Melanoma is a serious type of skin cancer that originates from melanocytes in the skin. If not treated in a timely manner, this cancer can metastasize to other organs, posing a threat to life. According to statistics, the incidence of melanoma continues to rise globally, closely related to increased ultraviolet (UV) exposure and genetic factors. Early diagnosis and treatment are key to improving cure rates, making public awareness crucial.
Melanoma lesions typically appear on the skin's surface but can also occur in non-skin areas such as the eyes, mucous membranes, or internal organs. The disease progresses rapidly, but if detected early, surgical removal often achieves a curative effect. In recent years, advancements in immunotherapy and targeted therapy have provided more treatment options for advanced patients. Understanding its causes, symptoms, and diagnostic methods can help the public take timely action.
The causes of melanoma are complex, involving the interplay of genetic and environmental factors. Long-term exposure to ultraviolet (UV) radiation is the primary environmental trigger, especially UVA and UVB wavelengths that can damage DNA and induce genetic mutations in melanocytes. Clinical studies indicate that a single severe sunburn (especially during childhood or adolescence) significantly increases risk, while repeated sun exposure exacerbates this risk.
Genetic predisposition plays a key role in about 10% of cases, with certain gene mutations such as CDKN2A and BRAF mutations associated with family history. Additionally, individuals with weakened immune systems (such as those on immunosuppressants after organ transplants) or specific hereditary syndromes (such as xeroderma pigmentosum) are at higher risk. Other risk factors include:
The symptoms of melanoma typically manifest as skin lesions, with common presentations including:
Some lesions may be accompanied by symptoms such as itching, bleeding, or ulceration. Non-skin melanoma (such as intraocular or mucosal melanoma) may present as vision abnormalities, mucosal ulcers, or unexplained bleeding. If changes in the skin or mucous membranes are observed, immediate medical evaluation is necessary.
Diagnosing melanoma typically involves two phases: initial screening and pathological confirmation. First, a dermatologist will conduct a visual examination and dermatoscopy to assess whether the lesions meet the "ABCDE rule" criteria. If malignancy is suspected, a biopsy is required to confirm cytological characteristics. The pathology report will evaluate the depth of cancer cell invasion (e.g., Clark level) and molecular markers (e.g., BRAF gene mutation), which are crucial for treatment strategies.
Further diagnosis may include imaging studies, such as ultrasound to evaluate lymph node metastasis, CT or PET-CT scans to check for distant organ metastasis. For suspected advanced patients, physicians may recommend genetic testing to develop personalized treatment plans. The accuracy of early diagnosis depends on the patient's awareness of symptoms, and regular self-examination of the skin is key to prevention and early detection.
Treatment plans are tailored based on the stage of cancer and the presence of metastasis. The first-line treatment for early localized melanoma (stages 0-III) is surgical excision, typically requiring a safety margin of 2-3 centimeters. For high-risk patients, sentinel lymph node biopsy may be performed to assess the risk of metastasis. If metastasis to lymph nodes has occurred, additional immunotherapy or targeted drugs may be administered post-surgery.
The treatment for advanced or metastatic melanoma (stage IV) relies on systemic therapy. Immune checkpoint inhibitors (such as anti-PD-1/PD-L1 monoclonal antibodies) can stimulate the immune system to attack cancer cells. Targeted therapy focuses on BRAF or MEK gene mutations, such as the combination therapy of vemurafenib and trametinib. Chemotherapy is used less frequently in modern treatment but may still be an option for specific cases. Radiation therapy is typically used for symptom relief rather than cure.
The core of melanoma prevention lies in reducing UV exposure. Daily sun protection measures include:
High-risk groups (such as those with a positive family history) should increase the frequency of monitoring. Studies have shown that a history of childhood sunburn is associated with an increased risk of melanoma, making sun protection education during childhood extremely important. Avoiding tanning beds can reduce the risk of artificial UV exposure. Genetic testing can assist families with hereditary risks in conducting preventive monitoring.
If you notice the following conditions, seek medical attention immediately:
Symptoms of non-skin melanoma are harder to detect; if you experience unexplained vision changes, mucosal ulcers, or persistent skin ulceration, seek medical attention immediately. Regular skin examinations help with early detection, especially for high-risk groups with a history of sunburn or family history, who are advised to undergo professional checks annually.
It is recommended to use the "ABCDE criteria" for examination: A (Asymmetry), B (Border irregularity), C (Color unevenness), D (Diameter greater than 6 millimeters), E (Evolution in shape or size). Observe your entire skin under natural light at a fixed time each month, paying special attention to hard-to-see areas like the back and soles of the feet; mirrors or assistance from family members can be helpful.
What long-term follow-up checks do patients need after melanoma surgical excision?Post-surgery, patients typically require skin examinations every 3-6 months, with lymph node ultrasounds or whole-body scans scheduled based on malignancy severity. High-risk patients may need blood marker testing or genetic analysis to monitor recurrence risk. Physicians will develop personalized follow-up plans based on the patient's condition, and patients should regularly return for check-ups and document skin changes.
Besides the skin surface, where else can melanoma occur?Melanoma is not limited to the skin; mucous membranes (such as the mouth, nasal cavity, and around the genitals), eyes (choroidal melanoma), and nail beds can also be affected. Lesions in these areas are harder to detect early; if unexplained mucosal ulcers, iris discoloration, or black spots under the nails occur, immediate medical evaluation is necessary.
Is there scientific evidence that daily sun protection measures reduce melanoma risk?Research confirms that long-term UV exposure induces DNA damage, increasing the risk of malignant transformation. It is recommended to use broad-spectrum sunscreen (SPF 30 or higher) and combine it with physical barriers (such as hats and long-sleeved clothing). Additionally, avoiding outdoor activities during peak sunlight hours can significantly reduce the harmful effects of UV exposure.
Should individuals with a family history undergo genetic testing to assess risk?If there are two or more first-degree relatives with melanoma or if they carry related gene mutations such as CDKN2A, it is advisable to consult a geneticist for genetic screening. The results of genetic testing can help formulate more proactive screening strategies, such as increasing check-up frequency or employing imaging monitoring, but the necessity should be assessed by a professional medical team.
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