". The majority of melanomas, therefore, are black or brown. However, melanomas occasionally stop producing pigment. When that happens, the melanomas may no longer be dark, but are skin-colored, pink, red or purple."

"Everyone is at some risk for melanoma, but increased risk depends on several factors: sun exposure, number of moles on the skin, skin type and family history (genetics). "

"If you are in any of these risk groups, you can protect yourself and your children by "

". The first signs can appear in one or more of these moles. That's why it's so important to get to know your skin very well, so you can recognize any changes in the moles on your body.  Look for the "

"s of melanoma, and if you see one or more, make an appointment with a dermatologist immediately. "

"If you draw a line through this mole, the two halves will not match, meaning it is asymmetrical, a warning sign for melanoma."

"The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched."

"Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, white or blue."

"Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 inch or 6 mm), but they may sometimes be smaller when first detected."

"Any change ? in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting ? points to danger."

"Prompt action is your best protection.  As illustrated by the pictures below, common moles and melanomas do not look alike.  "

"; the fourth is invasive from the start.  Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body."

" is by far the most common type, accounting for about 70 percent of all cases. As the name suggests, this melanoma travels along the top layer of the skin for a fairly long time before penetrating more deeply."

"The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat geometrical in form. The color varies, and you may see areas of tan, brown, black, red, blue or white. This type of melanoma can occur in a previously benign mole.  The melanoma can be found almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both. Young people who have melanoma usually have this type. "

" is similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration."

" melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms, and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii.  When this cancer becomes invasive, it is referred to as "

" also spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians. "

" is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. It is usually black, but occasionally is blue, gray, white, brown, tan, red or skin tone."

"The most frequent locations are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men. This is the most aggressive of the melanomas, and is found in 10 to 15 percent of cases."

"Once the type of melanoma has been established, the next step is to classify the disease as to its degree of severity. "

"Classifications for melanomas are called stages.  The stage refers to both the thickness and the degree to which the melanoma has spread.  How advanced the cancer is will determine treatment, so a number of diagnostic techniques are employed to determine the stage."

"Early melanomas (Stages I and II) are localized, and advanced melanomas (Stages III and IV) have spread to other parts of the body, or "

"The most important factors in the staging system are the thickness of the tumor, known as "

" and the deepest point of the tumor's penetration.  The thinner the melanoma, the better the chance of a cure. "

"The presence of microscopic ulceration moves the tumor into a later stage.  Your doctor may elect to treat a tumor with ulceration more aggressively because of this."

" This is also subdivided according to gradations in thickness and/or depth, and the presence or absence of ulceration."

"By the time a melanoma advances to Stage III or beyond,an important change has occurred. The Breslow's thickness is by then irrelevant and is no longer included, but the presence of microscopic ulceration continues to be used in staging, as it has an important effect on the progression of the disease. At this point, the tumor has either spread to the lymph nodes ? small "

" located in various locations within the body that fight cancer, disease and other infections ? or to the skin between the primary tumor and the nearby lymph nodes."

". A tumor is assigned to Stage III if it has metastasized or spread. This can be determined by examining a "

" of the node nearest the tumor, known as the sentinel node. Such a biopsy is now frequently done when a tumor ismore than 1 mm in thickness, or when a thinner melanoma shows evidence of ulceration. As the "

" biopsy is not considered necessary in all cases, you may wish to discuss the matter with your physician. In-transit or satellite metastases are also included in Stage III. In this case, the spread isto skin or underlying tissue (subcutaneous) for a distance of more than 2 centimeters (1 cm equals 0.4 inch) from the primary tumor, but not beyond the regional lymph nodes. In addition, the new staging system includes metastases so tiny they can be seen only through the microscope."

". The melanoma has metastasized to lymph nodes far away from the primary tumor or to internal organs, most often the lung, followed in descending order of frequency by the liver, brain, bone, and gastrointestinal tract."

"When it comes to the early stages of the disease, the future is bright.  Most people with thin, localized melanomas are cured by appropriate surgery.  "

"For people with more advanced disease, there is still good news.  The cure rate continues to rise.  Treatments are varied and many; new discoveries are being made to improve the chances of those with metastatic disease."

" The first step in treatment is the removal of the melanoma, usually by surgical excision (cutting it out).  Most surgical excisions ? also called resections ? are done in a doctor's office or as an outpatient procedure using local anesthesia. Scars are usually small and improve over time."

". If the melanoma is larger and requires more extensive surgery, a better cosmetic appearance can be obtained with flaps made from skin that is near the tumor, or with grafts of skin taken from another part of the body. For grafting, the skin is removed from areas that are normally or easily covered with clothing. "

"In today's technique, much less of the normal skin around the tumor is removed. The borders of the entire area to be excised ? both tumor and healthy skin ? are known as the "

". Margins are much narrower than they ever were before. Most surgeons today are following the guidelines recommended by the National Institutes of Health (NIH) and the American Academy of Dermatology Task Force on Cutaneous Melanoma:"

"Once the melanoma has progressed beyond stage II, the key question is whether it has spread beyond the original site. If so, it is most likely to have reached the lymph nodes closest to the tumor."

"To find out whether melanoma cells have spread, the physician starts by feeling the nearby lymph nodes. If the melanoma is on the arm, the nearest nodes are in the armpit; if on the leg, they are in the groin. For a melanoma on the head, the closest lymph nodes are usually on the neck on the same side. For a tumor on the trunk, the nodes in either the armpit or the groin could be involved."

