Definition

Melanoma is a tumor that results from the transformation of melanocyte cells (cells that produce skin color pigments) into cancer cells. Malignant melanoma can appear on the skin. However, this condition can also arise in other areas such as the gastrointestinal tract and brain, due to its association with the migration of neural crest cells in the womb. Malignant melanoma has several stages. The 5-year survival rate for patients with stage 0 melanoma is 97%. On the other hand, malignant melanoma patients that have reached stage IV only have a 10% rate of 5-year survival.

The incidence of malignant melanoma is currently increasing in various countries and it is said that this is increasing at a faster rate than other cancers except lung cancer in women. Melanoma is more common in White races compared to Black and Asian races.

In general, malignant melanoma ranks 5th among all cancers in men and 7th among all cancers in women. Malignant melanoma is usually diagnosed at 57 years of age and over on average, with 75% of patients less than 70 years old.

Causes

The exact cause of malignant melanoma is still unknown. However, several causes are thought to play important roles in the development of malignant melanoma. Some of these causes include a family history of malignant melanoma, sun exposure, and economic status.

Family history of this disease, especially core family members that have malignant melanoma, is found in 5-10% of malignant melanoma patients. This disease also has a 2.2 times higher risk of showing up in people with siblings who have malignant melanoma.

Personal characteristics such as blue eyes, blonde hair, pale skin color, an easy skin reaction to sunburn when exposed to sunlight, and poor immune conditions also have quite an impact.

Prolonged sunlight exposure throughout a person's life may be a possible cause of malignant melanoma. Exposure to light, especially UVB and UVA rays from the outside can cause melanocyte cells to transform into malignant cells, although the exact mechanism is not yet known. Furthermore, exposure to ultraviolet light from tanning beds, although rare in Indonesia, can also be the cause.

Low economic status is associated with a slower rate of finding cases in the early stages, which makes the disease progress and become more severe. This is thought to be due to a lower perception and knowledge of malignant melanoma. Therefore, economic status may act as an indirect cause for the onset of malignant melanoma.

Risk factor

Recognition of several melanoma risk factors is critical to preventing and treating malignant melanoma. Everyone can be at risk of developing malignant melanoma. However, some risk factors determine whether or not you will develop malignant melanoma in the future.

Some of the risk factors that can increase your risk of developing this condition include: 

• Working in jobs that frequently expose you to ultraviolet rays from the sun
• Having a familial history of malignant melanoma 
• Low economic status (poverty)
• Low knowledge about malignant melanoma.

Symptoms

Malignant melanoma can occur anywhere on the skin, especially in skin areas that are often exposed to the sun. However, note that this condition can also occur in areas unexposed to sun rays, such as the heels or soles of the feet. Some of the possible signs and symptoms of malignant melanoma are changes in the shape of pre-existing skin spots or bumps, and unusual development and growth on the skin. If melanoma forms melanin (skin pigments), the tumor will become more brown or black.

Several signs and symptoms may indicate that the tumor, skin lump or abnormal mole is a malignant melanoma, namely irregular shapes or edges of skin lesions, the lesions are varied in color, the size of the lesions is more than 6 millimeters, and they could have elevated surfaces.

Malignant melanoma can itch and bleed if the skin lesions are scratched too often and eventually form a sunken wound. Patients who have a worsened condition or the cancer cells have metastasized, may have symptoms and signs in other organs such as the lung or brain. This is an indication that the cancer has entered Stadium IV.

Diagnosis

In general, the doctor can establish the diagnosis from an anamnesis or medical interview and examine the appearance of the typical skin lesion and the skin surrounding the lesion that can be seen, as well as from other diagnostic tests.

Doctors can perform a dermatoscopy to assess the shape, size, color, and texture of abnormal lumps or moles suspected of malignant melanoma.

If it is suspected that you have malignant melanoma, a small sample of the suspected skin tumor could be removed. Doctors perform a skin biopsy to examine the tissue microscopically and send the sample to the laboratory.

You should inform your doctor if you have had malignant melanoma previously. Information such as the onset of symptoms will also help the doctor diagnose and determine the best treatment for you.

Management

There are generally no home remedies to treat this condition. However, you can ensure that you do not apply any topical medication to the mole or lump suspected to be malignant melanoma. This condition generally requires surgery to treat the tumors. The cancer cells need to be removed depending on the depth and extent of the cancer. If the melanoma has spread to other organs, you may receive additional treatments such as chemotherapy and radiation.

Complications

Melanoma can spread to other organs of the body. Late diagnoses and treatments usually cause some of the complications that arise. For example, secondary bacterial infection of the wound on the mole, scars, swelling of the lymph nodes to metastasis (spread to other organs), and even depression and anxiety due to the appearance of skin lumps.

Prevention

Some steps that can be taken to help prevent malignant melanoma are:

• Use sunscreen with SPF 30 or higher, or wear clothings that cover your skin (such as long sleeves, high-collared clothes, long pants, neck scarves) if you work outdoors or are prone to sun exposure
• Avoid using tanning beds or going to a tanning salon whenever possible

When to see a doctor?

If you feel that the existing moles or lumps have grown abnormally, or if there are obvious changes to the moles, such as changing shape, size, or color, the lumps become more painful, swollen, and inflamed, or if the existing moles become more prone to bleeding and itching, you need to go to the nearest health facility for further examinations. You can consult with a dermatologist. The doctor will ask about your symptoms and medical history, check for abnormal skin lesions, and perform certain diagnostic tests if needed to establish a diagnosis and other conditions related to complications that can arise from malignant melanoma. They could also give appropriate treatment to you.

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