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Lane Bokros

Professor Blouch

English Composition II

2 May 2021

Melanoma’s Effect on the Individual

In the summer of 2019, I worked as a lifeguard at my local country club. I worked quite

frequently, clocking in an average of about 40 hours a week over the summer months. All these

hours were spent outside in the sweltering sun, sitting in the guard chair or walking around the

pool deck. In early August, my mom pulled me aside at my house after I returned from work one

day. She had noticed a large freckle on my forehead that had been there for years appeared to

have changed over the past month or so. While not being overly concerned, she sent a photo of

the freckle to a dermatologist friend out of precaution. Her friend showed concern and

recommended a visit to a different dermatologist for an official inspection. There, a biopsy was

taken and shortly after, the freckle, along with another spot on my scalp under my hair, was

diagnosed as pre-melanoma growth. It would have developed into melanoma and then spread

given more time. Thankfully, with the swiftness of the diagnosis I was able to go to a plastic

surgeon and undergo surgery to remove the spots before it was too late. I had stitches in my scalp

for several weeks, and I could barely move my face to eat, speak, or laugh for the first week that

I had the stitches. While certainly scary, this minor inconvenience on my life was nothing in

comparison to the deep effects that a fully developed case of melanoma could had had on my

life.
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Skin cancer is the most common form of cancer in the world, affecting some 20 percent

of Americans during their lifespans. It comes in many forms, ranging from common, less

problematic precancer forms such as actinic keratosis, to far more pervasive forms such as

melanoma (Skin Cancer Foundation). Melanoma is an extremely dangerous form of skin cancer

that has become increasingly prevalent in recent years. Melanoma can vary greatly in its severity,

the amount of time it takes to be eliminated, if it ever is, as well as the intensity and length of

that treatment process. Individuals who have not had or experienced the disease may be unaware

of the affect that having melanoma has on an individual. Skin cancer, specifically melanoma,

deeply impacts the individual in the long term biologically, medically, and psychologically. Its

seriousness is not always well-understood but understanding the effect it can have on a life is

critical to prevention and awareness of the cancer.

To understand the effects of melanoma on an individual’s life, the pervasiveness of

melanoma within the U.S. population must first be understood. How many people will have their

lives changed by this disease? Over 200,000 people are expected to be diagnosed with a new

case of melanoma in this upcoming year. In the last thirty years, the incidence rate of melanoma

in the population has approximately doubled (Skin Cancer Foundation).

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Image from Center for Disease Control.

The above image shows the frequency of melanoma in the U.S. population over an 18-

year span from 1999-2017. Even in this period, which is significantly shorter than the

previously-mentioned three-decade span, the incidence rate of melanoma increases from 15.2

people per 100,000 to 22.7 people per 100,000 during this time span. The rate is continually

increasing, and the cancer thus affects increasingly more of the population that was once not

impacted as much.

One of the most dangerous aspects of melanoma is misinformation and thinking that “It

could never happen to me!” A common misconception about melanoma is that it only affects

older people- while the average age of individuals diagnosed with melanoma is 63, it is the
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number one most diagnosed cancer in people 25-29 years old. Of the 200,000 some cases to be

diagnosed in the U.S., 7,000 people will die of melanoma per year. All these statistics combine

to a paint a portrait of a disease that is relevant to the population at all ages, and extremely

serious when it takes hold (Melanoma Research Alliance). Once the statistical significance of

melanoma is understood, the biological basis of the cancer can then be explored.

Melanoma is a form of cancer, meaning that it is abnormal cell growth and development

within the body that can lead to disastrous effects. It affects melanocytes, which are cells that

produce skin pigment. Generally, it is caused by UV exposure, which is most often from the sun,

but can be from use of artificial lights such as tanning beds (Melanoma Research Alliance). Less

commonly, it may appear in places on the body that are typically not exposed to light. Joan, a

stage IV melanoma patient, shared in an interview: “It was just a mole on my underarm- not even

a sun-exposed part. Like, for all the lifeguarding and time I’ve spent outside in my teenage

years... this one was in my armpit, just a mole.” These cases are incredibly dangerous, as Joan’s

cancer was not even discovered until it was already in its final stage (“Interview with Joan”). The

permeance of the disease does typically vary by demographic, however. Melanoma is most often

found in individuals with light skin, by a very wide margin, as they have more of a type of

melanin that does not protect the skin cells against UV rays. What makes melanoma so

problematic and so deadly is its ability to spread to the rest of the body with rapid ease,

particularly in comparison to other more common forms of skin cancer (Skin Cancer

Foundation). The journey and battle of an individual who will be diagnosed with melanoma

begins with the recognition of the disease and the diagnosis.

The disease can first appear in individuals as an abnormal and mutated freckle or splotch

somewhere on the skin. It can be discolored, typically very dark, raised, and misshapen. This is
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not a guarantee, however, as most melanoma cases develop in normal-appearing skin. Even

before diagnosis, if there ever is one, the affect melanoma has on many individuals begins here.

