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Malignant Melanoma: Pathology and Epidemiology Case Study

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Updated: Jun 30th, 2021

This paper studies malignant melanoma, one of the most dangerous types of cancer in the world. It discusses its pathology and epidemiology and presents information about its incidence. The paper addresses risk factors associated with the disease, including sun exposure, as well as host and environmental factors. It also studies the role of genetics and personal behavior in melanoma acquisition. Finally, the paper discusses the role of healthcare services and self-diagnosis in disease prevention and decreased mortality rates.

Pathology and Epidemiology of Melanoma

Melanoma is the most rapidly growing type of cancer in the world, as well as the fifth leading cancer in men and the seventh in women in America (Nikolaou & Stratigos, 2014). There has been an increase in melanoma incidents over the past several decades. In the US, the incidence of the disease has grown from approximately 8,5 cases per 100,000 population in 1975 to around 35 cases in 2010 (Berwick et al., 2016). There is a globally observed dramatic increase of incidents in the 60 and more years old age group (Nikolaou & Stratigos, 2014). The number of melanoma cases does not correspond with mortality rates, which have remained stable since the 1980s. The reason for it is the trend for an expanded skin screening and earlier detection of the disease at a potentially curable stage. The location of melanoma on human bodies varies and depends on their age and is usually truncal for young people and can be found on the necks or heads of older people.

Nikolaou and Stratigos (2014) report that the highest incidence of the disease worldwide is presented in New Zealand and Australia, each having up to 60 newly diagnosed patients per 100,000 population annually. The male/female ratio differs among the countries, but the predominance of melanoma in men has been reported in countries with high disease incidence, including America. Most Northern and Western European countries, however, disclose a higher percentage of women having melanoma, while in Central Europe it prevails in men (Nikolaou & Stratigos, 2014). Both females and males should equally protect themselves from the disease.

Risk Factors

Sun Exposure

There are several risk factors associated with the disease; the primary one is sun exposure. In America, Canada, Australia, and Nordic countries, the proportion of melanoma incidents related to sun exposure is more than 90%, and between 80% and 90% in the majority of European countries (Berwick et al., 2016). The authors report that an irregular pattern of sun exposure can raise the risk of the disease. Short periods of sunbathing and other outdoor activities damage the skin as it is not protected from the sun. Intermittent sun exposure is most dangerous for humans as there is no epithelial thickening and tanning effect on the skin. At the same time, chronic sun exposure can have an adverse influence on humans, but it shows a weak association with melanoma because the skin receives extra protection with tan (Berwick et al., 2016). It is clear that people living in sunny areas are at higher risk of the disease; however, any individual can have melanoma.

Host Factors

Several groups of people are at higher risk of acquiring the disease than other ones. For example, fair-skinned individuals are more likely to acquire melanoma than people with darker skin are. The other risk factors include poor tanning ability, freckling, and multiple naevi, as well as dark hair color and light eye color (Nikolaou & Stratigos, 2014). It is crucial to mention that children are more sensitive to sun exposure than adults are, which makes them a risk group as well.

The number and type of nevi are primary host factors contributing to the development of the disease, as it modifies an individual’s response to sun exposure. Berwick et al. (2016) report that individuals with less than 15 nevi are at a seven times smaller risk of melanoma than the ones having more than 100 nevi. The size of the nevus is also significant, as it can increase the chances of disease as well. Atypical nevi are known to be the factors influencing the disease as well. Notably, increased sun exposure in the early years of life can result in a greater number of nevi and the occurrence of dysplastic ones (Berwick et al., 2016).

Environmental Factors

Several environmental factors are contributing to the disease as well. For example, Berwick et al. (2016) suggest that exposure to benzene and other chemicals usually used in printing, as well as to ionizing radiation, can contribute to the development of melanoma. Risk factors may also include exposure to chromium and organochlorine compounds, including chlorine-based pesticides (Berwick et al., 2016). It means that people working in factories and chemical or electronic industries are at higher risk of melanoma.

