Understanding and Managing Melanoma

This assignment delves into the multifaceted aspects of melanoma, a type of skin cancer. It examines the causes of melanoma, including UV exposure and genetic factors, and outlines various diagnostic methods used to detect the disease. The assignment also discusses treatment options for melanoma, such as surgery, radiation therapy, and immunotherapy, highlighting the importance of early detection and intervention. Furthermore, it addresses the social and emotional challenges faced by individuals diagnosed with melanoma, emphasizing the crucial role of support systems and palliative care.

Melanoma In Australia and Japan- Prevalence, Treatment, Prevention
Name of the Student: LivleenKaur
Student Number: 19017060
Email Address: [e-mail]
Course: BSc Health Sciences.
Unit: Foundations for Professional Health Practice CMHL1000
Lecturer/Tutor: Deborah Kruger/ Lee Fei Sim
Student ID Submission Date

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Table of Contents
1.0 Introduction................................................................................................................................2
2.0 Prevalence of Melanoma...........................................................................................................2
2.1 Prevalence of Melanoma in Australia....................................................................................2
2.2 Prevalence of Melanoma in Japan.........................................................................................3
3.0 Treatment for Melanoma...........................................................................................................4
3.1 Adjuvant Therapy..................................................................................................................4
3.2 Chemotherapy........................................................................................................................4
3.3Immunotherapy.......................................................................................................................4
4.0 Role of Health Professionals Providing the Treatment.............................................................5
4.1 Oncology Doctor....................................................................................................................5
4.2 Oncology Nurse.....................................................................................................................5
5.0 Impact on Community...............................................................................................................6
6.0 Conclusion.................................................................................................................................6
7.0 References..................................................................................................................................7
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1.0 Introduction
Melanoma is defined as the most dangerous form of skin cancer (Reisfeld&Ferrone,
2012).“The World Health Organization (WHO) estimates that worldwide there are 66,000
deaths annually from skin cancer, with approximately 80% due to melanoma”(Hodi et al., 2010,
pp. 712).The main cause behind the occurrence of melanoma is the ultra violet radation causing
damage of the DNA of the skin cells or in the pigment producing melanocytes, to be
precise(Rass&Reichrath, 2008, pp. 162-178). This damage is manifested as detrimental DNA
mutation leading to the development of the malignant tumors or melanoma(Rass&Reichrath,
2008, pp. 162-178). The other causes of melanoma apart from increased sun exposure or
exposure to ultraviolet (UV) radiation are, increased in the rate of outdoor activities, a total
change in the dressing style, increased rate of longevity, high rate of ozone layer depletion or
global warming, geneticpredispositionand immune suppression(Leiter&Garbe, 2008, pp.88-103).
The tumours originate in the basal layers of the epidermis and mostly resembles to skin moles
during the initial stage of the development(Shields et al., 2011, pp. 389-395). Melanoma is
curable if detected and treated early. However, in the majority of the cases, melanoma remains
undetected during its latent stage and leading to the principal cause of death behind skin cancer
(Tsao et al., 2015, pp.717-723). The following report will shed a detailed light on the prevalence
of melanoma in Australia and Japan. The report also discusses three possible treatments for
curing melanoma and the role of the healthcare professionals in providing such treatments. At
the end, the report throws a brief light on the impact of this fatal disease, melanoma on the
community.
2.0 Prevalence of Melanoma
2.1 Prevalence of Melanoma in Australia
Australia has one of the highest occurancerates of melanoma in the world (Melanoma
Institute Australia, 2017). The occurrence rate is so high that melenoma is now regarded as
‘Australia’s national cancer’. It is the third most common cancer in Australia. Melanoma comes
only after prostate cancer (male)/breast cancer (female) and bowel cancer(Melanoma Institute
Australia, 2017).
