Melanoma Its Causes and Treatments

Melanoma. Who is at risk, and how can this deadly cancer be prevented?
1. Abstract
Melanoma cancer has been identified and rapidly increasing over the years as the deadliest skin cancer amongst young adults with women being at a higher risk than men. The purpose of this research is to attain knowledge on the risk involving this cancer, look into preventative ways to minimize the exposure to this type of cancer, and how to live a healthy life post-cancer. Melanoma is a skin cancer-affecting people that lack a pigment in their body called melanin. Furthermore, overexposure to ultraviolet sunlight with the use of tanning booth at a young age has been linked with individuals obtaining melanoma. This cancer can be deadly, and depending on the type of insurance it can be costly to the individual. The cost can vary depending on the severity of melanoma, which is why prognosis plays a big part in detecting it (Guy, 2012). Peer-reviewed articles were used to identify the risk and prevention methods of melanoma. In conclusion, more research needs to be done to diagnose the cause of melanoma cancer accurately, and find ways to prevent it. Although women are at higher risk for melanoma, studies have discovered that women depict a higher engagement in taking proactive measures to battle the cancer and ultimately remaining cancer free with less probabilities of reappearing.
2. Review and Analysis
A. Introduction:
The disorder has been known since antiquity, and Hippocrates first coined a term to describe it from the Greek melas meaning dark and oma meaning tumor in the 5th century BCE (Smith, 2017). Although the first successful excision of a melanoma tumor was performed in 1787, it was not until 1804 that melanoma was identified as a separate disease and the term melanoma was first applied to the condition in 1838 by the Scottish pathologist Sir Robert Carswell (Smith, 2017). Despite these minor advances in identification, prior to the latter half of the 20th century, most of the studies on melanoma were descriptive in nature and did not provide any indication of the disease’s underlying etiology or mechanistic basis (Rebecca, Sondak & Smalley, 2012).
In recent years, less invasive surgical procedures have been developed to treat melanoma and far more has been learned about its causes (Rebecca et al., 2012), including the concentrated ultraviolet lights in popular tanning booths (Gershenwald, Halpern & Sondak, 2016; Konkolova, Provaznikova, Jirakova & Hercogova, 2014). Based on this track record of consistently improving success in diagnosing and treating the disease, Rebecca and his associates (2012) conclude that, “We are confident that as we move forward, our rapidly evolving knowledge will allow us to bring melanoma to level of a chronic, manageable disease and not the intractable ‘black cancer’ of old that struck fear into the hearts of those who observed it” (p. 122). Notwithstanding this impressive progress, however, tens of thousands of Americans still develop melanoma each year as discussed further below.
B. Statistics/Epidemiology:
In 2014, about 1.2 million Americans were living with melanoma of the skin in the United States (Melanoma statistics, 2018). Approximately 87,110 new cases of melanoma are diagnosed each year in the United States representing about 5.2% of all new cancer cases (Melanoma statistics, 2018). About 9,370 people die each year as a result of melanoma, representing around 1.6% of all cancer deaths and a rate of about 22.3 new cases and deaths per 100,000 men and women per year due to the disease (Melanoma statistics, 2018). Moreover, despite improvements in early diagnosis and the development of more efficacious interventions, there has been a slow but insidiously steady increase in the prevalence of melanoma over the past 25 years in the United States as shown in Figure 1 below.
Figure 1. Number of new cases of diagnosed melanoma in the U.S.: 1992 – 2014
Source: National Cancer Institute (2018) at https://seer.cancer.gov/statfacts/html/melan.html
The lifetime risk rate for developing melanoma is approximately the same for both men and women, and about 2.2% of each sex will be diagnosed with melanoma of the skin during their lives (Melanoma statistics, 2018). Likewise, the 5-year survival rates for both sexes and all races are comparable, depending on the stage at diagnosis, as shown in Figure 2 below.
Figure 2. Percent of Cases & 5-Year Relative Survival by Stage at Diagnosis: Melanoma of the Skin: Both sexes and all races in the U.S.
