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| | __NOTOC__ |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox_Disease |
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| Name = Melanoma |
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| Image = Melanoma malignum.jpg|
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| Caption = Melanoma malignum on the left leg of a 60-year-old woman |
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| Width = 225 |
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| DiseasesDB = 7947 |
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| ICD10 = {{ICD10|C|43||c|43}} |
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| ICD9 = {{ICD9|172}} |
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| ICDO = {{ICDO|8720|3}} |
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| OMIM = 155600 |
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| MedlinePlus = 000850 |
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| eMedicineSubj = derm |
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| eMedicineTopic = 257 |
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| }}
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| {{CMG}}
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| {{Editor Join}}
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| {{Melanoma}} | | {{Melanoma}} |
| ==[[Melanoma overview|Overview]]==
| | {{CMG}} {{AE}} {{YD}}; {{SSK}}{{Sab}} |
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| ==[[Melanoma historical perspective|History]]==
| | {{SK}} Malignant melanoma; Acral lentiginous melanoma; Lentiginous melanoma; Lentigo maligna melanoma; Nodular melanoma; Amelanotic melanoma; Familial melanoma; Non-pigmented melanoma; MM; Metastatic melanoma; Metastatic malignant melanoma; Cutaneous melanoma; Actinic melanosis; Solar melanoma; Melanose; Malignant nevus; Melanocyte malignancy; Melanotic cancer |
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| ==Epidemiology== | | ==[[Melanoma overview|Overview]]== |
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| The incidence of melanoma has increased in the recent years, but it is not clear to what extent changes in behavior, in the environment, or in early detection are involved.<ref>{{cite journal | author = Berwick M, Wiggins C | title = The current epidemiology of cutaneous malignant melanoma. | journal = Front Biosci | volume = 11 | issue = | pages = 1244-54 | year = | id = PMID 16368510}}</ref>
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| ==[[Melanoma causes|Causes]]== | | ==[[Melanoma historical perspective|Historical Perspective]]== |
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| ==[[Melanoma risk factors|Risk factors]]==
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| | ==[[Melanoma classification|Classification]]== |
| ==[[Melanoma pathophysiology|Pathophysiology]]== | | ==[[Melanoma pathophysiology|Pathophysiology]]== |
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| == Diagnosis == | | ==[[Melanoma causes|Causes]]== |
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| :[[Melanoma history and symptoms| History and Symptoms]] | [[Melanoma physical examination | Physical Examination]] | [[Melanoma staging | Staging]] | [[Melanoma laboratory tests | Lab Tests]] | [[Melanoma electrocardiogram|Electrocardiogram]] | [[Melanoma x ray|X Ray]] | [[Melanoma MRI|MRI]] | [[Melanoma CT|CT]] | [[Melanoma echocardiography|Echocardiography]] | [[Melanoma other imaging findings|Other imaging findings]] | [[Melanoma other diagnostic studies|Other diagnostic studies]]
| | ==[[Melanoma differential diagnosis|Differentiating Melanoma from other Diseases]]== |
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| ==Treatment== | | ==[[Melanoma epidemiology and demographics|Epidemiology and Demographics]]== |
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| [[Melanoma medical therapy|Medical therapy]] | [[Melanoma surgery|Surgical options]] | [[Melanoma metastasis treatment|Metastasis Treatment]] | [[Melanoma primary prevention|Primary prevention]] | [[Melanoma secondary prevention|Secondary prevention]] | [[Melanoma cost-effectiveness of therapy|Financial costs]] | [[Melanoma future or investigational therapies|Future therapies]] | | ==[[Melanoma risk factors|Risk Factors]]== |
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| ==Diagnosis== | | ==[[Melanoma screening|Screening]]== |
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| | ==[[Melanoma natural history|Natural History, Complications and Prognosis]]== |
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| [[Lactate dehydrogenase]] (LDH) tests are often used to screen for [[metastasis|metastases]], although many patients with metastases (even end-stage) have a normal LDH; extraordinarily high LDH often indicates metastatic spread of the disease to the liver. It is common for patients diagnosed with melanoma to have chest X-rays and an LDH test, and in some cases [[computed tomography|CT]], [[MRI]], [[Positron emission tomography|PET]] and/or PET/CT scans. Although controversial, sentinel [[lymph node]] biopsies and examination of the lymph nodes are also performed in patients to assess spread to the lymph nodes.
| | == Diagnosis == |
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| ==Types of primary melanoma== | |
| [[Image:Superficial spreading melanoma 1 060619.jpg|thumb|right|220px|Superficial spreading melanoma on the right leg of a 63-year-old man. This is an asymmetric black and 2 cm nodule with variable color, texture and well demarcated border.]]
