As we commemorated the World Cancer Day on February 4 as a day for raising awareness to early detection, prevention and treatment of cancer, it is also a time for everyone to reflect on how far we have advanced in the management of many types of cancers and appreciate that cancer is no longer the end of life or hope in Rwanda.
Public awareness has been done for most common cancers such as breast cancers, cervical cancers in various ways, and this has undoubtedly led to a positive response with people presenting early to hospitals with curable cancer stages. This outcome is also greatly attributed to the availability of the high-level equipment for early detection of these cancers, access to radiation therapy, and experts in cancer treatment.
It is, however, important to note that cancers are a wide spectrum of diseases with some cancers more commonly seen than others, and appreciate the need to know even the least commonly seen forms because they can be fatal if delayed to treat.
Melanoma, or malignant melanoma as commonly referred to medically, is a form of skin cancer that develops from the cells that are normally found in skin. It is the most aggressive form of skin cancer and can lead to loss of life if detected late—even in the highly developed cancer centres. It has been around for ages although has shown a remarkable increasing incidence over the years, globally.
Overall, melanoma is the fifth most common malignancy in men and the seventh in women. Although melanoma accounts for less than 5% of all skin cancer cases, it results in greater than 75% of skin cancer deaths. In the USA, a person dies from melanoma every hour. Studies have shown the incidence of melanoma about 25 times higher in people with white skin compared to black skin. The lifetime risk of getting melanoma is about 2.6% (1 in 38) for whites, 0.1% (1 in 1,000) for Blacks, and 0.6% (1 in 167) for Hispanics.
Despite the low though rising incidence in African populations, everyone needs to know about melanoma due to its aggressive nature and the fatality rates once the disease has advanced. It usually presents as a painless mole with shades of black, tan and brown colours. It usually has irregular dimensions with changing shapes and size overtime and sometimes the lesions get super-imposed wounds.
They commonly present on the lighter areas of the body, hence, tend to manifest on the palms, soles, under the nails (as dark colourations under the nails) among people with black skin. For white populations, melanomas can develop anywhere on the skin, but they are more likely to start on the trunk (chest and back) in men and on the legs in women. The neck and face are other common sites.
There is no specific single known cause of melanoma but various risk factors have been identified. The most significant and modifiable environmental risk factor for melanoma is sun exposure, particularly intermittent and intense exposure resulting in sunburns, especially in childhood. The other non-modifiable risk factors for melanoma development include certain types of skin (fair skin), blue or green eyes, family history of melanoma (10%) and if one has had melanoma before (5%). Being born with multiple or extensive birth marks also increases the risk for developing melanoma cancer and one should look out for any change in any of those birth marks.
In its early stages, melanoma can be treated with a simple surgery to remove the cancer with or without other further therapies and this can achieve complete cure at this stage. However, once melanoma treatment is delayed, the cancer can spread to distant organs such as liver, lungs, intestines or other distant skin areas, and this unfortunately becomes almost incurable.
Dr Ian Shyaka,Resident, Plastic Surgery Rwanda Military Hospital
iangashugi@gmail.com