It is recommended by doctors that one checks themselves for these spots frequently, even more

so for those who are often outside. It is a cause of concern and caution for many people, who

seek lots of sun protection including protective clothing and plenty of sunscreen, to decrease the

likelihood that they will ever be diagnosed with melanoma to begin with (Skin Cancer

Foundation).

Image from Melanoma Research Alliance.

The above image is a visual representation of the different stages of melanoma. When a

doctor diagnoses an individual with melanoma, it is staged at that time based on the current

permeation of the cancerous growth. The skin surface represents the earliest stage, then in

multiple later stages, the growth takes hold in the epidermis increasingly deeper. In the final

stage, the cancerous growth has breached the fat beneath the layers of skin, and thus easily

spreads to other parts of the body. Staging during diagnosis is a critical part to determining the

best possible path of treatment for an individual’s case.

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Once an individual is diagnosed with melanoma, the treatment options open. The cancer

is known as local melanoma if it affects only the skin at the specific site of diagnosis and has not

yet spread to other organs or parts of the body. Local melanoma encompasses stages 0, I, and II

of melanoma development. In all three of these stages, the treatment is surgical removal of the

affected tissue at the site of abnormality. In most cases and stages, this surgery proves to be the

most effective and common treatment for melanoma. In the later stages of local melanoma, a

biopsy elsewhere on the body, such as lymph nodes, may be taken to ensure that the disease has

not yet spread elsewhere. While stages I and II have intermediate to elevated risk of recurrence

after surgical treatment, all instances of local melanoma across these stages have a 98.4 survival

rate after 5 years (Melanoma Research Alliance). Local, noninvasive melanoma accounts for half

of the expected melanoma cases that will be diagnosed every year. Unfortunately, the remaining

half of those cases are ones where the cancer has spread in some way to other parts of the body

(Skin Cancer Foundation). Both treatments and survival rates change with these developments.

The first of the later stages of melanoma is stage III, otherwise known as regional

melanoma. It is defined by having spread to other areas of skin that were not initially affected, as

well as lymph nodes and vessels. It is grouped into substages based on how far the cancer has

gone into those specific areas. Treatment options at this stage can vary but the primary focus is

surgery if the melanoma is what is known as resectable, or able to be entirely and safely removed

through excision. If the cancer is not resectable, then the most common option is surgery to

remove most of the growth combined with immunotherapy. Immunotherapy is the taking of

drugs that specifically and selectively stimulate the immune system into targeting the cancer. It’s

done when there are no other ways to reach all the cancerous growth in the body (Melanoma

Research Alliance).
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While not as intense as other treatment options, immunotherapy certainly has a

significant effect on the individual undergoing the treatment. It often goes for a great deal of

time, as the process is slow and difficult, requiring the body to fight the cancer. It also comes

with many side effects, often flu-like symptoms of fever, chills, fatigue, nausea, headaches, and

respiratory issues. These side effects are unpredictable in frequency, intensity, or appearance

whatsoever, and thus the stress placed on the individual going through immunotherapy ranges

from significant to intense (National Cancer Institute). Other options for treatment include

targeted drug therapy to block cell growth, as well as radiation therapy in the worst cases of stage

III, although it is usually used for the next stage. When melanoma is accurately diagnosed and

treated in the regional stage, it has a 5-year survival rate of 66 percent (Melanoma Research

Alliance). Unfortunately, this rate drops significantly if the cancer develops to the next and final

stage of growth.

Stage IV of melanoma, otherwise known as metastatic melanoma, is defined by its

aggressive and pervasive spread to other organs, like the heart, lungs, GI tract, and far reaches of

the skin. It is the final and most deadly stage of development, as it begins to impact organs that

regulate basic body functions. The severity can vary at this stage, as it is open-ended once one

organ has been metastasized, meaning some cases of stage IV melanoma can be much worse

than others. The 5-year survival rate for this stage of the disease is approximately 27 percent

(Melanoma Research Alliance). While serious, the good news is that the entire gamut of

treatment options is available at this stage, and some of them are very successful for individuals.
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Image from American Cancer Society.

A common treatment option is that of clinical trials of combined therapies, which

typically take the form of an experimental immunotherapy being used alongside an established

and approved drug. The aforementioned Joan, who suffered from stage IV melanoma, found her

success with one such clinical trial and was able to be declared cancer-free after a few months of

treatment. While immunotherapy can certainly have some of the negative side effects mentioned

earlier, the advantage of it versus radiation therapy or chemotherapy is that it does not affect the

rest of the body in the way that those do. In Joan’s case, she made a point to exercise frequently

and was able to make her trips for treatment without very much pervasion of her independence

(“Interview With Joan”).