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| The most common types of Melanoma in the skin:
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| * [[superficial spreading melanoma]] (SSM)
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| * [[nodular melanoma]]
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| * [[acral lentiginous melanoma]]
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| * [[lentigo maligna melanoma|lentigo maligna (melanoma)]]
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| Any of the above types may produce melanin (and be dark in colour) or not (and be amelanotic - not dark). Similarly any subtype may show desmoplasia (dense fibrous reaction with neurotropism) which is a marker of aggressive behaviour and a tendency to local recurrence.
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| Elsewhere:
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| * [[clear cell tumor|clear cell sarcoma]] (Melanoma of Soft Parts)
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| * mucosal melanoma
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| * [[uveal melanoma]]
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| ==Prognostic factors==
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| {{see also|Breslow's depth}}
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| [[Image:Melanoma 2.jpg|thumb|right|220px|Black, irregularly shaped, uniformly brown pigmented nevus on a 19-year-old man's right cheek. The Breslow index measured 2.88 mm, and a thorough medical evaluation revealed no evidence of metastases. The scar was reexcised with a 2-cm margin, and the skin was repaired with a graft.]]
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| Features that affect [[prognosis]] are [[tumor]] thickness in millimeters ([[Breslow's depth]]), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating [[lymphocyte]]s (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant [[metastasis]].<ref>{{cite journal | author = Homsi J, Kashani-Sabet M, Messina J, Daud A | title = Cutaneous melanoma: prognostic factors. | journal = Cancer Control | volume = 12 | issue = 4 | pages = 223-9 | year = 2005 | id = PMID 16258493}}''[https://www.moffitt.usf.edu/pubs/ccj/v12n4/pdf/223.pdf Full text (PDF)]''</ref>
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| Certain types of melanoma have worse prognoses but this is explained by their [[Breslow's depth|thickness]]. Interestingly, less invasive melanomas even with lymph node metastases carry a better prognosis than deep melanomas without regional metastasis at time of staging. Local recurrences tend to behave similarly to a primary unless they are at the site of a [[wide local excision]] (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion.
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| When melanomas have spread to the [[lymph node]]s, one of the most important factors is the number of nodes with malignancy. Extent of malignancy within a node is also important; micrometastases in which malignancy is only microscopic have a more favorable prognosis than macrometastases. In some cases micrometastases may only be detected by special staining, and if malignancy is only detectable by a rarely-employed test known as [[polymerase chain reaction]] (PCR), the prognosis is better. Macrometastases in which malignancy is clinically apparent (in some cases cancer completely replaces a node) have a far worse prognosis, and if nodes are matted or if there is extracapsular extension, the prognosis is still worse.
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| When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.<ref name=AJCC>{{cite journal | author = Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J | title = Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. | journal = J Clin Oncol | volume = 19 | issue = 16 | pages = 3635-48 | year = 2001 | id = PMID 11504745}}''[http://www.jco.org/cgi/content/full/19/16/3635 Full text]''</ref> The median survival is 6 to 12 months. Treatment is [[Palliative care|palliative]], focusing on life-extension and quality of life. In some cases, patients may live many months or even years with metastatic melanoma (depending on the aggressiveness of the treatment). Metastases to skin and lungs have a better prognosis. Metastases to brain, bone and liver are associated with a worse prognosis.
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| There is not enough definitive evidence to adequately stage, and thus give a prognosis for ocular melanoma and melanoma of soft parts, or mucosal melanoma (e.g. rectal melanoma), although these tend to metastasize more easily. Even though regression may increase survival, when a melanoma has regressed, it is impossible to know its original size and thus the original tumor is often worse than a [[Pathology|pathology report]] might indicate.
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| ==Staging==
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| ''Further context on [[cancer staging]] is available at [[TNM]].''