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Parameter Percentage of Occurrence Year
Occurrence rate in male 12% of all cancer 2017
Occurrence rate in female 9% of all cancer 2017
Total population diagnosed 14000 2017
Rate among skin cancer 2% 2017
Casualty of melanoma 75% of all skin cancer death 2017
Table: Prevalence Rate of Melanoma in Australia
(Source: Melanoma Institute Australia, 2017)
(Source: Australian Institute of Health and Welfare, 2017)
2.2 Prevalence of Melanoma in Japan
According to the nationwide survey with malignant skin tumours conducted among the
Japanese patients during the year of 1987 to 2001 reflected that basal cell carcinoma is the most
prominent cancer in Japan followed by squamous cell carcinoma and malignant
melanoma(Ishihara, Saida, Otsuka& Yamazaki, 2008, pp.33-41). Malignant melanomas are
mostly observed in the skin and are rare in the mucosal region of head and neck(Shiga et al.,
2012). The male to female ratio was found to be 1: 0.97 to 1: 1.14(Ishihara, Saida, Otsuka&
Yamazaki, 2008, pp.33-41). The survival rate has found higher in females than that of male
(70.6% female and 60% male)(Ishihara, Saida, Otsuka& Yamazaki, 2008, pp.33-41). As per the
age distribution, melanoma is detected during the later stages in life during 40 to 49 years of age
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with highest occurrence rate at the age of 60 years(Ishihara, Saida, Otsuka& Yamazaki, 2008,
pp.33-41). Sole of the foot was found as the main site of occurrence for melanoma in both males
and females. However, lower limbs of the females were also detected as the common site of
occurrence. Among Melanoma type, AcralLentiginous melanoma accounted to about 50% of
occurrence among the Japanese population which is followed by nodal melanoma (Ishihara,
Saida, Otsuka& Yamazaki, 2008, pp.33-41).
3.0Treatment for Melanoma
3.1Adjuvant Therapy
Adjuvant therapy with interferon alpha is the best suited therapy for the patients who are
suffering from surgically restricted melanoma without or without the metastases of the lymph
node. Interferon alpha is the principal agent to deliver significant survival benefit in patients who
are suffering from high risk melanoma(Garbe, Eigentler, Keilholz, Hauschild& Kirkwood, 2011,
pp. 5-6). According to Garbe et al., (2011), patient patients who received intravenous therapy for
interferon alpha 2b (20 million units per meter square per day) for one month showed increases
rate of survival. This dosage instruction was further revised with 10 million units per meter
square, 3 times per week for tenure of 48 weeks(Garbe et al., 2011).
3.2 Chemotherapy
Chemotherapy is by far the most accepted palliative therapy for melanoma. It is used for
the treatment of stage four metastatic melanoma. Among the chemo therapeutic agent, the most
popularly used drug for the treatment of melanoma is decarbazine(Garbe, Eigentler, Keilholz,
Hauschild& Kirkwood, 2011, pp.10). On the other hand, oral consumption of temozolomide and
yield same success result in comparison to that of decarbazine(Garbe, Eigentler, Keilholz,
Hauschild& Kirkwood, 2011, pp. 10).The antitumor activity of decarbazine is not because of the
formation of diazoniumcations but due to the subsequent high proteolysis rate of
decarbazine(Iradyan, Iradyan, Stepanyan, Arsenyan&Garibdzhanyan, 2010, pp. 175-176). As per
the obswervation, administration of decarbazine results in the oxidation of the long triazene
chain present in the microsomonal cells of the human body. This leads to cell death in the G1
phase of the cell cycle. Sometimes, cell death is also encountered in early S-phase of the mitosis
cell cycle (Iradyan, Iradyan, Stepanyan, Arsenyan&Garibdzhanyan, 2010, pp. 175-176).
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3.3Immunotherapy
This therapy is recommended for the immuno suppressed individuals who are suffering
from melanoma. The immunotherapy has been found to improve the process of immune
recognition followed by antitumor immune response of the effector via the process of antigen
presentation and eliciting effector memory T-cells(Garbe, Eigentler, Keilholz, Hauschild&
Kirkwood, 2011 pp. 9). This therapy is also known as vaccination therapy and is found to be
effective at it prevents recurrence of the disease due to the generation of the memory response.
The advanced in the domain of structural analysis of the antigenic epitiopes have led to the
foundation of the immunotherapy (Garbe, Eigentler, Keilholz, Hauschild& Kirkwood, 2011 pp.