Outside of just clinical trials, established and approved immunotherapies that fight the

cancer cells are still quite common, sometimes in combination with targeted therapies. Targeted

therapies are drugs that seek to inhibit the action and growth of the cancerous cells or mutations

in the genes, which prevent cancer from spreading in the first place. They’re tailored to the
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individual. When the therapies that kill cancer are combined with those that stop its growth, the

optimal success stories of metastatic melanoma are often found. Less common due to their

inconvenience and adverse effects are the previously mentioned chemotherapy and radiation

therapies. They are not recommended in most cases, because they are untargeted and have a

disastrous effect on the entire body. They make patients weak and ill and overtake the entire

lives of those who go through those treatments. With advancements of targeted therapies,

chemotherapy and radiation therapy have been reserved for only the most extreme of

metastasized cases, where surgery and even immunotherapies will not be able to help (Skin

Cancer Foundation).

Once an individual is cancer-free, after months and sometimes even years of treatment,

the impact of the cancer on their lives is not yet over. First are the medical and lifestyle

implications of having had melanoma. If an individual has had melanoma once, the odds that

they will get it once again through recurrence increase significantly. These odds vary depending

on what stage it was diagnosed and treated within, as mentioned previously, Patients are

recommended to get full body screening multiple times per year to check for abnormal skin

growths. Individuals recovering from more serious cases get regular CT scans that look for

cancerous growths elsewhere in the body (Melanoma Research Alliance). This pervades an

individual’s life and leads to extraneous effects without as much of a tangible physical element

to them.

It’s highly recommended that patients who recovered from melanoma or skin cancer in

general are closely monitored, not only physically, but mentally as well. Individuals who have

recovered from cancer have an extremely high risk for anxiety, depression, and panic disorders

after their medical recovery. Concern about side effects of treatment, the impact of the treatment
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process on one’s family, and particularly medical costs are all sources of anxiety for patients.

Another significant concern is that of recurrence, or the cancer returning, which is much more

likely than the odds of an individual getting cancer for the first time (Brown, Stephen L., et al.).

Another component of anxiety after melanoma recovery is the intense care and caution through

lifestyle changes needed to prevent recurrence. Individuals need to exercise great care in

preventing sun exposure, including hats, extreme use of sunscreen, long sleeves and long pants,

and umbrellas and shade whenever possible (Skin Cancer Foundation). These lifestyle changes

add stress on an individual and only compound with the other sources of worry for recovered

patients.

The impact that having melanoma presents on an individual’s life is immense and spans a

great deal of time. It begins with prevention methods, the cancer’s development, and carries

through treatment methods. Those methods vary greatly and can be very pervasive to an

individual’s health depending on the stage of the disease’s development. The impact continues

long after the cancer itself is eradicated, with lifestyle changes and anxiety about recurrence and

medical treatment. I have undergone lifestyle changes as well in response to the threat of

recurrence of my precancer. I wear a hat any time I go outside for an extended period, and am

sure to wear sunscreen all the time, even when it does not seem necessary. Understanding the

risks and impacts that melanoma has is crucial to prevention of the disease in oneself. Reader,

wear sunscreen next time you are at the pool or the beach, throw on a hat more often this

summer, and consider more long sleeve shirts. Take all the possible precautions to prevent this

deadly disease.
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Works Cited

American Cancer Society. “Survival Rates for Melanoma Skin Cancer.” American Cancer

Society, cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/survival-

rates-for-melanoma-skin-cancer-by-stage.html. Accessed 8 Apr. 2021.

Brown, Stephen L., et al. “Predictors of Long‐term Anxiety and Depression in Uveal Melanoma

Survivors: A Cross‐lagged Five‐year Analysis.” Psycho-Oncology, vol. 29, no. 11, Nov.

2020, pp. 1864–1873. Academic Search Complete, doi:10.1002/pon.5514.

Center for Disease Control and Prevention. “Annual Rates of New Cancers, 1999-2017.” Center

for Disease Control and Prevention, https://gis.cdc.gov/Cancer/USCS/DataViz.html.

Accessed 8 Apr. 2021.

"Immunotherapy Side Effects”. National Cancer Institute, https://www.cancer.gov/about-

cancer/treatment/types/immunotherapy/side-effects. Accessed 10 Mar. 2021.

“Interview with Joan, CTOAM Patient.” Cancer Treatment Options and Management,

https://www.ctoam.com/success-stories/patient-interviews/joan-interview/. Accessed 7

Mar. 2021.

Jewett, Patricia I., et al. “Sun Exposure and Protection Behaviors in Urban and Rural Long-Term

Melanoma Survivors.” Archives of Dermatological Research, vol. 312, no. 6, Aug. 2020,

pp. 413–420. Academic Search Complete, doi:10.1007/s00403-019-02023-7. Accessed 7

Mar. 2021.
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“Long-Term Effects of Cancer.” University of Texas MD Anderson Cancer Center,

https://www.mdanderson.org/patients-family/life-after-cancer/long-term-effects.html.

Accessed 7 Mar. 2021.

Melanoma Research Alliance. Cure Melanoma. Melanoma Research Alliance, Washington, DC,

www.curemelanoma.org. Accessed 7 Mar. 2021.

Skin Cancer Foundation. Skin Cancer. Skin Cancer Foundation, New York City, NY.

www.skincancer.org. Accessed 7 Mar. 2021.