Malignant melanoma is a tumor that arises from the melanocytes or pigment cells in the skin although it less commonly also forms in the eyes and internal tissues like the gastrointestinal tract or nose. While most melanomas are caused by exposure to ultraviolet (UV) light from the sun or tanning beds, they can also form on the skin or other organs that have not been exposed to UV radiation.
Melanoma is a form of skin cancer that is rapidly increasing worldwide. Unlike many other types of cancer, melanoma commonly impacts younger and middle-aged people with up to 75% of patients being younger than 70 years of age.
An integrative approach that combines conventional medical treatments with complementary strategies offers holistic care for melanoma patients. This type of collaborative and personalized care offers the hope of earlier detection and more successful treatment that takes all of the patient’s needs into account.
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What is Melanoma?
Melanoma forms due to malignant transformation and proliferation of melanocytes due to changes in their DNA that tell the cells to make many more cells quickly. These cells normally give pigment or melanin to the skin. During the formation of an embryo, melanocytes are derived from the neural crest stem cells which give rise to the skin and also migrate to other locations like the gastrointestinal tract and brain where melanomas can also sometimes develop.
Melanomas are most likely to develop in those with a family history, a fair complexion with blond or red hair and/or blue eyes, those with a lot of freckling, and people who burn easily in the sun. Being immunosuppressed after a transplant or due to hematologic malignancies or other conditions also increases the risk.
While melanomas often develop in previously healthy skin, they can sometimes develop in or near a precursor lesion like a mole (common acquired nevus), dysplastic nevus, congenital nevus, or cellular blue nevus. Because of this, melanomas are common in those with atypical mole syndrome (B-K mole syndrome, dysplastic nevus syndrome, familial atypical multiple mole melanoma) especially when several family members are affected.
Sun exposure heightens the risk of developing a melanoma. High exposure to UVB and UVA radiation contribute to the development of melanoma with risk factors like living at a low latitude, having a high number of blistering sunburns, and using tanning beds contributing to the risk.
Early detection of melanoma is crucial and impacts survival. Patients with stage 0 melanoma have an excellent five-year relative survival rate of 97% while those with more advanced stage IV disease that has spread beyond the skin to other organs have a survival rate of only 10%.
Conventional Treatments for Melanoma
The standard melanoma treatments are targeted to the type of lesion, stage of disease, and individual needs and preferences. Melanomas are staged based on the thickness of the lesion and if they have spread to lymph nodes or other areas of the body. Thin small lesions in just the skin are stage 0 or 1 while stage 4 lesions have spread to other organs like the lungs or liver.
If a full-thickness biopsy of a melanoma shows a high risk of spread, a sentinel node biopsy is done where dye is injected in the area where the melanoma was removed and the first lymph nodes that take up the dye are removed and tested for melanoma cells. If there is concern that the melanoma has spread beyond the lymph nodes, imaging studies like MRI, CT, and/or positron emission tomography (PET scan) are used to assess cancer spread to other body areas.
Small, thinner melanomas may be treated with surgical removal alone. For thicker lesions and those that have spread beyond the skin, radiation and/or chemotherapy are usually used to try to destroy cancer cells throughout the body.
In addition to being used to help treat cancer that has spread to lymph nodes or reduce symptoms due to cancer that has spread to distant organs, radiation therapy is sometimes used to treat remaining melanoma cells that cannot be completely removed with surgery.
Immunotherapy is another conventional therapy option for melanoma. This approach involves giving medication that stimulates your body’s immune system to target and kill cancer cells. It may be used to target melanoma cells that have spread to the lymph nodes or other areas of the body or injected directly into remaining melanoma tissue that cannot be completely removed with surgery.
To prevent and slow the spread of advanced-stage melanoma, targeted therapies are incorporated into an individualized approach to care. These medications identify and attack specific targets on melanoma cancer cells such as certain proteins and gene mutations (changes) that control cell growth and death. For example, BRAF mutations are found in about half of melanomas and are targeted with BRAF inhibitors including vemurafenib (Zelboraf®), dabrafenib (Tafinlar®), and encorafenib (Braftovi®). Other targeted therapies involve the MEK protein that works with the BRAF gene and KIT inhibitors that target mutations found in melanomas of the nail beds, palms, and soles. This is a more narrow approach than chemotherapy which acts on any fast-growing cells.
