Melanoma is one of the most aggressive types of skin cancer – it can grow and spread quickly to the lungs, liver and brain compared to most other types of skin cancers (e.g., basal cell carcinomas or squamous cell carcinomas). The best way to treat melanoma early on is through early detection using the ABCDE criteria for warning signs: A is for asymmetry, B is for irregular borders, C is for uneven colour, D is for large diameter, and E is for evolving changes of a mole. Modern immunotherapy, such as Keytruda, has improved the prognosis for patients with advanced melanoma.
Key Takeaways
Melanoma is a much more aggressive skin cancer than many others because it may metastasise quickly to sites such as the lungs, liver and brain.
Early identification of melanoma is important through observation and recognition of warning signs (ABCD).
Unlike other skin cancers, melanoma may occur in areas that are not easily visible, such as beneath hair, on the palms or soles of the feet, or under the nails.
Early-stage melanoma has a very high cure rate; however, if left untreated, a patient's ability to obtain effective treatment becomes more limited and complicated.
Keytruda (an immunotherapeutic agent) can substantially improve the prognosis of patients with advanced melanoma.
Most people assume skin cancer is skin cancer. One type, one risk, one treatment path. That assumption is understandable but genuinely dangerous. Skin cancers span a wide spectrum of severity, and at the far end is one type that behaves unlike anything else. Understanding that difference is not just medically interesting. It can be lifesaving.
Who Is Most at Risk
Although people who have lighter complexions tend to have a greater than average chance of developing skin cancer, people who have darker complexions are also prone to developing skin cancer because they do not receive as much information on early detection. In addition, those with a history of receiving bad sunburns, people whose immune systems are compromised, and people who have relatives who have had unusual skin changes have an increased chance of developing skin cancer. There has also been an increase in cases amongst younger people being diagnosed with more aggressive types of skin cancer than previously thought possible.
What Makes This Cancer Genuinely Different
Most skin cancers, such as basal cell and squamous cell carcinomas, have a slow-growing, localised behaviour and respond well to surgical removal. Melanoma differs from other skin cancers because the cells that produce the pigment are called melanocytes. How does melanoma differ:
Melanoma spreads to the lymph nodes, lungs, liver and brain much quicker than the other skin cancers
Melanoma can form in areas of the body that see little sun, like the scalp, the bottom of the feet or under nails
Melanoma will sometimes start in a pre-existing mole, causing it to be overlooked in the early stages
A patient diagnosed with stage 1 melanoma (the earliest stage of melanoma) has a greater than 95 % chance of surviving for five years. Stage 4 historically indicated a median survival of less than one year, but thanks to modern treatments, this is no longer the case.
Where on the Body It Appears
Men typically develop melanoma on their backs, but women develop melanoma on their legs, although melanoma can develop anywhere. The ABCDE rule outlines basic features to look for when doing a quick self-check for melanoma:
- Asymmetry - one-half of the mole does not match the other half
- Border - irregular or unclear edges
- Colour - multiple colours within a single spot
- Diameter - greater than 6 mm in size
- Evolving - any change in the size, shape, colour or if there is blood from it
If you find a mole with 1 or more of the characteristics from this list, then it is important that you make an appointment with a dermatologist ASAP, not just wait to see if it changes.
When Treatment Becomes Complex
Surgery with clear margins is how you treat early melanoma, but the biggest challenge is when the cancer has spread beyond the skin. At this point in time, the patient needs some type of systemic therapy rather than just surgery. This is where immunotherapy has fundamentally changed the playing field for patients who have advanced disease.
Why Immunotherapy Rewrote the Outlook
For decades, advanced melanoma was one of the most treatment-resistant cancers. Chemotherapy produced limited and short-lived responses. That changed with checkpoint inhibitors, drugs that remove the mechanism cancer uses to hide from the immune system.
Pembrolizumab is one of the most studied checkpoint inhibitors in oncology today. It blocks the PD-1 pathway that tumours exploit to avoid immune detection, allowing the body's own immune cells to recognise and attack cancer more effectively. Clinical trials have shown durable responses in advanced melanoma patients, including long-term remission that was virtually unheard of in this disease a decade ago.
How Treatment Works in Practice
Every 3 to 6 weeks, Keytruda 100mg Injection (Pembrolizumab) is administered by IV under an oncologist's supervision in a clinical setting. The patient is to be aware of the different immune-related side effects:
- Fatigue/Skin rashes within 2-4 weeks.
- Possibly, some lung, liver, or colon inflammation.
- Thyroid issues need to be routinely monitored.
- More serious autoimmune reactions happen very infrequently and require immediate attention.
It is necessary for the patient to have regular blood tests/imaging and to maintain close communication with their treating oncologist.
Final Thoughts
There are different types of skin cancer. There can be a vast difference between a benign lesion that can be treated in the office and an aggressive lesion that requires systemic therapy. It's critical that patients know there are differences and be aware of early warning signs, so they can seek an evaluation immediately. Advances in medicine have enabled the development of many ways to treat, and even cure, conditions once considered untreatable. The outcome depends heavily on how the patient or healthcare provider perceives the presence of early warning signs.
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