The paper provides a brief overview of the current literature about malignant melanoma. Pathology and risk factors are discussed. The paper discusses the complexities in diagnosing malignant melanoma and suggests that nurses must play essential role in the process of investigating and diagnosing melanoma. Ultimately, a brief discussion of the available treatment methodologies is provided. The paper confirms that malignant melanoma is resistant to all forms of chemotherapy and suggests that treatment prognoses for the patients with the last stages of malignant melanoma will be unfavorable.
Malignant Melanoma Malignant melanoma is fairly regarded as one of the most dangerous forms of cancer, which affects people of all ages and social strata and causes more years of lost life than all other forms of cancer, including leukemia (Rubin & Lawrence, 2009). In the second half of the 20th century, the incidence and prevalence of malignant melanoma increased significantly and continues to increase at 5% annually (Stas, 2003). The process of diagnosing malignant melanoma is full of difficulties and controversies.
Malignant melanoma is resistant to all forms of chemotherapy and surgery remains the basic instrument of curing melanoma at the earliest stages of the disease. Physicians and oncologists must involve nurse practitioners into the process of diagnosing and treating malignant melanoma, to improve their chances to find and identify the tumor and to reduce the risks of negative health consequences for patients. Malignant Melanoma: Description and Risk Factors Malignant melanoma is “a tumor that develops from epidermal melanocytes in the skin.
It often presents as a newly pigmented lesion of changes in an existing mole on the skin” (Plester, 2008, p. 23). If identified and treated early, melanoma is fully curable (Plester, 2008). If patients delay their visit to the doctor and the melanoma becomes thicker and bigger, prognoses are mostly poor (Plester, 2008). Today, people over the age of 54 years are at the highest risks for malignant melanoma (Plester, 2008). The incidence of malignant melanoma varies widely, from 1 case per 100,000 in India and Japan to 37.
8 cases per 100,000 of Australian females and males (Rubin & Lawrence, 2009). The evolution of untreated malignant melanoma can last from several months to several decades (Stas, 2003). At the earliest stages, the tumor does not cause much discomfort to patients, whereas larger lesions can result in bleeding and show ulceration (Stas, 2003). Malignant melanoma is highly resistant to various types of medical and pharmacological treatment; once the tumor extends beyond its primary site, it immediately turns into a life-threatening health condition and the primary cause of death (Stas, 2003).
The major risk factors for malignant melanoma include exposure to sun and ultraviolet light, the growing number of moles, especially atypical ones, fair skin and light hair (including freckling), family history of melanoma, personal history of melanoma, immunosuppression, age, gender (males are at higher risks for malignant melanoma than women), and xeroderma pigmentosum (Rubin & Lawrence, 2009). Persons with fair skin and inability to tan, with red or blonde hair, with blue eyes and multiple nevi are the population group at highest risk for developing malignant melanoma.
Exposure to ultraviolet radiation and immunosuppression contribute to these risks. Those who have multiple nevi face relative risks of melanoma between 5 and 12, while those with atypical nevi have a relative risk of 7-27 (Rubin & Lawrence, 2009). It should be noted, that genetics plays not the last role in the development of malignant melanoma risks. Actually, the current research is becoming more and more attentive to the potential role of genetics in incidence and prevalence of malignant melanoma across different population groups.
For example, Rubin and Lawrence (2009) refer to the gene on chromosome 9, which is responsible for the cell cycle: this gene is believed to be one of the primary predictor of malignant melanoma in patients. Despite the recent developments in medicine, the process of diagnosing malignant melanoma remains extremely complex even for experienced professionals. On the one hand, physicians and oncologists face the risks to overlook the important signs of malignant melanoma among numerous nevi.
On the other hand, nurse practitioners rarely or never participate in diagnosis; however, nurse practitioners could readily become the primary source of knowledge about patients. Malignant Melanoma: Diagnosis and the Role of Nurse Practitioners Malignant melanoma is difficult to identify and evaluate, especially in patients who have multiple nevi (Rubin & Lawrence, 2009). When evaluating atypical nevi, medical professionals must identify and remove all lesions suggestive of melanoma (Rubin & Lawrence, 2009).
The latter will be used for the detailed histologic examination. Unfortunately, even the simplest histopathological analysis of lesions presents a serious problem, because there is no single criterion specific of melanoma (Barnhill & Trotter, 2004). Theoretically, any malignant melanoma can be easily cured with complete removal, but “there is no definitive biologic parameter, such as metastasis, that may be correlated with histopathologic criteria” (Barnhill & Trotter, 2004, p. 17).
More often than not, medical professionals and experts will use a naked-eye examination, to analyze numerous nevi and lesions and to identify the most suspicious ones (Marghoob & Scope, 2009). Here, the risk exists that some suspicious lesions will appear banal while others will be overlooked (Marghoob & Scope, 2009). Other components of the routine medical examination, including anamnesis and diagnostic aids like dermoscopy are only supplementary and can help filter the most dangerous lesions and MMs (Marghoob & Scope, 2009).
Even sentinel lymph node biopsy as one of the most important diagnostic tools for localized malignant melanoma, presents a technical challenge to radiologists and requires that medical professionals account for numerous details, to ensure that the prognostic data they obtain are relevant and reliable (Moroi, 2009). In light of the discussed diagnostic complexities, it is not yet clear why nurse practitioners and staff nurses rarely or never participate in melanoma assessment and counseling.
According to Furfaro et al. (2008), nurse practitioners are the prime candidates for conducting skin assessments in different groups of patients. Nurse practitioners perform more surface examinations and counseling sessions with patients, compared with their physicians (Furfaro et al. , 2008). Furthermore, nurse practitioners believe that health education and health promotion are the necessary preconditions for reducing the risks and consequences of melanoma (Furfaro et al. , 2008).
Based on their experience and the knowledge they get about patients while they are interacting with them, nurse practitioners have greater chances to timely identify the first signs of malignant melanoma. Furfaro et al. (2008) suggest that nurse practitioners, rather than physicians, have greater abilities to distinguish between malignant and benign lesions and to detect specific skin cancer lesions.