What are the symptoms ?

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The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, or of a mole may be a sign of melanoma.

The most important warning sign for melanoma is a change in size, shape, or color of a mole or other skin growth, such as a birthmark. One of the things to watch for is diameter.

Diameter is width. If the diameter across a mole or skin growth is larger than 1/4 inch (6 mm), or about the size of a pencil eraser, talk to your doctor. Also, call your doctor if any mole seems to be growing, even if it is still smaller than 1/4 inch (6 mm).

Melanoma Exams and Tests

Evaluation of a skin lesion

A physical exam of the skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your doctor will remove a sample of skin tissue and send it to a pathologist to be looked at under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to find out how advanced the cancer is.

Other techniques may include total-body photography to monitor for changes in any mole and to watch for new moles appearing in normal skin. A series of photos of the suspicious lesions may be taken. Then the photos can be used as a baseline to compare with follow-up photos.

Evaluation of lymph nodes

Testing the lymph nodes may not be needed if the melanoma is less than 1 mm (0.04 in.) thick when measured with a microscope, because the risk of the cancer spreading may be low. But if your melanoma is large or thick, you can expect more lab tests.

If a melanoma is thicker than 1 mm (0.04 in.), your doctor will do a physical exam that includes checking the lymph nodes to see whether they are larger than normal. This may be followed by a lymph node biopsy to see whether the melanoma has spread to the lymph system.

A sentinel lymph node biopsy is a relatively new technique that may be used instead of conventional lymph node biopsy. Like a conventional biopsy, sentinel lymph node biopsy is done to identify lymph nodes that may contain melanoma.

Evaluation for possible metastases (spread of cancer)

A complete medical history and a physical exam are needed to find out whether the cancer has spread (metastasized) to other parts of the body. Imaging tests, including positron emission tomography (PET scan), computed tomography (CT scan) or magnetic resonance imaging (MRI), may be used to identify metastases in other parts of the body, such as the lungs, brain, liver, or other organs.

Early Detection

Skin self-exam is a good way to detect early skin changes that may point to melanoma. A skin self-exam is used to identify suspicious growths that may be cancer or growths that may develop into skin cancer (precancers). Adults should examine their skin once every month. Look for any abnormal skin growth or any change in the color, shape, size, or appearance of a skin growth. Check for any area of injured skin (lesion) that does not heal. Have your spouse or someone such as a close friend help you monitor your skin, especially places that are hard to see such as your scalp and back.

There are other steps you can take to prevent skin cancer or detect it at an early stage.

• Be aware of the risk of skin cancer and the steps you can take to prevent it, including using sunscreen, wearing protective clothing, and staying out of the midday sun.
• Have your doctor examine any suspicious skin changes. Screening guidelines from the American Cancer Society and other expert groups advise adults older than 40 to have their skin checked by a doctor at least once a year and during all other health exams. This may lead to early treatment, which may prevent the spread of cancer. You may wish to begin screening earlier, especially if you have:
• Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop melanoma. Examine your skin every month and be examined by a doctor every 4 to 6 months, preferably by the same doctor each time.
• Increased occupational or recreational exposure to ultraviolet (UV) radiation.
• Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous. But their presence is a warning of an inherited tendency to develop melanoma.

What is Melanoma ?

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Melanoma is a kind of skin cancer. It is not as common as other types of skin cancer, but it is the most serious.
Melanoma can affect your skin only, or it may spread to your organs and bones. Luckily, it can be cured if it’s found and treated early. Melanoma is a serious form of skin cancer that starts in the pigment-producing skin cells (melanocytes). These cells become abnormal, grow uncontrollably, and aggressively invade surrounding tissues.

What  causes melanoma?

You can get melanoma by spending too much time in the sun. This causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.

Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and “pebbly.” These moles don't cause cancer by themselves. But having many of them is a sign that melanoma may run in your family.

melanoma skin cancer

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Melanoma is the least common type of skin cancer. Still, it is the most deadly because it can spread if not caught early. Melanoma symptoms include a change in the shape, size, or color of a mole, but melanomas can also look like a bruise that doesn't heal or a dark streak under a finger or toenail. Excess sun is linked to melanoma risk. However, melanomas can also occur on skin not exposed to the sun (such as inside the mouth).

What about herbal or other alternative medicine treatments for prostate cancer?

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Alternative medicine, also called integrative or complementary medicine, includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. A major problem with most herbal treatments is that their composition is not standardized. Moreover, the way herbal treatments work and their long-term side effects usually are not known. Currently, there is no evidence to prove that these medications have any therapeutic benefit in prostate cancers that have What is active surveillance for prostate cancer?

Active surveillance is observing a patient while no immediate treatment is given. Such a patient usually has a less aggressive, small-sized, organ-confined tumor and no symptoms. This management strategy is based on the premise that most early prostate cancers are slow-growing tumors and will remain confined to the prostate gland for a significant length of time. This implies that in selected patients it may be possible to defer definitive treatment for many years or avoid it altogether thereby preventing the side effects associated with treatments like surgery or radiation. Understand, however, that although active surveillance involves no actual treatment, the patient still needs close follow-up and monitoring. The follow-up involves frequent visits to the doctor, perhaps every three to six months. The visits include questions about new or worsening symptoms and digital rectal examinations for any change in the prostate gland. In addition, blood tests are done to watch for a rising PSA, and imaging studies can be conducted to detect the spread of the cancer. Most experts also recommend performing a confirmatory set of prostate biopsies to ensure that there is low-volume disease. Additional prostate biopsy is required every year to detect any increase in the volume and Gleason grade of the cancer. As mentioned before, Gleason grade is a measure of aggressiveness of the tumor and increase in this value may point toward a need to treat the cancer with other means. If the history, examinations, or any of the tests signal the possibility of an advancing cancer, the active surveillance usually is discontinued and active treatment is recommended, often with radiotherapy or surgery.

