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Melanoma
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Melanoma

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WOMEN'S HEALTH

Hair/Nails/Skin

CANCER

Skin

From MayoClinic.com

Causes

Although it's common to think of skin in cosmetic terms — how soft, smooth or resilient it is — your skin is your body's largest organ and performs a number of essential functions, including protecting you from temperature extremes, injury and infection.

Your skin consists of three layers — the epidermis, dermis and subcutis. The epidermis, the topmost layer, is as thin as a pencil line. It provides a protective layer of skin cells that your body continually sheds. Squamous cells lie just below the outer surface. Basal cells, which produce new skin cells, are at the bottom of the epidermis. The epidermis also contains cells called melanocytes, which produce melanin — the pigment that gives skin its normal color. When you're in the sun, these cells produce more melanin, which helps protect the deeper layers of skin. The extra melanin is what produces the darker color of a "tan."

Normally, skin cells within the epidermis develop in a controlled and orderly way. In general, healthy new cells push older cells toward the skin's surface, where they die and eventually are sloughed off. This process is controlled by DNA — the genetic material that contains the instructions for every chemical process in your body. But when DNA is damaged, changes occur in these instructions. One result is that new cells may begin to grow out of control and eventually form a mass of malignant cells.

Just what damages DNA in skin cells and how this leads to melanoma is under study. Cancer is a complex disease that often results from a combination of factors rather than from a single cause. Still, excessive exposure to ultraviolet (UV) radiation is a leading factor in the development of melanoma.

UV radiation is a wavelength of sunlight in a range too short for the human eye to see. Commercial tanning lamps and tanning beds also produce UV radiation. UV light is divided into three wavelength bands — ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC). Only UVA and UVB rays reach the earth — UVC radiation is completely absorbed by atmospheric ozone, a naturally occurring substance that filters UV radiation.

At one time scientists believed that only UVB rays played a role in the development of melanoma. And UVB light does cause harmful changes in skin cell DNA, including the development of oncogenes — a type of gene that can turn a normal cell into a malignant one. But UVA light may also damage melanocytes. People who visit commercial tanning salons are especially at risk because tanning lamps and beds mainly produce UVA radiation.

Even so, UVB light remains a major concern, especially because of the ongoing depletion of atmospheric ozone, which normally screens the earth from some UVB radiation. In the past two decades, ozone levels have, primarily from widespread use of chlorofluorocarbons (CFCs) — synthetic chemicals commonly used as refrigerants, solvents and foam-blowing agents. Less ozone means that more UVB radiation reaches the ground.

In addition, the amount of UVB light reaching the earth varies considerably from one geographic region to another. Rays are strongest closer to the equator and at high altitudes.

But no matter where you live, your skin absorbs UV radiation whenever you're outdoors unless you wear protective clothing and sunscreen. What's more, exposure to occasional periods of intense sunlight puts you at greater risk of melanoma than spending long hours in the sun. An initial high dose of UV radiation will severely damage melanocytes, but not destroy them. When these damaged cells are subjected to further intense bouts of UVA light, they have little capacity to repair their DNA and so are more likely to become malignant.

Chronic sun exposure doesn't explain all melanomas. Other factors that may lead to melanoma include:

  • Heredity. A small percentage of people who develop melanoma have a family history of the disease. Having a parent, child or sibling with melanoma greatly increases your risk. Damage to the tumor suppressor gene, p16, appears to play a role in inherited melanomas.

  • In addition, some families are affected by a condition called familial atypical multiple mole and melanoma (FAMMM) syndrome. The hallmarks of FAMMM include a history of melanoma in one or more close relatives and having more than 50 moles — some of which are atypical. People with this syndrome have an extremely high risk of developing melanoma. For that reason, screening for signs of skin cancer is crucial. Check with your doctor about getting a screening exam every 4 to 6 months.

  • Age. In general, your risk of developing melanoma increases with age. But younger people can also develop skin cancer, and melanoma is, in fact, one of the most common cancers in people under 30. Complicating matters further, the age at which melanomas tend to develop appears to be different for men and women. In general, women have a higher rate of melanoma than men do until age 40. After age 40, the rate for men rises dramatically. Researchers don't yet know the reason for the disparity, although they believe hormonal factors may play a role. After age 60, the melanoma rate for women once again increases. Overall, however, men have a greater lifetime risk of melanoma than women do.

  • Carcinogens. The American Cancer Society has identified several substances that may contribute to melanoma, including coal, tar, the pitch used in road paving, the wood preservative creosote, arsenic compounds in pesticides and radium.

As with other types of cancer, it's likely that many melanomas result from a combination of environmental and genetic factors.

Melanoma > 1 > 2 > 3 > 4

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