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| Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.<ref> [http://chorus.rad.mcw.edu/doc/00955.html Malignant melanoma: staging] at Collaborative Hypertext of Radiology</ref>
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| Melanoma stages:<ref name=AJCC />
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| '''Stage 0''': Melanoma in Situ (Clark Level I), 100% Survival
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| '''Stage I/II''': Invasive Melanoma, 85-95% Survival
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| *T1a: Less than 1.00 mm primary, w/o Ulceration, Clark Level II-III
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| *T1b: Less than 1.00 mm primary, w/Ulceration or Clark Level IV-V
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| *T2a: 1.00-2.00 mm primary, w/o Ulceration
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| '''Stage II''': High Risk Melanoma, 40-85% Survival
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| *T2b: 1.00-2.00 mm primary, w/ Ulceration
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| *T3a: 2.00-4.00 mm primary, w/o Ulceration
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| *T3b: 2.00-4.00 mm primary, w/ Ulceration
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| *T4a: 4.00 mm or greater primary w/o Ulceration
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| *T4b: 4.00 mm or greater primary w/ Ulceration
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| '''Stage III''': Regional Metastasis, 25-60% Survival
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| *N1: Single Positive Lymph Node
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| *N2: 2-3 Positive Lymph Nodes OR Regional Skin/In-Transit Metastasis
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| *N3: 4 Positive Lymph Nodes OR Lymph Node and Regional Skin/In Transit Metastases
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| '''Stage IV''': Distant Metastasis, 9-15% Survival
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| *M1a: Distant Skin Metastasis, Normal LDH
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| *M1b: Lung Metastasis, Normal LDH
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| *M1c: Other Distant Metastasis OR Any Distant Metastasis with Elevated LDH
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| ''Based Upon AJCC 5-Year Survival With Proper Treatment''
| | [[Melanoma staging | Staging]] | [[Melanoma history and symptoms| History and Symptoms]] | [[Melanoma physical examination | Physical Examination]] | [[Melanoma laboratory tests | Laboratory Findings]] | [[Melanoma biopsy|Biopsy]] | [[Melanoma chest x ray|Chest X ray]] | [[Melanoma CT|CT]] | [[Melanoma MRI|MRI]] | [[Melanoma echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Melanoma other imaging findings|Other Imaging Findings]] | [[Melanoma other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Treatment of advanced malignant melanoma is performed from a multidisciplinary approach including [[Dermatology|dermatologists]], medical [[oncologists]], radiation oncologists, surgical oncologists, general surgeons, [[plastic surgery|plastic surgeons]], [[neurologists]], [[neurosurgeons]], [[otorhinolaryngologists]], [[radiologists]], [[pathologists]]/dermatopathologists, research scientists, [[nurse practitioner]]s and [[physician assistant]]s, and [[palliative care]] experts. Nurse practitioners (NPs) and physician assistants (PAs) are qualified to evaluate and treat patients on behalf of their supervising physicians. Treatment guidelines can be found through many resources available to health care professionals around the world. Inspired by melanoma’s increasing prevalence, researchers are seeking to understand the pathways that regulate [[melanin]] production.
| | [[Melanoma medical therapy|Medical Therapy]] | [[Melanoma surgery|Surgery]] | [[Melanoma primary prevention|Primary Prevention]] | [[Melanoma secondary prevention|Secondary Prevention]] | [[Melanoma cost-effectiveness of therapy|Cost Effectiveness of Therapy]] | [[Melanoma future or investigational therapies|Future or Investigational Therapies]] |
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| ===Surgery=== | | ==Case Studies== |
| [[Image:Sentinel lymph node (axilla).jpg|thumb|370px|A blue stained sentinel lymph node in the [[axilla]].]] | | :[[Melanoma case study one|Case #1]] |
| Diagnostic punch or excisional biopsies may appear to excise (and in some cases may indeed actually remove) the tumor, but further surgery is often necessary to reduce the risk of recurrence.
