Melanoma is one of the deadliest skin cancers and it is ranked as the 19 th most

common cancer worldwide as of 2018 (Ferlay et al., 2019). This arises from the
malignancy of melanocytes in the skin, but this can also arise from oral and anogenital
mucosal surfaces, esophagus, meninges, and uvea of the eyes (Kumar, Abbas, Aster,
& Turner, 2014). This malignancy is may be due to germline mutations or somatic
mutations that can be acquired through UV radiation exposure. Since this involves
melanocytes, the incidence is heavily determined by racial skin phenotype, which is why
its incidence between countries is variable. Aside from UV radiation exposure, other risk
factors associated with the disease is the presence of nevi, family history of melanoma,
and immunosuppression (Curiel-Lewandrowski, 2020).

There are several factors associated with melanoma incidence and mortality. In the US,
the incidence rate of melanoma is 21.8 per 100,000 and it is estimated that about
77,698 new cases occur each year (Centers for Disease Control and Prevention, 2019).
Incidence in men is slightly greater than in women (1.3:1) and the median age of
diagnosis is at late fifties (Kasper, Fauci, Hauser, Longo, Jameson, & Loscalzo, 2015).
Incidence is increased in persons aged 40 years and above but is not limited to this age
range (jama). The incidence rate also varies per race wherein incidence for white
Americans (24.9 per 100,000) is greater as compared to black Americans (1.1 per
100,000) (Centers for Disease Control and Prevention, 2019). For American Indian,
Asian, and Hispanic, the incidence is 7.1, 1.5, and 5.0 per 100,000, respectively
(Centers for Disease Control and Prevention, 2019). Incidence rate of the melanoma is
also determined by geographic location such that increased incidence of melanoma is
associated with increased UV index and lower latitude but only in non-Hispanic whites
(Eide). As for the mortality, the overall death rate is 2.5 per 100,000, and it is the highest
among non-Hispanic white males (4.7 per 100,000) and lowest among black and Asian
females (0.3 per 100,000) (Centers for Disease Control and Prevention, 2019).

Melanocyte is a type of dendritic cell that is responsible for the production of melanin
through melanosomes (Kasper et al., 2015). These cells are found in the basal layer of
the epidermis. Melanin is the molecule responsible for the skin pigment, and it protects
the skin from UV radiation induced DNA damage by scattering and absorbing UV
radiation (Shain & Bastian, 2016). Melanocytes are also found in hair follicles, the inner
ear cochlea where it functions in the production of endolymph, and it can also be found
in the iris where it also functions for pigment production (Bertolotto, 2013).

Cutaneous melanocytes may proliferate and become a nevus usually at the first and
second deacdes of life (Damsky & Bosenberg, 2017). However, not all nevi are
cancerous, and most are benign. There are several factors that affect the proliferation of
melanocytes. Abundance of melanocytes is genetically determined but may also be due
to environmental factors such as UV radiation exposure (Bertolotto, 2013; Shain &
Bastian, 2016). Proliferation of melanocytes may become uncontrolled due to inherent
genetic mutations or acquired due to UV exposure (Shain & Bastian, 2016). Mutations
that cause melanoma usually affect cell cycle control genes, pro-growth signaling
pathways, and activation of telomerase (Kumar et al., 2014). All of these promote
excessive proliferation of abnormal cells. This disrupts the normal skin barrier which
may cause secondary infections (Heistein & Acharya, 2020). What makes melanoma
deadly is metastasis. Melanoma cells may metastasize through the vascular and
lymphatic vessels to other organs such as in the brain or lungs (Shain & Bastian, 2016).
This will cause proliferation of abnormal cells in the site of metastasis and will disrupt its
normal function by deprivation of nutrients for normal cells or by impeding blood flow
which ultimately lead to apoptosis (Kumar et al., 2014).

Mortality can be prevented through early diagnosis and treatment; thus, warning signs
of melanoma must be determined (Kumar et al., 2014). Before metastasis, melanomas
are usually asymptomatic (Kumar et al., 2014). Lesions having asymmetry, irregular
borders, variegated color, increasing diameter, and rapidly changing must be identified
because these may be highly proliferative melanocytes (Kumar et al., 2014). Lesions
like this must undergo biopsy to confirm the diagnosis of melanoma. Cells from the
biopsy are examined for mitotic rate and thickness, and also presence of mutations via
fluorescence in situ hybridization (FISH) (Kasper et al., 2015). Presence of metastasis
can be determined via imaging modalities such as CT scan, MRI, and nuclear medicine
scans.

Treatment of non-metastatic melanoma involves surgical excision and if there is risk for
recurrence the patient is given adjuvant therapy which can be through radiotherapy or
use of chemotherapeutic drugs that augment antitumor responses such as ipilimumab
(Kasper et al., 2015). Those with metastasis are treated though surgical excision of
metastatic tumor along with immunotherapy (Kasper et al., 2015). Side effects of
treatment is usually caused by chemotherapeutic drugs or drugs used in
immunotherapy. Chemotherapeutic drugs can be cytotoxic such that it also affects
healthy cells, while immunotherapy side effects may cause autoimmune responses
where immune cells attach healthy cells.

It is important that people should be aware of melanoma because sun exposure is part
of our daily lives and this may cause melanoma that can ultimately lead to death. It is
kind of scary that simple things like sun exposure may cause disease, hence preventive
measures should always be done. Prevention of melanoma includes avoidance of
midday sun, regular use of sunscreen, and avoidance of tanning beds (Heistein &
Acharya, 2020). We should also be familiar of our skin and look out for skin changes
that might be melanoma. In this way, melanoma induced by UV-exposure can be
prevented. However, some melanomas are caused by inherent genetic mutations. This
is where the advent of cancer vaccines may bring a solution to this problem.

Most vaccines that are being developed are designed to activate tumor specific CD8+
cytotoxic t-cells that can attack the cancer cell directly, minimizing the side effects of
conventional melanoma treatment (Maurer, Butterfield, & Vujanovic, 2019). Some are
using killed tumor cells that induce expression of immune stimulatory cytokines that
allow immunity to melanoma (Maurer, Butterfield, & Vujanovic, 2019).
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Options. Scientifica, 2013, 1–22. https://doi.org/10.1155/2013/635203

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for Disease Control and Prevention, US Department of Health and Human Services

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