9).
4.0 Role of Health Professionals Providing the Treatment
4.1 Oncology Doctor
Apart from framing proper treatment regime for the patient there are other important
roles that need to be played by an oncologist. Communication related the overall disease
prognosis, treatment and advanced therapy plan to the patient and the family is one of the vital
parameters in the domain of developing a strong relationship between the oncologist and the
patient(Fujimori, Shirai, Asai, Kubota, Katsumata &Uchitomi, 2014).. Proper communication
and development of trust helps the patient to generate less psychological stress and promoting
quality of life and well-being during the treatment(Fujimori, Shirai, Asai, Kubota, Katsumata
&Uchitomi, 2014).. One of the greatest challenges for the oncologist is, breaking the bad news in
the front of the patient and his family members. Questions related to the disease prognosis, the
life expectancy of the patient needs to be answered with care and in detail. This is indeed a
stressful task and demands a lot of knowledge in the field of signs of the disease prognosis and
proper flexibility in the communication skills with the patients and sensitivity(Fujimori, Shirai,
Asai, Kubota, Katsumata &Uchitomi, 2014). Apart from administering medicines, the oncologist
needs to be careful about the nutritional balance of the patient. Since chemotherapy causes high
level of immune suppression(Kudo-Saito, Shirako, Takeuchi & Kawakami, 2009, pp. 195-206),
proper nutritional back is mandatory for maintain the patient physical health strong enough to
withstand the overall therapy.
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4.2 Oncology Nurse
Oncology nurses practise in diverse settings. The settings encompass, acute care unit of
the hospital, ambulatory care clinics in the hospitals, radiation therapy unit and as an assistant
with the private oncologist(Swanson &Koch, 2010).Nurses in the oncology unit are expected to
be nimble in assessing both the physical and emotional status of the patient. This is usually done
via knowing patients past history. They also review the treatment plan with the oncologist and
are totally aware of the possible outcome of the disease treatment(Swanson &Koch, 2010). The
nursing care plan for a patient with melanoma is framed in response to the specific needs of the
patient like patient’s understanding of the disease via educating them, setting proper therapy
goals, psychological and physical preparation of the patient and compliance(Corner& Bailey,
2009).
5.0 Impact on Community
Melanoma has a huge impact on the community. It affects the social and emotional well-
being of the patients who are suffering from melanoma and these affects are gradually imposed
on the care givers and the members of the family(Cancer Institute NSW, 2017). The common
emotional reaction to cancer like melanoma are anger or sadness, fear or feeling out of control or
feeling that there is nothing that they can do to save themselves from this fatal disease(Cancer
Institute NSW, 2017). The social and emotional issues are extremely difficult for the patients to
understand or to discuss about. This can also lead to problem like severe mental depression and
anxiety(Cancer Institute NSW, 2017).
6.0 Conclusion
Thus from the above discussion it can be concluded that melanoma most dangerous form
of skin cancer with highest prevalence rate in Australia and Japan. Melanoma or skin cancer is
however canbe effectively treated if detected at an early stage of disease prognosis. Three of the
most commonly used therapy for the treatment of melanoma is adjuvant based drug therapy via
interferon alpha, chemotherapy and immunization therapy. Of these three therapies,
chemotherapy is the most widely accepted therapy in the treatment of melanoma. It is generally
recommended when there is no chance or scope for operation or surgery. Two of the most
important pillars of the health care professionals in the treatment of melanoma are oncologist and
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a registered nurse in the domain of oncology. However, in spite of the high possibility of getting
cured and advancement in the field of cost effective treatment and medical research, cancerous
disease like melanoma affects the social and the emotional well-being of the affected person.
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7.0 References
Corner, J., & Bailey, C. D. (Eds.). (2009). Cancer nursing: care in context. John Wiley & Sons.