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| Complete surgical excision with adequate margins and assessment for the presence of detectable metastatic disease along with short and long term follow up is standard. Often this is done by a "wide local excision" (WLE) with 1 to 2 cm margins. The wide excision aims to reduce the rate of tumour recurrence at the site of the original lesion. This is a common pattern of treatment failure in melanoma. Considerable research has aimed to elucidate appropriate margins for excision with a general trend toward less aggressive treatment during the last decades. There seems to be no advantage to taking in excess of 2 cm margins for even the thickest tumors.<ref>{{cite journal | author = Balch C, Urist M, Karakousis C, Smith T, Temple W, Drzewiecki K, Jewell W, Bartolucci A, Mihm M, Barnhill R | title = Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. | journal = Ann Surg | volume = 218 | issue = 3 | pages = 262-7; discussion 267-9 | year = 1993 | id = PMID 8373269}}</ref>
| | {{Epithelial neoplasms}} |
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| [[Mohs micrographic surgery]] is not well accepted in the treatment of melanoma. In this surgery, performed by specially-trained dermatologists, a small layer of tissue is excised and prepared as a frozen tissue section. This section can be prepared and examined by the dermatologist/dermatopathologist within one hour, and the patient will return for further stages of excision as needed, with each excised tissue layer being examined until clear margins are obtained.<ref name="AFP">{{cite journal | author = Bowen G, White G, Gerwels J | title = Mohs micrographic surgery. | journal = Am Fam Physician | volume = 72 | issue = 5 | pages = 845-8 | year = 2005 | id = PMID 16156344}}''[http://www.aafp.org/afp/20050901/845.html Full text]''</ref> However, the usefulness of Moh's surgery in melanoma is limited because of the difficulty of identifying melanocytic atypia on a frozen section, which may lead to incomplete resection of the melanoma.<ref name="AFP"/><ref>{{cite journal | author = Nahabedian M | title = Melanoma. | journal = Clin Plast Surg | volume = 32 | issue = 2 | pages = 249-59 | year = 2005 | id = PMID 15814121}}</ref> | | [[Category:Dermatology|Melanoma]] |
| | [[Category:Types of cancer|Melanoma]] |
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| Other issues to consider with Moh's technique are risks of tumor implantation and possible false negative margins due to suboptimal melanocytic staining.<ref>{{cite journal | author = Nahabedian MY | title = Melanoma | journal = Clin Plastic Surg | volume = 32 | pages = 249-259| year = 2005 }}</ref> Deviation from recommended 1-2 cm margins of excision should thus be approached carefully.
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| | [[Category:Oncology]] |
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| Melanomas which spread usually do so to the [[lymph nodes]] in the region of the tumour before spreading elsewhere. Attempts to improve survival by removing lymph nodes surgically ([[lymphadenectomy]]) were associated with many complications but unfortunately no overall survival benefit. Recently the technique of [[sentinel lymph node]] biopsy has been developed to reduce the complications of lymph node surgery while allowing assessment of the involvement of nodes with tumour.
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| Although controversial and without prolonging survival, "sentinel lymph node" biopsy is often performed, especially for T1b/T2+ tumors, mucosal tumors, ocular melanoma and tumors of the limbs. A process called [[lymphoscintigraphy]] is performed in which a radioactive tracer is injected at the tumor site in order to localize the "sentinel node(s)". Further precision is provided using a blue tracer [[dye]] and surgery is performed to biopsy the node(s). Routine H&E staining, and [[immunoperoxidase]] staining will be adequate to rule out node involvement. [[PCR]] (Polymerase Chain Reaction) tests on nodes, usually performed to test for entry into clinical trials, now demonstrate that many patients with a negative SLN actually had a small number of positive cells in their nodes. Alternatively, a fine-needle aspiration may be performed, and is often used to test masses.
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| If a lymph node is positive, depending on the extent of lymph node spread, a radical lymph node dissection will often be performed. If the disease is completely resected the patient will be considered for adjuvant therapy.
