Melanoma is a very serious form of Skin cancer. It begins in melanocytes cells that make the Skin pigment called melanin. Although melanoma accounts for only about 4% of all Skin cancer cases, it causes most Skin cancer-related deaths. The good news is that melanoma is often curable if it is detected and treated in its early stages. For more information, see Skin cancer section. In men, melanoma is found most often on the area between the shoulders and hips or on the head and Neck. In women,

melanoma often develops on the lower legs. It may also appear under the fingernails or toenails or on the palms or soles. The chance of developing melanoma increases with age, but it affects all age groups and is one of the most common cancers in young adults.

Skin

Skin Eye

CUTANEOUS MELANOMA

Seventy per-cent (70%) of cutaneous melanomas are “superficial spreading”, meaning that they have a superficial radial growth phase before they mature/clone and begin to invade vertically. The majority of melanomas could therefore potentially, at least in theory, be cured if they were diagnosed early enough and excised with adequate margins. It is mostly the superficial spreading melanomas that are increasing in incidence globally. Twenty per-cent (20%) of cutaneous melanomas are Nodular Malignant Melanoma, and they do not have a radial growth phase, at all. Instead, they start out with a vertical growth phase, which explains why they are more aggressive. The other ten per-cent (10%) of the cutaneous melanomas include Lentiginous Malignant Melanoma, a slow growing, extended radial growth phase, on sun exposed Skin, mostly on the face and Neck.

ACRAL LENTIGINOUS MELANOMA

Found on the palms, soles and nail beds, also in Asians and African Americans; has a radial growth phase initially but diagnosis is often delayed, perhaps because it looks like a wart or fungus.

DEMOPLASTIC MALIGNANT MELANOMAS

A scar like lesion which delays diagnosis, is not very aggressive even though it starts to grow in the vertical growth phase, but may spread to the Lungs.

GIANT MELANOCYTIC NEVUS

Giant Melanocytic Nevus is defined as a mole present at birth and measuring more then 20 cm diameter. Up to five per-cent (5%) of these giant birthmarks may develop into melanomas.

AMELANOTIC MALIGNANT MELANOMA

Is without melanin pigment. Not having the “darkness” of “typical” melanoma they can be very difficult to recognize. They show up as pink or red growths.

Melanomas are not usually painful. The first sign of melanoma is often a change in the size, shape, colour, or feel of an existing mole. Melanomas also may appear as a new, black, or abnormal mole. Symptoms result from the uncontrolled growth of cancer cells. It's important to remember that most people have moles, and almost all moles are benign.

CT Scan -Llooks for melanoma in Abdomen (bowel + Liver) and Chest (Lungs and lymph nodes). PET Scan – Looks for ‘metabolically active’ areas in the body which may be melanoma. MRI Scan – Used (primarily) to determine if the Brain has any melanoma involvement. Bone Scan – Uses radioactive material to find if any Bone involvement with your melanoma. Blood Work – Non-specific indicator that melanoma maybe involved in several organ systems. Sentinal Node Biopsy – Looks for involvement of lymph nodes that melanoma may spread to from its primary site. Ultrasound – Use of sound waves to try to make a diagnosis of melanoma (usually in solid organs).

The goal is pain management not only relief from pain, but also the maintenance of your normal quality of life. All methods of pain management attempt to either control the cause of the pain or alter your perception of it. Although pain management techniques are many and varied, therapeutic approaches can be classified as either pharmacological or non-pharmacological. Pharmacological pain control involves the use of analgesics, as well as other medications that intensify the analgesics' effects or modify your mood or pain perception. Non-pharmacological approaches include

Behavioural techniques Radiation Surgery Neurological and neurosurgical interventions Traditional nursing and psychosocial interventions

The latter measures attempt to promote your comfort and evaluate the effectiveness of the therapy. Because of the complex nature of cancer-related pain, successful management usually involves a combination of techniques.

Thick malignant melanomas (greater than or equal to 3.0 mm), in general, have a poor prognosis and as a direct result these lesions tend to receive less clinical and pathological interest all thick melanomas have a poor prognosis, and that there appears to be a subset of these thick lesions with a lower metastatic potential.

Haemorrhagic complication in an unsuspected macular choroidal melanoma