Active surveillance is different from watchful waiting. Watchful waiting means following up patients without any tests or biopsies and treating them only when symptoms arise. This is reserved for men who have a life expectancy of less than 10 years. Therefore, watchful waiting seems to make sense for organ-confined (localized) prostate cancers in men who are elderly. Additionally, watchful waiting often is the most appropriate choice in men who are ill with other serious medical diseases, such as heart or lung disease, poorly controlled high blood pressure, diabetes, AIDS, or other cancers.

Active surveillance and watchful waiting in prostate cancer, however, remains controversial. Some medical authors have stated outright that it is not a good choice. They point out that few doctors would just watch other cancers to see whether they would spread without treatment. Furthermore, the treatment for an individual could become less effective in the future if and when the cancer does progress. Moreover, there is no standardized protocol for selecting appropriate patients for active surveillance with different institutions having their own different guidelines. Studies are under way to compare these protocols with more established methods of treatment, and more information is likely to emerge in the future.

What are the differences between hormonal treatment and chemotherapy?

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Hormonal therapy is the mainstay of treatment for symptomatic, advanced-staged prostate cancer. A vast majority of prostate cancers, particularly initially, are dependent on testosterone (the male hormone produced by the testes) for their growth and spread. The objective of hormonal treatment is to withdraw this source of sustenance for prostate cancer cells in an attempt to slow down or control this disease. The following are treatments available for hormonal therapy:

Orchiectomy is the surgical removal of the testicles. Luteinizing hormone-releasing hormone (LHRH) agonists, such as leuprolide (Lupron, Viadur, Eligard), goserelin (Zoladex), or buserelin (Suprefact), stop the production of testosterone from the testes and induce a state of "medical castration" (castration without surgery). Many men prefer this over surgical castration.

Antiandrogens, such as flutamide (Eulexin) or bicalutamide (Casodex), block the action of testosterone on the prostate cancer cells and other parts of the body. Each of the above two classes of medicines produce symptomatic relief in about 80% of patients. Improvement is often dramatic.

Side effects of these medications vary. Orchiectomy and LHRH agonists may cause impotence, hot flashes, and loss of sexual desire. Antiandrogens may cause nausea, vomiting, diarrhea, and breast enlargement or tenderness. Any of these therapies can weaken bones and lead to osteoporosis and bone fracture.

Other agents that are helpful include the following: progestins such as megestrol acetate given daily orally and other drugs that inhibit androgen production such as aminoglutethimide (Cytadren) or ketoconazole (Nizoral, Extina, Xolegel, Kuric). These agents are effective but are sometimes difficult to tolerate. Corticosteroids are often given simultaneously.

As opposed to hormonal therapy, chemotherapy provides relief in only 20%-25% of symptomatic patients with prostate cancer. Various regimens are being used. Estramustine, cisplatin, 5-FU, vinorelbine, and mitoxantrone are the most popular agents. However, recently docetaxel (Taxotere) has become the drug of choice used by oncologists in treating castrate-resistant prostate cancer (prostate cancer which has become unresponsive to hormonal therapy).

When to use hormonal therapy and chemotherapy depends on the nature of the prostate cancer itself. If the prostate cancer is hormone-sensitive, then hormonal therapy is the therapy of choice. When the cancer becomes hormone-resistant (for example, manipulation of the hormone levels has no effect on the prostate cancer), then the only potential therapy available to the patient is chemotherapy. Chemotherapy, then, is used generally when advanced prostate cancer is hormone-resistant. Unfortunately, chemotherapy after hormone therapy is nowhere near as effective as hormonal therapy because the cancer itself has often evolved to become more aggressive so that the prognosis is significantly worse. When prostate cancer transforms from being hormone-sensitive to hormone-resistant, the prognosis has taken a significant turn for the worse and the chemotherapy option at that particular time is usually the only treatment option available.

Other factors considered in choosing treatment include the age, general health, and preference of the individual and the Gleason score and stage of the cancer. The results of the PSA test sometimes also can help to decide on the treatment. For example, a borderline elevation of the PSA (4-10), if shown to be due to a prostate cancer, suggests that the cancer is confined to the gland. If other tests also point to an organ-confined tumor, surgery or possibly radiation can be considered to attempt a cure. In contrast, a very high PSA (for example, over 30 or 40) raises the possibility of metastases. If the metastases are then confirmed by other tests, the treatment options would be limited to hormonal therapy or chemotherapy.

PSA tests also should be done periodically after treatment to help assess the results of treatment. For example, an increasing PSA suggests growth or spread of the cancer, despite the treatment. In contrast, a decreasing PSA indicates improvement. As a matter of fact, a post-treatment undetectable PSA (PSA less than 0.05 or 0.1 ng/ml) may indicate complete control or cure of the cancer.