Source: National Cancer Institute (2018) at https://seer.cancer.gov/statfacts/html/melan.html
Although the precise causes of melanoma remain under investigation, both genetics and environmental conditions have been implicated. At present, some of the risk factors that have been identified for the disease include the following:
· Fair skin (it is important to note that people with darker skin such as Hispanics and blacks can also develop melanoma);
· A history of sunburn;
· Excessive UV light exposure (i.e., tanning booths, living at higher elevations or closer to the equator);
· Having many moles or unusual moles;
· A family history of melanoma; and,
· A weakened immune system (Risk factors for melanoma, 2018).
C. Financial Costs:
Based on their analysis of the treatment costs of melanoma during the period from 1990 through 2011, Guy, Ekwueme and Tangka (2015) calculated the overall per patient costs of melanoma as well as the costs by phase of care, stage of diagnosis as well as the health care setting and type of care received. The annual overall costs for treating all stages of melanoma were estimated at between $44.9 million for Medicare patients that had existing cases of the disease to nearly one billion dollars ($932.5 million) for newly diagnosed cases among all age groups (Guy et al., 2015).
These overall costs include the direct costs of medical care, but the costs to American society also include lost productivity and the financial burdens on families (Guy et al., 2015). Moreover, these costs differed significantly depending on the stage of diagnosis and the treatment setting, with outpatient treatments for later-stage diagnoses costing far more (Guy et al., 2015). Based on their findings, Guy and his associates (2015) conclude that, “It is clear that melanoma treatment presents a substantial economic burden, particularly among late-stage diagnoses and during the terminal phase of care” (p. 544).
D. Anatomy & Physiology/Etiology:
As noted throughout, although the precise etiology of melanoma remains under investigation, a growing body of evidence implicates UV light from the sun and/or tanning booths as a major cause of the disease (Koh, Sinks & Geller, 1999).
E. Diagnosis/Treatments/Prognosis:
Skin examinations performed individually or by a healthcare practitioner are the main way melanoma is currently diagnosed (Diagnosing and treating melanoma, 2018). A range of chemotherapy and immunotherapy interventions have been developed in recent years that have proven efficacy in treating melanoma. In this regard, Earl (2016) advises that, “Immunotherapy and chemotherapy regimens targeted for [melanoma-related] mutations have been two of the most fruitful so far in achieving remissions and longer life for advanced melanoma patients” (p. 248). The types of treatment that are used for melanoma depend on the stage of the disease, with early interventions typically involving one-time surgical excisions; in later stages, however, more aggressive surgical procedures or radiation therapy may be required (Diagnosing and treating melanoma, 2018). At present, there is a 91.7% 5-year survival rate for all new melanoma cases (Melanoma statistics, 2018). While additional research is needed to determine the reasons, the research to date also indicates that women have a slightly higher survival rate for melanoma than their male counterparts (Khosrotehrani, Dasgupta, Byrom, Youlden, Baade & Green, 2015) and that an unknown but higher number of males are at risk of developing the disease (Hood, 2009).
3. Conclusion
First identified in antiquity, melanoma has been the focus of a growing body of research due in large part to its continuing increases among the American population in general and among tanning booth and sun-bathing enthusiasts of all ages and races in particular. Although the research showed that people with fair skin are at higher risk of developing melanoma, the disease affects men and women of all ages and races. One of the more perplexing findings that emerged from the research was the fact that the risk of excessive exposure to ultraviolet lights has been consistently identified as a risk factor for melanoma, but tens of thousands of consumers continue to develop melanoma due to these largely preventable causes. In the final analysis, it is reasonable to conclude that greater efforts at public education are needed to raise awareness of the dangers of excessive exposure to ultraviolet lights while the search for a precise cause and more efficacious treatments for melanoma continue.



References
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Gershenwald, J. E., Halpern, A. C., & Sondak, V. K. (2016). Melanoma prevention-Avoiding indoor tanning and minimizing overexposure to the sun. JAMA: Journal Of The American Medical Association, 316(18), 1913-1914. doi:10.1001/jama.2016.16430
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