Role of Genetics

The study by reading, Wadt, and Hayward (2016) report that positive family history is related to an increased risk of the diseases. The researchers point out that although the primary causes of melanoma are randomly acquired mutations within melanocytes, the presence of a heritable gene can increase susceptibility to the disease significantly. The most common gene related to familial melanoma is the cyclin-dependent kinase inhibitor 2A (Read et al., 2016). Genetics can also contribute to other types of the disease, including pancreatic cancer. Moreover, melanoma risk genes may interact with other factors to affect the contraction of the disease. However, it is necessary to mention that no germline alternation guarantees the occurrence of melanoma.

Role of Personal Behaviors

Individuals’ behavior can have a crucial role in the disease. As exposure to the sun is the primary cause of melanoma, people need to be cautious during outdoor activities. Tan is perceived as an attribute of a healthy and wealthy individual; however, spending time under the sun can cause severe damages to health. Many people prefer not to use sun protection, including clothing items and sunscreen because they are not aware of the adverse consequences of sun exposure. Moreover, some individuals suppose that the sun is not dangerous to the darker skin. Such ignorance can lead to inevitable consequences and poor health conditions.

To reduce the risk of melanoma, individuals should utilize sun protection methods both in summer and in winter. Those methods may include using sunscreen, wearing a hat, and avoiding exposure to the sun during the day. Moreover, they should consider seeing a medical professional if they have multiple nevi or moles, especially if they have an atypical shape or size. Finally, individuals that are often exposed to the sun should undergo preventive skin screening to increase the chance of early diagnosis.

Diagnosis and the Role of Healthcare Services

The key factor in decreasing mortality is the early detection of malignant melanoma. Healthcare services in many countries, including America, Brazil, Australia, and others, have contributed to the lower level of incidence by promoting prevention methods and early diagnosis during campaigns. However, the topic remains acute, as many people cannot visit a medical professional for testing. For example, Escobedo et al. (2017) note that in the US, only 30% of the population receive insurance from public or government programs, which means that many Americans do not have access to care and, specifically, cannot utilize preventive methods, such as skin screening. Rastrelli, Tropea, Rossi, and Alaibac (2014) suggest that self-examination can be an essential part of the early diagnosis for those who cannot afford professional assistance. Individuals may use the ABCD (Asymmetry, Border Irregularity, Color variegation, Diameter) criteria or a Glasgow 7-point checklist to recognize the disease in its early stages.

For diagnosis, healthcare services use dermoscopy or epilumenescent microscopes as non-invasive methods of skin observation. Melanoma-specific criteria include atypical pigment network, irregular dots or globules, irregular streaks or pigmentation, regression structure, vascular pattern, and the blue-whitish veil (Rastrelli et al., 2014). Modern techniques of diagnosis also include total body photographic images and short-term surveillance. Unlike other types of cancer, malignant melanoma is located on a patient’s skin, which makes the early diagnosis possible.

Conclusion

Melanoma is a dangerous condition that has to be addressed and discussed as many people are at risk of the disease. It is mainly caused by sun exposure, although there are environmental and genetic factors that contribute to its acquisition. Melanoma can be prevented by the use of protection methods, avoiding sunbathing, and seeing a medical professional in case of multiple naevi. It is crucial to raise awareness of the risk factors to decrease the incidence of the disease.

References

Berwick, M., Buller, D. B., Cust, A., Gallagher, R., Lee, T. K., Meyskens, F.,… Ward, S. (2016). Melanoma epidemiology and prevention. In H. L. Kaufman & J. M. Mehnert (Eds.), Melanoma (pp. 17-49). Cham, Switzerland: Springer.

Escobedo, L. A., Crew, A., Eginli, A., Peng, D., Cousineau, M. R., & Cockburn, M. (2017). The role of spatially-derived access-to-care characteristics in melanoma prevention and control in Los Angeles County. Health & Place, 45, 160–172.

Nikolaou, V., & Stratigos, A. J. (2014). Emerging trends in the epidemiology of melanoma. British Journal of Dermatology, 170(1), 11-19.

Rastrelli, M., Tropea, S., Rossi, C. R., & Alaibac, M. (2014). Melanoma: Epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo, 28(6), 1005-1012.

Read, J., Wadt, K. A., & Hayward, N. K. (2016). Melanoma genetics. Journal of Medical Genetics, 53(1), 1-14. Web.

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