The word melanoma comes from the Greek words, Melas, meaning black and -Oma which means tumor. Melanoma is one of the ten most common and dangerous skin cancers with a steadily increasing incidence. Melanoma results from malignant transformation of melanocytes, which are responsible for the production of endogenous pigments in the epidermis called melanin (Skalnikova, 2017). Malignant melanoma is one of the major problem due to its high occurrence among patients compared with any other type of cancer worldwide. Melanomas are highly metastatic and resilient to chemotherapy and can be formed where there is pigment. Therefore, it is crucial to treat melanomas with an early detection and prevention (Chakraborty, 2017). Melanoma can affect adults of all ages as well as teenagers. According to the American Cancer Society (ACS), an estimated 91,270 new melanomas would be diagnosed in 2018. With about 9,320 deaths from melanoma. Melanoma is a very difficult cancer to advert on the skin. It is noteworthy how research has come up with a variety of therapies for melanomas, yet some of them might be more harmful compared to its effectiveness. This leads to seek for better solutions like gene therapy for melanoma skin cancer. Because it can cure an individual, it also averts diseases through a blood line (Chakraborty, 2017). Therefore, could gene therapy offer clues for new treatments for diseases including melanomas.
Composition of the skin and Symptoms of melanomas
Foremost, human skin has 2 layers; the epidermis, is the outer layer of the skin and the dermis is the inner layer of the skin. The deeper layer of the epidermis contains the melanocytes responsible for the color of the skin. Whereas the melanoma stars in the melanocytes when the skin is exposed, resulting in the damage and therefore in the abnormal and uncontainable growth of the cell creating a tumor. This can grow deep into the dermis, where some of the risks include invading the lymph nodes, and therefore, speeding entirely through the body. Melanocytes originate from neural crest. Outside the skin, melanocytes occur in eye, mucosal epithelia and meninges (Lo, 2014). According to AIM at Melanoma Foundation, Melanoma is the third most common cancer among women ages 20-39 and the second most common cancer in men ages 20-39. The melanoma types are based on its appearance on microscope or naked eyed. However, studies have shown that symptoms for most of the types of melanomas non-melanomas are almost the same. The American Cancer Society recommends the ABDCDE rule, for recognizing the usual symptoms of melanoma:
• Asymmetry: the two sides of the pigment spot or mole do not match.
• Border: irregularity in the borders of the lesion, blurred, ragged or notched.
• Color: the pigmented mole contains several colors. Different shades of black, brown, sometimes with patches of other colors like pink, red, white and even blue.
• Diameter: the spot is larger than 6mm in diameter.
• Evolving: the mole changes with time the size or color.
A normal mole is usually considered small, should have smooth, symmetrical borders, and an even color. People with serious risk factors or symptoms should have regular full body exams by a dermatologist to identify any skin abnormalities, and baseline photographs should be taken so that any changes can be tracked. Suspect moles or skin abnormalities should be removed and analyzed for cancer cells (Crowder, 2014).
Melanomas can also be divided according to the place of origin to the most common cutaneous melanoma, uveal melanoma, and mucosal melanoma. Also, there has be some consideration of the factors that can influence the development of melanoma comparable to the degree of skin pigmentation, hereditary predisposition, as about 10% of melanomas have familial occurrence and the length of skin exposure to Ultraviolet radiation (Yang GB, 2011). Additional risk factors include large or multiple moles and past personal history of melanoma or of less serious skin cancers, known as basal cell which is the least malignant but most common, accounts nearly 80% of cases. The lesion often occurs on sun exposed areas of the face; it appears as dome shaped nodules that later on develop as an ulcer. This type of cancer is slow growing, and metastasis can occur. The second most common type is squamous cell carcinoma that rises from the keratinocytes of the stratum spinosum. This type of cancer tends to grow quickly and metastasize if it is not removed (Learning, 2018). According to Crowder, occupational exposure to coal asphalt, pitch, creosote, arsenic compounds, or radium increase a person’s risk for the disease.
In addition, melanoma skin cancer can be associated with genes. Most of melanoma occurs due to mutations in BRAF gene, which alter the protein causing the cancer. Also, melanomas can change the C-KIT gene that help them grow. Changes in the CDKN2A gene roots some melanomas to run in certain families through their bloodline. Modern treatment therapies have been flourishing; one of them is based on experiments and clinical trials known as “Gene Therapy.” it is an advance type of therapy meant to cure the disease by introducing the correct copy, replacing the defective gene. When a mutation on a specific gene occurs, it will develop as a defective protein, leading to complex diseases such as cancer. Most of the time cancer occurs due to the activation of onco-genes that create malignant tumors due to the inactivation of cancer suppressor genes. Gene therapy could solve this problem by stopping the activation of onco-genes and antisense sequence which block onco-gene translation into mutated protein, by hybridization and creation of a double stranded complementary RNA sequence. Another therapy is known as suicide gene therapy, where a set of trans-gene is introduced into cancerous cell which will cause apoptosis to prevent cancer.
The cancer can also be treated by immunotherapy, chemotherapy, and surgery. However, there are targeted drugs for specifics genes that can serve as a solution to control the changes in these certain genes (Chakraborty, 2017). Chemotherapy is a general term used for cancer treatment which requires using chemical to kill cancer cells. This type of therapy travels through the bloodstream throughout the body. One of the advantages is the effectiveness on destroying cancer cells. On the other hand, there are some long-term effects since chemotherapy attracts the division of cells, meaning that other cells that are normally dividing could be at risk of being attacked. Another reason is that chemotherapy tends to destroy white blood cell, making the body weak against common diseases. Also, it can cause infertility to both men and women depending of the type of chemotherapy. Radiation therapy implement high energy rays to kill cancer cells. However, this type of therapy does not cure cancer, but instead helps to shrink the tumor. It also has some negative aspect, such as lack of energy, hair loss, nausea, vomit, and loss of appetite.
According to AIM at melanoma foundation, Melanoma is considered the least common, but the deadliest skin cancer, accounting for only about 1% of all cases; yet the vast majority of skin cancer death. The key to survive melanoma is early detection (Learning, 2018). According to the American Cancer Society, 5,990 males and 3,330 females are expected to die in the U.S. of melanoma during 2018. Advances in the understanding of genetics related to melanomas could prevent and improve strategies that will perhaps evolve over the next decades. Gene therapy has emerged as a potential alternative treatment due to its clinical success and safety developments in the field of gene transfer method. Gene therapy shows promising results by shrinking the tumor and prolonging a patient’s life. Yet, prevention and early detection remains the primary goal against melanomas (Sotomayor, 2002). Where the most important key factor for skin cancer is due to UV exposure, damaging the DNA bases. In other cases, irritation of the skin by infections, physical trauma and chemicals tend to be a predisposing factor. Survival rates decline with increasing thickness of the melanoma, and the degree of involvement of the lymph nodes and level of metastasis (Learning, 2018). The mortality rate for melanoma is 100,000 people per year, increasing at slower step and has been stable over the past 10 years. Therefore, prevention and early detection rely on the understanding and explanation to the vulnerable population, the need of protection from UVR in order to achieve an optimal prevention of melanoma rates (Lo, 2014). While referring to gene therapy for melanoma or specific diseases it means that certain genes are associated with events that are responsible for the disease and should be targeted. Therefore, those genes responsible for melanoma must be discovered and studied in order to apply a therapy for making it a complex but doable process.