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| ===Adjuvant treatment===
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| High risk melanomas may require referral to a medical or surgical oncologist for adjuvant treatment. In the United States most patients in otherwise good health will begin up to a year of high-dose [[interferon]] treatment, which has severe side effects, but may improve the patients' prognosis.<ref>{{cite journal | author = Kirkwood J, Strawderman M, Ernstoff M, Smith T, Borden E, Blum R | title = Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. | journal = J Clin Oncol | volume = 14 | issue = 1 | pages = 7-17 | year = 1996 | id = PMID 8558223}}</ref> This claim is not supported by all research at this time and in Europe interferon is usually not used outside the scope of clinical trials.<ref>{{cite journal | author = Kirkwood J, Ibrahim J, Sondak V, Richards J, Flaherty L, Ernstoff M, Smith T, Rao U, Steele M, Blum R | title = High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. | journal = J Clin Oncol | volume = 18 | issue = 12 | pages = 2444-58 | year = 2000 | id = PMID 10856105}}</ref><ref>{{cite journal | author = Kirkwood J, Ibrahim J, Sondak V, Ernstoff M, Ross M | title = Interferon alfa-2a for melanoma metastases. | journal = Lancet | volume = 359 | issue = 9310 | pages = 978-9 | year = 2002 | id = PMID 11918944}}</ref>
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| Metastatic melanomas can be detected by X-rays, CT scans, MRIs, PET and PET/CTs, ultrasound, LDH testing and photoacoustic detection.<ref>{{cite journal | author = Weight RM, Viator JA, Dale PS, Caldwell CW, Lisle AE. | title = Photoacoustic detection of metastatic melanoma cells in the human circulatory system. | journal = Opt Lett.| volume = 31 | issue = 20 | pages = 2998-3000 | year = 2006 | id = PMID 17001379}}</ref>
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| ====Chemotherapy and immunotherapy====
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| Various [[chemotherapy]] agents are used, including [[dacarbazine]] (also termed DTIC), [[Cancer immunotherapy|immunotherapy]] (with [[interleukin-2]] (IL-2) or [[interferon]] (IFN)) as well as local perfusion are used by different centers. They can occasionally show dramatic success, but the overall success in metastatic melanoma is quite limited.<ref>{{cite journal | author = Bajetta E, Del Vecchio M, Bernard-Marty C, Vitali M, Buzzoni R, Rixe O, Nova P, Aglione S, Taillibert S, Khayat D | title = Metastatic melanoma: chemotherapy. | journal = Semin Oncol | volume = 29 | issue = 5 | pages = 427-45 | year = 2002 | id = PMID 12407508}}</ref> IL-2 (Proleukin®) is the first new therapy approved for the treatment of metastatic melanoma in 20 years. Studies have demonstrated that IL-2 offers the possibility of a complete and long-lasting remission in this disease, although only in a small percentage of patients.<ref>{{cite journal | author = Buzaid A | title = Management of metastatic cutaneous melanoma. | journal = Oncology (Williston Park) | volume = 18 | issue = 11 | pages = 1443-50; discussion 1457-9 | year = 2004 | id = PMID 15609471}}</ref> A number of new agents and novel approaches are under evaluation and show
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| promise.<ref>{{cite journal | author = Danson S, Lorigan P | title = Improving outcomes in advanced malignant melanoma: update on systemic therapy. | journal = Drugs | volume = 65 | issue = 6 | pages = 733-43 | year = 2005 | id = PMID 15819587}}</ref>
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| ===Lentigo maligna treatment===
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| Some superficial melanomas (lentigo maligna) have resolved with an experimental treatment, [[imiquimod]] (Aldara®) topical cream, an immune enhancing agent. Application of this cream has been shown to decrease tumor size prior to surgery, reducing the invasiveness of the procedure. This treatment is used especially for smaller melanoma in situ lesions located in cosmetically sensitive regions. Several published studies demonstrate a 70% cure rate with this topical treatment. With lentigo maligna, surgical cure rates are no higher. Some dermasurgeons are combining the 2 methods: surgically excise the cancer, then treat the area with Aldara® cream post-operatively for 3 months.
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| ===Radiation and other therapies===
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| [[Radiation therapy]] is often used after surgical resection for patients with locally or regionally advanced melanoma or for patients with unresectable distant metastases. It may reduce the rate of local recurrence but does not prolong survival.<ref>{{cite journal | author = Bastiaannet E, Beukema J, Hoekstra H | title = Radiation therapy following lymph node dissection in melanoma patients: treatment, outcome and complications. | journal = Cancer Treat Rev | volume = 31 | issue = 1 | pages = 18-26 | year = 2005 | id = PMID 15707701}}</ref>
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| In research setting other therapies, such as [[gene therapy]], may be tested.<ref>{{cite journal | author = Sotomayor M, Yu H, Antonia S, Sotomayor E, Pardoll D | title = Advances in gene therapy for malignant melanoma. | journal = Cancer Control | volume = 9 | issue = 1 | pages = 39-48 | year = | id = PMID 11907465}}''[https://www.moffitt.usf.edu/pubs/ccj/v9n1/pdf/39.pdf Full text (PDF)]''</ref> [[Radioimmunotherapy]] of metastatic melanoma is currently under investigation.