The Role of Integrative Strategies in Melanoma Care
Integrative strategies can be used to complement conventional treatments. This approach helps to make the body as strong as possible while targeting the cancer as well as improving patient outcomes and quality of life. Lifestyle approaches like getting adequate sleep and staying physically active help to keep the mind and body healthy and strong to reduce symptoms resulting from treatment, support the immune system, and improve well-being.
To support the body in entering a healing parasympathetic nervous system state, it is important to get regular adequate restorative sleep, aiming for 7-9 hours of quality sleep each night. Keep your bedroom quiet, dark, and cool, and try a calming ritual in the evenings like stretching or taking a warm bath to help you settle towards deep sleep.
Regular physical activity is also crucial for keeping the body and mind balanced and healthy and improving cancer outcomes. Regular moderate exercise supports the immune system, muscles, flexibility, and balance. It is also beneficial for the gut and therefore helps to balance inflammation. Exercise also promotes autophagy, the process that your body uses to remove dysfunctional components and debris.
An emerging integrative strategy for melanoma care is based on the recognition of the important role that gut microbes play in regulating the immune system. Evidence suggests that imbalances in the gut microbiome (dysbiosis) can increase the risk of several cancers. The gut microbiome strongly influences your immune system by modulating cytokines, immune cells, and inflammation. Fecal microbiota therapy (FMT) has been studied as a means to alter the gut microbiota in patients who are resistant to treatment with immunotherapy. Transferring fecal material from patients who successfully responded to immunotherapy for melanoma into someone who did not previously respond has successfully converted non-responding patients into responders.
Nutritional and Herbal Support
In addition to managing stress and staying physically active, it is important to optimize diet and nutrient levels to support the body during melanoma treatment and prevent future disease.
Complementary care for melanoma patients incorporates an individualized anti-inflammatory diet that is rich in antioxidants. Consume a diet full of diverse colorful fruits and vegetables, whole grains, and healthy fats while avoiding processed foods, added simple sugars, chemical preservatives, and alcohol. Plant-based diets are associated with lower rates of cancer due to their ability to reduce inflammation and support the gut microbiome. This makes new cancers less likely to develop and helps the patient tolerate other treatments successfully.
In particular, anti-inflammatory diets such as the Mediterranean Diet include high levels of colorful plant-based foods that provide antioxidants, including polyphenols. These phytonutrients inhibit cancer-related biological pathways, helping to reduce inflammation, support proper cell differentiation and proliferation, and promote DNA repair by inhibiting toxins that are formed internally that can damage DNA.
Vitamin D is one nutrient that has been studied for its effects on the immune system and cancer prevention. Inadequate levels of vitamin D are associated with higher levels of inflammation and more advanced stages of melanoma. Overall, lower vitamin D levels were associated with poorer overall and disease-free survival. Foods rich in vitamin D include wild fatty fish and mushrooms. If needed, vitamin D supplements can also be tailored to your individual needs under the guidance of a professional.
Another nutritional supplement that can support health and reduce the risk of cancer is probiotics. Probiotic-rich foods like kimchi and sauerkraut and oral probiotic supplements help to support a diverse microbiome, support the immune system, and reduce inflammation. Studies show that oral supplementation with Lactobacillus reuteri probiotics can colonize melanomas to make immunotherapy more successful. This effect appears to be due to these bacteria releasing indole-3-aldehyde (I3A), a metabolite of tryptophan, that has anti-tumor effects.
Mind-Body Practices for Enhancing Treatment
Chronic uncontrolled stress has many detrimental impacts on the body, including increasing inflammation and contributing to the risk of cancers like melanoma. Managing and reducing stress improves mental and physical health during melanoma treatment and can prevent future disease.
During periods of chronic stress, you make hormones like cortisol and epinephrine (adrenaline) that help your body cope with the threats at hand. When they are constantly flooding the body though, these hormones can have detrimental effects like suppressing the immune system. Chronically elevated cortisol and epinephrine levels also increase the risk of metastasis, in part due to their ability to stimulate the creation of new blood vessels (angiogenesis).
