Definition

Melanoma is a form of skin cancer characterized by the excessive proliferation of melanocytes, the cells responsible for producing skin pigment or melanin. Melanoma is a severe type of malignant skin cancer. Approximately 17% to 20% of melanoma patients are expected to develop several melanomas, leading to the term multiple melanoma. Additional melanomas typically develop within 0–6 months after the initial diagnosis. The likelihood of developing additional melanomas increases in the year following the initial diagnosis and remains heightened for a minimum of 20 years.

Melanoma can form on any part of the skin, but it is more common on the torso in men and on the legs in women. Melanoma frequently affects the neck and face. Furthermore, melanoma can develop in the eye and, in extremely uncommon instances, cancer may occur in the nose or throat.

Melanoma is a less common form of skin cancer, accounting for approximately 1% of all skin cancer cases. Yet, melanoma poses a greater threat due to its increased propensity to metastasize to other areas of the body if not identified and addressed promptly.

Causes

Melanoma initiates when there is a disturbance in the melanocytes, which are responsible for producing the melanin that determines skin color. Skin cells typically undergo a regulated process of development in which new, healthy cells displace older cells towards the skin's surface, leading to their eventual shedding. When certain cells experience DNA damage, they may proliferate uncontrollably and develop into a mass of cancerous cells.

Experts generally concur that excessive sun exposure, particularly sunburn during youth, is the primary factor that can lead to the development of melanoma. UV (ultraviolet) lights of the sun are attributed to up to 86% of melanomas, according to statistics. UV exposure can result in DNA damage in cells, leading to mutations in specific genes that impact the regulation of cell growth and division. Tanning lights are also believed to cause DNA damage in the skin.

Melanomas can develop in areas of the body not exposed to the sun, indicating that other factors may influence their development besides ultraviolet lights. This indicates that there are additional elements that could influence the development of melanoma. Various factors, such as environmental and genetic influences, are believed to play a role in melanoma development.

Risk Factor

Factors that could increase your likelihood of acquiring multiple melanomas are:

• A history of previous melanoma diagnosis
• Advancing age
• Possessing pale skin, blonde or red hair, and blue eyes
• A history of previous sunburns
• Prolonged exposure to ultraviolet (UV) lights, whether from the sun or tanning lights
• Residing near the equator or in places with higher altitudes
• Having several moles, particularly ones with irregular shapes
• Having a family member with a history of melanoma
• Individuals with compromised immune systems, such as organ transplant patients, AIDS patients, or those consuming immune-suppressive medications

Symptoms

Melanoma could develop on any part of the body but typically appears on sun-exposed parts including the back, legs, arms, and face. Melanoma can develop in body areas with limited sun exposure, like the soles of the feet, palms of the hands, and under the nails. Melanomas in concealed body areas are more prevalent among those with darker skin.

Multiple melanomas refer to the presence of more than one melanoma on the body at the same time. Multiple melanomas may not be simultaneously detected and often manifest within 6 months of the initial melanoma diagnosis.  Common early indicators of melanoma include alterations in existing moles and atypical growths or skin discolouration. An atypical mole could suggest the existence of a melanoma. Some characteristics of melanoma are seen through:

• A (asymmetric) mole shape is asymmetrical and uneven, consisting of two distinctly different-looking parts.
• B (border) is a mole with an irregular, indented, or jagged border.
• C (color) refers to discolored moles that may exhibit numerous colors or an uneven color distribution. Melanomas exist in brown, black, gray, red, and white coloration.
• D (diameter) refers to a mole with a diameter larger than 1/4 inch (about 6 millimeters).
• E (evolving) moles undergo continual changes, such as widening, changing color, or shape modification. New signs and symptoms, such as itching or bleeding, may also arise. 

Diagnosis

In the process of diagnosing multiple melanoma, your doctor will begin by having a medical interview with you. The healthcare provider will inquire about your symptoms, including whether there are changes in the skin lesions over time, the location of the moles, potential triggers that could contribute to the development of melanoma, and any personal or family history with this condition. Subsequently, the doctor will do a physical examination. They will physically examine the affected skin area. Overall, melanoma typically has a distinct clinical presentation. The doctor will conduct a biopsy, which is considered the gold standard for diagnosing melanoma. During a biopsy, the healthcare provider will remove a tiny sample of the impacted skin tissue to analyze it under a microscope. The results may show melanocyte cells that have become cancerous. Furthermore, the doctor may recommend additional diagnostic tests, including blood tests, CT scans, MRIs, or PET scans, to evaluate the metastasis of melanoma to other organs.

Management

Treatment for multiple melanomas is determined by the stage of the cancer and your overall health. Some choices are:

• Surgery is usually the primary treatment for melanoma. The procedure entails removing the afflicted patch of skin, as well as some of the surrounding healthy skin. The extent of healthy skin removed will vary depending on the dimensions and position of the melanoma. During the first phases, surgery offers a high likelihood of curing melanoma.
• Targeted cancer therapy. This treatment entails using medications to target specific cancer cells. This focused treatment will specifically target cancer cells while sparing healthy cells.
• Radiation therapy involves using high-energy radiation to target cancer cells and reduce the size of the tumor.
• Immunotherapy activates the body's immune system to combat cancer.

Complications

Early detection and proper treatment could effectively resolve melanoma. Nevertheless, the danger of melanoma returning in the future would still persist. Melanoma is a type of skin cancer that can metastasize to other organs if it is not promptly treated.

Prevention

Measures to prevent the development of multiple melanomas include:

• Early detection and prompt intervention are crucial in preventing the progression of multiple melanomas
• Avoid prolonged sun exposure, particularly from 10 a.m. to 4 p.m.
• Avoid using tanning lamps
• Consider wearing a brimmed hat, sunglasses, a long-sleeved shirt, and long pants when you are going out
• Apply a broad-spectrum sunscreen with SPF 30 or higher and reapply every 90 minutes, especially when swimming or sweating
• Apply lip balm that contains sunscreen
• Remember to use sunscreen on infants and young children who are older than 6 months 

When to See a Doctor?

Seek medical advice if you notice any abnormal changes in your skin or existing moles.

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