma develop from different skin cells. Melanoma is generally more aggressive and can spread more readily.

Can changing my diet help prevent melanoma?

While there's no specific diet proven to prevent melanoma, a healthy diet rich in fruits, vegetables, and whole grains might contribute to overall health and potentially reduce cancer risk.

What is life expectancy with melanoma?

The life expectancy with melanoma depends heavily on the stage of diagnosis and treatment success. Early detection and treatment significantly improve the prognosis. Consult with your doctor for a more specific outlook based on your individual case.

How often should I see a dermatologist for skin checks if I've had melanoma?

The recommended frequency for skin checks after melanoma diagnosis depends on the specific case and risk factors. Typically, more frequent checkups are advised in the initial years following treatment, with intervals gradually increasing over time. Discuss a follow-up plan with your doctor.

Reviewed By P K Julka- Vice Chairman Cancer Care / Oncology, Gynecologic Oncology, Hematology Oncology, Head & Neck Oncology on 17 Sept 2024.