Fujimori, M., Shirai, Y., Asai, M., Kubota, K., Katsumata, N., &Uchitomi, Y. (2014). Effect of
communication skills training program for oncologists based on patient preferences for
communication when receiving bad news: a randomized controlled trial. Journal of
clinical oncology, vol. 32(20), pp. 2166-2172.DIO: 10.1200/JCO.2013.51.2756
Garbe, C., Eigentler, T. K., Keilholz, U., Hauschild, A., & Kirkwood, J. M. (2011). Systematic
review of medical treatment in melanoma: current status and future prospects. The
oncologist, vol. 16(1), pp. DOI 5-24.10.1634/theoncologist.2010-0190
Hodi, F. S., O'day, S. J., McDermott, D. F., Weber, R. W., Sosman, J. A., Haanen, J.
B., ...&Akerley, W. (2010). Improved survival with ipilimumab in patients with
metastatic melanoma. N Engl j Med, vol. 2010(363), pp. 711-723. DOI:
10.1056/NEJMoa1003466
Indicator: A-15 Skin melanoma rates by Australian Institute of Health and Welfare. (2017).
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Iradyan, M. A., Iradyan, N. S., Stepanyan, G. M., Arsenyan, F. G., &Garibdzhanyan, B. T.
(2010). Antitumor activity of imidazole derivatives: dacarbazine and the new alkylating
agent imidazene. Pharmaceutical chemistry journal, vol. 44(4), pp. 175-182.
Ishihara, K., Saida, T., Otsuka, F., & Yamazaki, N. (2008). Statistical profiles of malignant
melanoma and other skin cancers in Japan: 2007 update. International journal of clinical
oncology, vol. 13(1), pp. 33-41.https://doi.org/10.1007/s10147-007-0751-1
Kudo-Saito, C., Shirako, H., Takeuchi, T., & Kawakami, Y. (2009). Cancer metastasis is
accelerated through immunosuppression during Snail-induced EMT of cancer
cells. Cancer cell, vol. 15(3), pp. 195-206.https://doi.org/10.1016/j.ccr.2009.01.023
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Leiter, U., &Garbe, C. (2008).Epidemiology of melanoma and nonmelanoma skin cancer—the
role of sunlight.In Sunlight, vitamin D and skin cancer (pp. 89-103).Springer New York.
Melanoma facts and statistics - Melanoma Institute Australia.(2017). Melanoma Institute
Australia. Retrieved 25 September 2017, from
https://www.melanoma.org.au/understanding-melanoma/melanoma-facts-and-statistics/
Rass, K., &Reichrath, J. (2008). UV damage and DNA repair in malignant melanoma and
nonmelanoma skin cancer. In Sunlight, Vitamin D and Skin Cancer (pp. 162-
178).Springer New York.
Reisfeld, R. A., &Ferrone, S. (2012). Melanoma antigens and antibodies.Springer Science &
Business Media.
Shields, C. L., Markowitz, J. S., Belinsky, I., Schwartzstein, H., George, N. S., Lally, S. E., ... &
Shields, J. A. (2011). Conjunctival melanoma: outcomes based on tumor origin in 382
consecutive cases. Ophthalmology, vol. 118(2), pp. 389-
395.https://doi.org/10.1016/j.ophtha.2010.06.021
Shiga, K., Ogawa, T., Kobayashi, T., Ueda, S., Kondo, A., Nanba, A., ...& Takahashi, M. (2012).
Malignant melanoma of the head and neck: A multi‐institutional retrospective analysis of
cases in Northern Japan. Head & neck, vol. 34(11), pp. 1537-1541.DOI:
10.1002/hed.21984
Swanson, J., & Koch, L. (2010, January). The role of the oncology nurse navigator in distress
management of adult inpatients with cancer: a retrospective study. In Oncology Nursing
Forum (Vol. 37, No. 1).
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treatment-side-effects-a-guide-for-aborigi/the-effects-of-cancer-on-social-and-emotional-
well-being
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Tsao, H., Olazagasti, J. M., Cordoro, K. M., Brewer, J. D., Taylor, S. C., Bordeaux, J. S., ...
&Begolka, W. S. (2015). Early detection of melanoma: reviewing the ABCDEs. Journal
of the American Academy of Dermatology, vol. 72(4), pp. 717-
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