DISTRIBUTION OF MELANOMA

Distribution of Melanoma William Landa California State University San Bernardino

DISTRIBUTION OF MELANOMA Introduction One of the most drastic threats to both personal and public health comes in the form of cancer. Cancer is defined by the National Cancer Institute (2010) as a disease characterized by uninhibited cell growth that may invade other tissues in the body. There are numerous types of cancer, which are mostly named for the type of organ, tissue or cell that the cancer originates from. For example, carcinoma is a type of cancer that will develop in the skin tissue and tissue lining the internal organs. The skin is the largest organ in the body, and appropriately skin cancer is the most common form of cancer. The general term skin cancer encompasses all types of cancer including the most common three: basal cell skin cancer, squamous cell skin cancer, and melanoma. While melanomas make up only about 5% of all skin cancers, they are the most fatal (American Cancer Society, 2013). Definition and Description of Melanoma As stated earlier cancer is the uncontrolled growth of cells that invade and damage surrounding tissue. Uncontrolled cancerous growth from Melanocytes is termed melanoma. Melanocytes are skin cells found in the uppermost layer of the skin, the epidermis, that produce melanin which gives the skin a brown or black tint. Melanoma is unique to other skin cancers in that it is far less common but has a higher case fatality rate. A melanoma tumor will be detected on the skin of the affected patient. An abnormal looking mole, or nevus, will be identified as cancerous by criteria such as irregular shape, color, border, symmetry, and growth. A diagnosis will be completed by doctors by removing the suspected mole and running tests on the removed tissue. After diagnosing the mole as melanoma, further tests will be done to determine the extent of the cancer. The progression of the disease is classified into stages ranging from the cancer being localized on the skin to the cancer metastasizing to other, distant organs in the body.

DISTRIBUTION OF MELANOMA Uncontrolled cell growth in melanocytes may result in two different types of tumors: benign and malignant. Begnin tumors are not dangerous because they will not invade neighboring tissue and therefore will not be able to travel to other sites in the body. When a tumor becomes malignant it will be considered cancerous; a malignant tumor will pose a threat to health by having the potential to invade neighboring tissue. In a worst case scenario, malignant melanoma may enter the lymphatic or circulatory system and end up in parts of the body far away from the skin such as the lungs or kidney. This migration of cancerous cells to different parts of the body is called metastasis. If the melanoma reaches a stage of metastasis then the prognosis of the patient becomes drastically worse. There are several treatment options for melanoma. Choice of treatment depends on the stage of cancer as well as personal factors of the patient. Survival rates of people diagnosed with melanoma depend on the stage of disease at diagnosis and also personal factors such as age. 5 year survival rates range from 97% for the earliest stage diagnosis to 15-20% for the latest stage at diagnosis. 10 year survival rates range from 95% for the earliest stage diagnosis to 10-15% for the latest stage at diagnosis. These rates show us that survivorship varies greatly from early stage detection to late stage detection. This wide range of variation places emphasis on early detection of the disease in high risk patients (American Cancer Society, 2013; National Cancer Institute, 2010). Causative agents and etiology Cancer is a chronic disease with a typically long latency time between exposure and occurrence of the disease. Chronic diseases generally arise from a complex mix of various exposures to risk factors that differ from lifestyle behaviors to environmental chemicals, to genetic predispositions. Melanoma is no less etiologically complex than any other chronic disease; there is no known direct cause of melanoma, but instead there is general knowledge of why cancer occurs and also a known mix of factors that leave individuals at a higher risk for developing a melanoma tumor.

DISTRIBUTION OF MELANOMA Cancer is caused by a mutation in cell genes that turns off tumor suppressing genes. Specific genes are suspected in specific types of cancers. In melanoma for example, genetic diagnostics on removed tumors have found that the majority, as much as 82% of cancerous moles in one study, of removed cancerous moles had BRAF gene mutations. These mutations are a crucial piece, but not completely necessary for melanoma to occur (Pollock et al., 2003). Germ line mutations have also been found to play a role in the etiology of melanoma. Inherited mutations of the tumor genes CDKN2A and CDK4 have been shown in many studies to play a key role in allowing uncontrolled growth of melanocytes. However, these germline mutations do not even account for 30% of all family related cases of melanoma and so research continues to try and identify other inheritable genes that may play a role in melanogenesis (Meyle & Guldberg, 2009). Specific etiologic pathways for melanoma are complex and thus far unknown (American Cancer Society, 2013). Regardless of whether scientists can determine the exact cause of disease, there are a mix of known risk factors that have been identified, whose implications have real world value in prevention and detection of melanoma. Categories of risk factors for melanoma include exposure to UV light rays, presence of irregular moles, presence of fair skin and hair, family history, age, gender, immune suppression, and personal history. These risk factors are not causative; they instead alter a persons chance of developing melanoma. The presence of one or more risk factors does not guarantee development of the disease, and conversely the disease can emerge with few to none of the risk factors present. Some risk factors are more prominent then others. For example, UV light exposure is thought to account for the majority of all skin cancers, with UVB light rays being the main culprit (American Cancer Society, 2013). A meta-analysis of 57 studies looking specifically at the relationship between UV exposure and melanoma found that UV exposure, including sun light and artificial light, just about doubles the relative risk of getting melanoma. The combination and interaction of risk factors is complex; the incidence of melanoma cannot be explained by the presence of UV light alone. The presence of

DISTRIBUTION OF MELANOMA moles is another factor that greatly affects relative risk. The presence of moles is a direct result of sun exposure and therefore would be considered a host factor (Gandini et al., 2011). Other prominent risk factors such as age, gender, and race are built into the epidemiological description of melanoma seen below. Epidemiological description of disease Similar to other cancers, onset and diagnosis of cancer is more common in older adults than in young children. The median age of diagnosis between the years of 2006 to 2010 was 61. Risk of melanoma in younger age groups is low; of the total number of diagnosis between 2006 and 2010 .6% were in the under 20 age group, 6.5% were in the 20 to 34 age group, and 10% were in the 34 to 45 age group. A steep increase in risk is seen as age increases; 17.8% of cases are found in the 45 to 48 age group, 21.8% of cases are found in the 55 to 64 age group, and 19.6% of cases are found in the 65 to 74 age group. There is a decline in incidence later in life; 16.8 % of cases are diagnosed between the ages of 75 and 84 and only 7.0% of cases in the age of 85 and up (Howlander et al., 2012). Although melanoma incidence is much higher in the older adult population, the age-based distribution relative to other cancers in the younger population is of great significance. Relative to other cancers, melanoma is more commonly diagnosed in the younger portion of the population; between 1975 and 2000, melanoma was the second most commonly diagnosed cancer in adolescents and young adults between the ages of 15 and 29. Between the ages of 25 to 29 melanoma is the most commonly diagnosed cancer (Gandini, 2011). While only a small percentage of all melanomas diagnosed are found in the child and adolescent population, melanoma is the most common skin cancer in people under the age of 20. Also notable is the fact that, along with an overall increase in incidence of melanoma, Incidence rates of melanoma have been steadily rising in children and adolescents under the age of 20 by about 2% per year between 1973 and 209 (Wong et al. 2013).Whether the reason for this increase has to do with an actual increase in disease or just more successful screening and diagnostic tools is..