"When an enlargement or lump in a lymph node can be recognized by touch, it is called "

" laboratory to be tested for the presence of malignant cells. If any are found, the patient usually has the other nodes in that lymph node basin removed. Then, additional, or adjuvant, treatments that stimulate the immune system and/or chemotherapy will be recommended."

"Sometimes the lymph nodes are not palpable. When that is the case, one of two approaches will usually be followed:"

"Palpable nodes may ? or may not ? be a sign of melanoma. The diagnosis must be confirmed by microscopic evaluation. This is also the procedure for sentinel nodes that are non-palpable, but may still contain cancerous cells. Research is now going on into special biochemical techniques that canidentify those melanoma cells that do not show up under routine microscopic examination."

", has been developed for mapping the lymph system. A small amount of a radioactive substance is injected at the site of the melanoma to trace the flow of lymph fluid draining from it to the nodes. Then, with the help of a scanner, the drainage pattern of the lymph fluid is determined. Armed with this knowledge, the surgeon can remove only those lymph nodes that receive the fluid preferentially."

"Another diagnostic technique makes use of a blue dye injected into the skin around the tumor. The dye passes into the lymph fluid, tracing its path. The blue color is picked up first by the node that is closest to the tumor, the sentinel node. Often, both a blue dye and a radioactive substance are used."

"Once a specific area of lymph drainage has been pinpointed by either method, that node or nodes can be removed surgically and tested in the pathology laboratory. If no cancer cells are found, no further surgery is performed. If cancer cells are present in the sentinel node, additional nodes in the region will often be removed and examined."

"Once the disease has advanced to Stage IV, melanoma cells have traveled through the body via the bloodstream or lymph vessels, goingfar from the original tumor site. They may have reached distant lymph nodes or invaded the internal organs. This can be in addition to or instead of the local spread to the lymph nodes or "

". In local forms of the disease, the metastases can reach skin or subcutaneous tissue more than 2 cm from the primary tumor, but not beyond the regional lymph nodes."

"chest, head, abdomen, and pelvis with a CT scan (computed tomography) in which special x-ray equipment and a computer program show a cross-section of body tissues or organs; an MRI (magnetic resonanceimaging) which uses a magnet instead of x-ray to create a map of the patient?s body; and by PET (positron emission tomography), an evolvingradiographic technique. For PET scanning, radioactive sugar, the basic carbohydrate utilized by the body for energy, is injected intravenously into the patient. This sugar is taken up rapidly by any melanoma cells that are present."

"For patients with Stages III and IV disease, surgery may be followed with adjuvant therapy. Have your physician explain the possibilities and grounds for selection of one treatment over the other."

"This palliative treatment is sometimes used when the melanoma is on an arm or leg.?Isolation? means that the chemotherapy is ?perfused? (added to) theblood flowing through the affected limb, and no other part of the body."

"This is one of the most exciting and changing fields in medicine, based on drugs that act on the body?s immune system. A number of newly-developed treatments are now being tested with some success. Among the immunotherapies, several types of experimental melanoma vaccines are now viewed as promising. Unlike the influenza "

", given when you are well to prevent disease, these are given to people who already have melanoma. Clinical trials of various types of vaccine are underway with patients whose disease is in Stages III and IV. The vaccines are intended to stimulate the immune system so that it reacts more strongly against a patient?s melanoma cells, destroying the cancer or slowing theprogression. These vaccines are not a part of routine treatment at this time, so patients with advanced melanomas may wish to discuss this possibility with their physicians."

"Another type of immunotherapy 9also known as biologic therapy) makes use of chemicals that occur naturally in the body. The one you are most likely to hear about is interferon-alpha. This is the only systemic drug with FDA approval, and it has been shown to improve five-year survival of Stage III patients. "

" (tumor-killing factor) is another of these naturally occurring substances. Both of these ? especially interferon-alpha ? are produced by white cells ("

") when they come in contact with tumor cells, viruses, or other harmful substances, and have been shown to kill a number of tumors, including melanomas. They have some anti-angiogenic properties as well. However, both drugs have significant side effects which can limit their use. Remember thatinterferon-alpha is FDA-approved, while tumor-necrosis factor is not. "

", which are chemicals occurring naturally in small quantities in the body, are being used for Stage IV patients. They may also beproduced by white blood cells (lymphocytes) which have been specially stimulated by antigens, a basic part of the immune system, to make them better ?killers? of malignant cells. The best known of these therapies uses the lymphokine, "

", with or without the addition ofinterferon alpha, which enters and attacks melanoma cells. However, interleukin-2 is associated with very significant side effects when given in high doses. This form of immunotherapy is still in the experimental stage."

"A gene is the basic unit of genetic material. It is the codeor ?blueprint? by which our body?s proteins are made. Alterations in these codes can result in uncontrolled cell growth as in cancer."

"On the other hand, selected genes can be altered so as to correct genetic defects or enhance the cancer-fighting potential of cells. Thereis hope that making changes in genes will lead to successes in treating a wide range of illnesses, so this kind of therapy frequently gets newspaper headlines. However, keep in mind that this treatment is in the very early stages of research, and its effectiveness is yet to be proven."

"One form of gene therapy is based on creating alterations in the white blood cells or in the tumor-infiltratinglymphocytes so that they will attack the melanoma. This is achieved by removing"

"these
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