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| <p>Experimental treatment developed at the National Cancer Institute (NCI), part of the National Institutes of Health in the US was used in advanced (metastatic) melanoma with moderate success.
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| The treatment, adoptive transfer of genetically altered autologous lymphocytes,
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| depends on delivering genes that encode so called T cell receptors (TCRs), into patient's lymphocytes. After that manipulation lymphocytes recognize and bind to certain molecules found on the surface of melanoma cells and kill them.<ref name="nih">[http://www.nih.gov/news/pr/aug2006/nci-31b.htm Press release from the NIH]</ref>
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| ==Equine melanoma==
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| Melanomas are also not uncommon in horses, being largely confined to grey (or white) animals - 80% of such pale horses will develop melanomata by 15 years of age<ref name=CeCO>Centre for Comparitive Oncology [http://www.vetmed.vt.edu/ceco/melanoma.html], accessed at 2220 on 12th July</ref>; of these, 66% are slow growing but all may be classified as malignant<ref name=CeCO/>. [[Surgical]] excision may be attempted in some cases, if the tumours are limited in extent and number. However, they are often multiple (especially in older animals) and [[perineal]] tumours are notoriously difficult to excise. Often, a position of "benign neglect" is assumed, especially if the tumours are not causing any [[clinical]] problems. [[Medical]] therapy with [[cimetidine]] (2.5-4.0mg/kg three times daily for 2 months or more)<ref>Warnick, LD, Graham, ME, and Valentine, BA (1995) "Evaluation of cimetidine treatment for melanomas in seven horses" ''Equine Practice'', 17(7): 16-22, 1995</ref> is also an option, although it has a lower success rate than [[surgery]] and [[cryosurgery]]<ref> RJ Rose & DR Hodson, ''Manual of Equine Practice'' (p. 498) 2000</ref>.
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| ==Future thought==
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| <p>One important pathway in [[melanin]] synthesis involves the transcription factor [[MITF]]. The MITF gene is highly conserved and is found in people, mice, birds, and even fish. MITF production is regulated via a fairly straightforward pathway. [[UV radiation]] causes increased expression of transcription factor [[p53]] in [[keratinocytes]], and p53 causes these cells to produce melanoctye stimulating hormone ([[MSH]]), which binds to [[MC1R]] receptors on [[melanocytes]]. Ligand-binding at MC1R receptors activates [[adenyl cyclases]], which produce [[cAMP]], which activates [[CREB]], which promotes [[MITF]] expression. The targets of MITF include [[p16]] (a CDK inhibitor) and [[Bcl2]], a gene essential to [[melanocyte]] survival. It is often difficult to design drugs that interfere with transcription factors, but perhaps new drugs will be discovered that can impede some reaction in the pathway upstream of MITF.
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| <p>Studies of [[chromatin]] structure also promise to shed light on transcriptional regulation in melanoma cells. It has long been assumed that [[nucleosomes]] are positioned randomly on [[DNA]], but murine studies of genes involved in melanin production now suggest that nucleosomes are stereotypically positioned on DNA. When a gene is undergoing transcription, its transcription start site is almost always nucleosome-free. When the gene is silent, however, nucleosomes often block the transcriptional start site, suggesting the nucleosome position may play a role in gene regulation.
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| <p>Finally, given the fact that tanning helps protect skin cells from UV-induced damage, new melanoma prevention strategies could involve attempts to induce tanning in individuals who would otherwise get sunburns. Redheads, for example, do not tan because they have MC1R mutations. In mice, it has been shown that the melanin-production pathway can be rescued downstream of MC1R. Perhaps such a strategy will eventually be used to protect humans from melanoma.
