|
A FEW weeks ago, I met a relative
of one of my students in medicine. I thought she was heavy with
child. Her tummy was really big with veins all over the abdomen
(caput medussae). She looked as if she was about nine months
pregnant. She also had a large pedunculated (hanging) and very
darkly pigmented mole, about the size of a large grape on the left
side of her chest. The mole had a rough, cracked, scaly surface, and
according to the patient, it bleeds occasionally even on trivial
contact. On further skin surveillance, I noted that there were
similar black moles (around four of them), although smaller in size,
scattered over her upper torso. These smaller moles, according to
her, just showed up recently.
Ana, as I will
call her here, has a diagnosed case of systemic melanoma (a
malignant mole that has already metastasized). She is a very pretty
and intelligent young lady. She is only 32 years old, a daughter, a
wife and mother of two beautiful kids.
Melanoma is a
serious form of cancer that can move unseen and sneak up on you in
just a matter of days or weeks. This very aggressive form of skin
cancer arises from the melanocyte of the skin. Melanocytes are cells
in the skin that produce a pigment called melanin. These cells
become cancerous when the melanocytes no longer respond to the
normal control mechanisms of cellular growth so that they mutate, or
transform into malignant cells in this case. The primary tumor
begins in the skin in some cases, often from the melanocytes of a
pre-existing mole. Once they mutate, they may become invasive and
spread to nearby structures or other organs in the body where they
invade and compromise the function of that organ. Usually they
initially travel to regional lymph nodes (kulani), but in some cases
they may invade a blood vessel directly without passing through the
lymph nodes, and then travel to other organ systems in the body and
become systemic in nature.
When systemic
disease or distant metastasis occurs, melanoma commonly involves the
lung, brain, liver or occasionally bone. The malignancy causes death
when its uncontrolled growth compromises vital organ function. A
battery of tests (MRI, CT scan and chest x-ray) done on Ana showed
metastasis in the lungs, liver and skull. She died a month after I
first saw her.
Melanoma
affects all age groups. Caucasians and fair skinned people are more
likely to get melanoma than dark skinned people like us Filipinos,
but we could get a fair share of this scary mole.
Ones risk
for developing melanoma is higher if:
one has
excessive sun exposure, especially sunburn in childhood
one has 2
or more family members who have a history of melanoma (risk
increases by 25 percent or more)
one has
moles present at birth (this increases the likelihood of more moles
later in life)
those with
blonde or red hair and blue or green eyes, and those who have fair
skin
new moles
appearing after age 30
new moles
at any age, if it is in an area that is rarely exposed to the sun
changes in
existing moles (asymmetry, border, color, diameter, elevation)
one or
more dysplastic nevi, also called atypical moles (a mole that looks
like fried egg)
at least
20 moles greater than 2 mm in diameter
at least 5
moles greater than 5 mm in diameter (larger than a pencil eraser)
freckles
caused by sun exposure
For
comments or suggestions call 373-1558, 414-5880, (0917) 497-6261,
e-mail at gc_beltran @yahoo.com.
|
