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Lentigo Maligna Melanoma
LMM
Lentigo maligna melanoma is a type of melanoma skin cancer. It accounts for approximately 5% of melanomas. Lentigo maligna melanomas are typically found on sun-exposed areas of the skin in adults and are clearly linked to exposure to the sun. Learn more about this rare type of melanoma of the skin.
Sun Damage
Image by Ernesto del Aguila III, NHGRI
Skin Cancer - Melanoma
Image by Blausen Medical Communications, Inc.
Source: Genetic and Rare Diseases (GARD) Information Center
Sun Damage
Image by Ernesto del Aguila III, NHGRI
Source: Genetic and Rare Diseases (GARD) Information Center
Melanoma Growth over 14 Months
Image by 0x6adb015/Wikimedia
Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. Melanoma may also appear as a new colored area on the skin.
The "ABCDE" rule describes the features of early melanoma:
Melanomas can vary greatly in how they look. Many show all of the ABCDE features. However, some may show only one or two of the ABCDE features (5). Several photos of melanomas are shown here. More photos are on the What Does Melanoma Look Like? page.
In advanced melanoma, the texture of the mole may change. The skin on the surface may break down and look scraped. It may become hard or lumpy. The surface may ooze or bleed. Sometimes the melanoma is itchy, tender, or painful.
Source: National Cancer Institute (NCI)
Skin Excisions - Benign appearance
Interactive by Mikael Häggström
In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures to find and diagnose melanoma:
There are four main types of skin biopsies. The type of biopsy done depends on where the abnormal area formed and the size of the area.
The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
For melanoma that is not likely to spread to other parts of the body or recur, more tests may not be needed. For melanoma that is likely to spread to other parts of the body or recur, the following tests and procedures may be done after surgery to remove the melanoma:
The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.
Source: PDQ® Adult Treatment Editorial Board. PDQ Melanoma Treatment. Bethesda, MD: National Cancer Institute.
Skin Cancer Screening
Also called: Skin exam, Skin self-exam
A skin cancer screening is a visual exam of the skin that looks for signs of skin cancer. Signs include moles, birthmarks, and other abnormal marks on the skin. It can be done with a self-exam and by a health care provider.
Skin Biopsy
Also called: Skin Lesion Biopsy
A skin biopsy is a procedure that removes a small sample of skin for testing. Skin biopsies are used to check for skin cancer, skin infections, or skin disorders, such as psoriasis.
Treating Melanoma with Adoptive Cell Therapy
Image by National Cancer Institute (NCI) / Steven A. Rosenberg, Mark Dudley
Surgery is the primary treatment for all stages of melanoma, particularly localized melanoma. A complete, wide local excision with sentinel lymph node biopsy and/or elective lymph node dissection is considered as standard treatment for patients with primary melanoma. Because examination of all layers of the skin is essential, shave biopsies are not recommended, and must be followed by re-excision.
Patients that present with clinically enlarged lymph nodes but no evidence of distant disease should have a complete regional lymph node dissection (LND) performed.
In absence of clinically palpable nodes, lymphatic mapping and sentinel node biopsy may be utilized to help decide whether to perform regional lymphadenectomy in patients with melanomas >1 mm in depth. If micrometastasis is found to be present in the sentinel node, lymph node dissection is performed.
Surgical treatment for patients with advanced disease involves removing metastatic tumors and/or lymph nodes, often followed by adjuvant therapy.
Melanomas are for the most part radioresistant. However, radiation therapy is sometimes used as palliative therapy for stage III and IV melanoma patients to relieve symptoms and improve the quality of life. Although radiation cannot cure advanced melanoma, it often shrinks tumors that cause discomfort. Radiation is the primary treatment for patients with CNS metastases. Postoperative radiation therapy also may help decrease residual neurological symptoms such as partial paralysis, headaches, and seizures in patients with CNS metastases.
Radiation therapy may be offered to patients who cannot be considered for surgery. It is rarely used to treat primary melanoma, except in cases where patients are poor candidates for surgery or refuse surgical treatment.
Radiation therapy has also been applied to the regional lymph node basin to try to prevent recurrence of the tumor after surgery.
Even if the surgical margins are found to be clear, some patients are offered chemotherapy as adjuvant therapy to kill any cancer cells that may be left. Chemotherapy is an adjuvant treatment often used for Stage IV disease and recurrent melanomas, and for lower stages if surgery is contraindicated.
However, chemotherapy as adjuvant treatment for patients with advanced-stage melanoma (stage IV) has been found to have only partial success. Chemotherapy drugs for the treatment of melanoma may be administered singly or in combination, or in conjunction with immunotherapy.
The most effective chemotherapy regimen to-date is the single-agent dacarbazine (DTIC), which is only successful in 10-15% of cases. Two combination chemotherapy regimens commonly used in the treatment of patients with advanced-stage melanoma are the cisplatin, vinblastine, and DTIC (CVD) regimen and the Dartmouth regimen, which is a combination of cisplatin, DTIC, carmustine, and tamoxifen.
When melanoma occurs in the extremities, chemotherapy agents may be delivered via hyperthermic isolated limb perfusion. With this technique, the blood flow to and from the limb is stopped using a tourniquet, and a warmed solution of chemotherapy drug is administered directly into the blood of the limb, allowing higher doses of drugs to be dispensed than with systemic treatment.
Hormonal therapy slows or actually stops the growth of certain types of cancer by increasing or eliminating hormonal levels or blocking hormonal action in the body. Hormonal treatment of melanoma has been investigated since the early 1970s. The use of tamoxifen (a hormonal therapy drug used effectively to treat breast cancer) to treat melanoma is controversial. As a single agent, tamoxifen has been found to have a success rate of only 6%. However, recent findings have shown the combination of dacarbazine and tamoxifen for metastatic melanoma to be effective in approximately 30% of cases, a benefit observed primarily among women.
Similarly, a chemohormonal regimen consisting of tamoxifen, dacarbazine, carmustine, and cisplatin, called the Dartmouth regimen, has been shown to produce a high response rate in patients with metastatic disease.
Another hormonal therapy being evaluated is daily oral melatonin. Melatonin is a melanocyte-suppressive hormone that has been found to suppress tumor growth and stimulate the immune system in animal models.
For treatment of melanoma, biological therapy is often utilized as adjuvant therapy following surgery to remove the melanoma, and is also used to treat advanced and recurrent melanoma.
Adjuvant interferon (IFN) alfa-2b and various experimental melanoma vaccines show potential in individuals with high-risk melanoma and those with regional nodal disease.
Biologic response modifiers such as GM-CSF, interleukins (IL-2, IL-12), and IFN gamma are often integrated into vaccine strategies. Although there is currently no clinical trial data that demonstrates a survival benefit for vaccine-treated melanoma patients, multiple studies are in progress.
Anti-angiogenesis therapy is a type of biological therapy that uses angiogenesis inhibitors to prevent or alter the growth of new blood vessels that feed malignant tumors, including melanomas.
Gene therapy consists of introducing new genetic material to damaged genes or cancer cells. The purpose of gene therapy is to exchange damaged cells with healthy ones, and to enhance the sensitivity of the melanoma cells to the immune system, immunotherapy, and chemotherapy.
Source: National Cancer Institute (NCI)
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