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| ==References==
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| {{Reflist|2}}
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| ==External links==
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| ===Websites===
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| *[http://www.mmmp.org Melanoma Molecular Map Project]
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| *[http://www.proleukin.com Proleukin]
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| *[http://www.melanomaperspectives.com Melanoma Perspectives]
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| *[http://www.skincancer.org/melanoma/index.php Information on Melanoma from The Skin Cancer Foundation]
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| * [http://www.cimit.org/ CIMIT Center for Integration of Medicine and Innovative Technology - New Advances and Research in Melanoma]
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| * [http://www.newsmonster.co.uk/sunlight-prevents-and-cures-cancer-and-a-healthy-tan-makes-you-look-good.html Sunbathing helps prevent cancer: UK newspaper article]
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| * [http://www.melanomainternational.org/ Melanoma International Foundation]
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| * [http://www.skincheck.org/ Melanoma Education Foundation]
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| * [http://www.melanoma.com/ melanoma.com] (commercially supported site)
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| * [http://www.dermnetnz.org/lesions/melanoma.html DermNet NZ: Melanoma]
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| * [http://www.startoncology.net/capitoli/interno_capitoli/default.jsp?menu=professional&ID=32&language=eng Professional melanoma information]
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| * [http://www.rah.sa.gov.au/cancer/melanoma/ Adelaide Melanoma Unit] (free information on diagnosis, prevention, treatment of melanoma; booklet available at cost)
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| *[http://copublications.greenfacts.org/en/sunbeds/index.htm Assessing health risks of sunbeds and UV exposure] summary by GreenFacts of the European Commission SCCP assessment
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| ===Patient information===
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| * [http://www.cancer.gov/pdf/WYNTK/WYNTK_moles.pdf What You Need To Know About Moles and Dysplastic Nevi] - patient information booklet from cancer.gov (PDF)
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| * [http://www.mpip.org/ MPIP: Melanoma patients information page]
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| * [http://www.MelanomaSupport.org.au/ Melanoma Support Organisation (Victoria, Australia)] - Ran by Melanoma Sufferers with strong links to Cancer Institutes in Victoria, Australia
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| * [http://www.melanomapatients.org/ Melanoma Patients Australia]
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| * [http://www.tustison.com/interests1.shtml/ Mikes Page - The Melanoma Resource Center]
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| * [http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=mel-l&A=1/ MEL-L - Melanoma e-mail list for patients, caregivers and healthcare professionals] - Supporting the Melanoma Patient since 1996
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| ===Images, photographs===
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| *[http://www.dermnet.com/thumbnailIndex.cfm?moduleID=14&moduleGroupID=427&groupIndex=0&numcols=0 Melanoma photo library at Dermnet]
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| * [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=53 DermAtlas: Melanoma images]
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| * [http://www.lumen.luc.edu/lumen/MedEd/medicine/dermatology/melton/melcont.htm Photographs of melanoma]
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| * [http://melanoma.blogsome.com/ Skin imaging methods for melanoma diagnosis](commercial advertising)
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| * [http://dermatologie.free.fr/cas21b.htm Pictures of melanomas]
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| * [http://dermatologie.free.fr/cas183re.htm Pictures of amelanotic melanomas]
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|
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| ===Videos===
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| * [http://www.healthination.com/skin_cancer.php Health Video: Melanoma and Non-Melanoma Skin Cancers - Overview, Prevention, and Treatment]
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| * [http://www.healthination.com/skin_self_exam.php Health Video: How to Perform a Skin Self Exam]
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| {{Epithelial neoplasms}}
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| [[Category:Dermatology|Melanoma]]
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| [[Category:Types of cancer|Melanoma]]
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
| | | [[Category:Up-To-Date]] |
| [[be-x-old:Мэлянома]] | | [[Category:Oncology]] |
| [[bg:Меланома]]
| | [[Category:Medicine]] |
| [[ca:Melanoma]]
| | [[Category:Dermatology]] |
| [[da:Malignt melanom]]
| | [[Category:Surgery]] |
| [[de:Malignes Melanom]]
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| [[et:Melanoom]]
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| [[es:Melanoma]]
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| [[fr:Mélanome]]
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| [[gl:Melanoma maligno]]
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| [[it:Melanoma]]
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| [[he:מלנומה]]
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| [[la:Melanoma Malignus]]
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| [[nl:Melanoom]]
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| [[ja:悪性黒色腫]]
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| [[no:Malignt melanom]]
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| [[pl:Czerniak złośliwy]]
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| [[pt:Melanoma maligno]]
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| [[ru:Меланома]]
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| [[sr:Меланом]] | |
| [[fi:Melanooma]] | |
| [[sv:Malignt melanom]] | |
| [[zh:黑色素瘤]] | |