Engaging in mind-body practices like yoga, meditation, and breathwork can help avoid chronic elevations in these stress hormones and help your body enter a more healing parasympathetic state.
Acupuncture is another effective integrative therapy to help reduce stress and its impacts on the body. This practice from Traditional Chinese Medicine (TCM) involves inserting tiny needles at energy points along the body. Randomized controlled trials show that acupuncture can treat chemotherapy-induced nausea and vomiting, fatigue, low white blood cell counts, cancer-related pain, and dry mouth that can occur during cancer treatment.
Integrating Complementary Approaches into Conventional Care
Patient-centered care with multidisciplinary teams of professionals allows patients to have the most appropriate strategies for care. Spreading awareness about melanoma and its early recognition amongst healthcare providers is needed so that an interprofessional team approach can be enacted. In addition, educating and empowering patients to become active participants and partners in their care helps encourage effective communication and optimal quality of care and life.
Early diagnosis of melanoma is crucial for improving the chances of successful treatment and long-term survival. Therefore, listening closely to the patient and taking a thorough history and physical examination can help identify early signs that lead to suspicion of melanoma.
A thorough history and physical examination noting changes to any moles or the appearance of new lesions is crucial for diagnosis. Typical moles appear uniform in pink, tan, brown, or black color with a distinct border and regular oval or round shape. They are usually small (less than ¼ inch in diameter).
Melanomas are commonly characterized by lesions that do not fit this typical mole appearance. This includes changing characteristics in an existing mole or a new mole that has appeared that has the ABCDE characteristics: A - Asymmetry, B - Irregular border, C - Color variations, especially red, white, and blue tones in a brown or black lesion, D - Diameter greater than 6 mm, and E - Elevated surface. These malignant lesions can also be itchy, bleed, or ulcerate. Any suspicious lesions should be removed with an excisional biopsy and sent to the laboratory for pathologic analysis.
Educating patients about these typical characteristics and how they can monitor their skin can help bring any suspicious lesions to medical attention at an earlier stage. Patient-centered care also involves educating patients about modifiable risk factors and lifestyle habits. This allows them to become empowered participants in their own health and care.
Lifestyle habits such as avoiding tanning beds and spending time in the sun between 10 am and 2 pm when the UV rays are the strongest can help to reduce UV exposure and melanoma risk. It can also be helpful to wear protective clothing, a wide-brim hat, and sunglasses to protect delicate skin in those with high risk and during times of the sun’s strongest rays.
Challenges and Considerations
The incidence of melanoma continues to increase worldwide, impacting more and more patients. To ensure the most effective and ethical care for patients with melanoma, it is important to consider the potential challenges that can arise. While incorporating these integrative approaches into care can greatly benefit melanoma patients, attention and care are needed to ensure safety and effective outcomes. When integrating complementary approaches with conventional melanoma treatments, it is crucial to remain aware of potential issues with evidence quality, patient preferences, and regulatory considerations.
Continued research is needed to elucidate the most effective strategies for diagnosis and care so that additional robust evidence is provided for the efficacy and safety of complementary strategies in melanoma care. Efforts to educate providers and improve tools for accurate and timely melanoma diagnosis are needed. Improving provider sensitivity for diagnosis can help improve early diagnosis of melanomas avoiding more intensive therapeutic interventions that come with additional personal and financial impacts for the patient.
Research is also needed to clarify modifiable risk factors and the best ways to empower people to prevent disease. For example, familial melanoma can result from shared environmental risk factors as well as heritable genetic mutations so research into environmental impacts should continue. In addition, community-based efforts should be enacted to improve primary and secondary melanoma prevention campaigns and education.
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Key Takeaways
An integrative approach to melanoma care embraces both conventional treatments and complementary strategies. This includes educating and empowering patients to know their own bodies and bring up signs of potential disease early in its course. It also involves a cooperative approach amongst practitioners from many disciplines to provide the most effective care for each individual.
Holistic melanoma treatment looks at the whole person and offers a personalized plan of care that strengthens the body and mind while treating the cancer and the rest of the person. Optimizing diet and nutrition, utilizing lifestyle approaches like sleep and exercise, and considering the important roles of stress and gut health are all key components of an integrative approach to melanoma care. The benefits of integrative care like this for the mind and body are great.
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