Glossary of Terms

A kind of lentiginous skin melanoma It is also known as subungual melanoma. Acral lentiginous melanoma is observed on the palms, soles and under the nail. It occurs on non hair-bearing surfaces of the body which may or may not be exposed to sunlight. It is also found on mucous membranes. Unlike other forms of melanoma, acral lentiginous melanoma does not appear to be linked to sun exposure.

Small, scaly red patch caused by sun exposure; it is potential precancer of the non-melanoma type.

The use of chemotherapy or radiotherapy in addition to surgical resection in the treatment of cancer.

Therapies such as IPI (Ipilimumab) and Yervoy, that act to put the brakes on tumor growth by becoming an immune booster. It blocks a protein called CTLA-4 that acts as a brake on T cells, the soldiers of the immune system. Approved by the FDA in March 2011 for use in Stage IV patients.

Promising therapy akin to Yervoy (anti-CTLA-4)

Asymmetry of a skin spot; one half does not match the other.

A type of common, non-melanoma skin cancer that arises from the basal cells – small round cells found in the lower part of the epidermis, the outer layer of the skin.

Not malignant; not recurrent; favorable for recovery.

The removal of cells or tissues for examination under a microscope.

Blood vessel invasion, aka angioinvasion, as well as lymphatic invasion are described as being present or absent. If present it means that the melanoma has invaded the blood or lymph system respectively.

A bone scan is used to determine if the cancer has spread to the bones, but is rarely used in melanoma.

The BRAF protein is a key component of the cellular pathways and may become mutated and cause tumor growth. New BRAF therapies target this mutation to eliminate tumor progression.

The depth a melanoma lesion extends below the skin surface measured in millimeters.

A national government agency to reduce the impact of cancer and improve the wellbeing of people affected by cancer.

Chemical, physical, or biological agent that causes cancer.

The individual unit that makes up all of the tissues of the body.

• Superficial Spreading Melanoma
• Nodular Melanoma
• Acral Lentiginous Lentigo Melanoma
• Mucosal melanoma

Treatment of cancer with anticancer drugs. Medicines prescribed by medical oncologists that can kill cancer cells directly. Some are given by pill or intravenously. It is considered a systemic therapy since it goes through the bloodstream to the entire body.

A Chest X-Ray is often performed to determine if the melanoma has metastasized to the lungs.

A measurement of how deep the melanoma lesion extends below the skin surface based on involved skin layer (the larger the level number the deeper into the tissue it extends). Depending upon where the melanoma is located on the body, the millimeters of depth for each Clark level can vary widely, so one person’s Clark’s III may be 1 mm, while another person’s is 2 mm.

• Clark Level I — The melanoma cells are only in the outer layer of the skin (the epidermis). Also referred to as in situ melanoma.
• Clark Level II — There are melanoma cells in the layer directly under the epidermis (the papillary dermis).
• Clark Level III — The melanoma cells are throughout the papillary dermis and touching on the next layer down (the reticular dermis).
• Clark Level IV — The melanoma has spread into the reticular or deep dermis.
• Clark Level V — The melanoma has grown into the layer of fat under the skin (subcutaneous fat).

A type of research study that tests how well new medical treatments or other interventions work in people. May also be called a clinical study.

The CT scan is more detailed than the x-ray and provides cross-sectional images of the body, specifically the soft tissues. The CT scanner takes several pictures as it rotates around the patient and then combines the pictures to provide a detailed image. Sometimes a contrast dye is used to better identify abnormal areas of the body.

Moles that are present at birth, sometimes called birthmarks.

Pertaining to Melanoma of the skin.

A class of substances that are produced by cells of the immune system and can affect the immune response. Cytokines can also be produced in the lab by recombinant DNA technology and given to people to affect immune responses.

The medical specialty concerned with the diagnosis and treatment of skin diseases.

Physician who has special training in diagnosing disease on the basis of microscopic examination of the skin.

The lower or inner layer of the two main layers of tissue that make up the skin.

The determination of the nature of a case of a disease or the distinguishing of one disease from another.

Atypical moles; moles whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles (over 5 mm in diameter) and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they are flat or have a flat part.

The upper or outer layer of the two main layers of tissue that make up the skin.

Technique in which a lesion is removed from the skin by cutting out the affected area as well as a portion of normal skin surrounding the lesion. This technique is also used to remove larger lesions.

Expanded access is a means by which manufacturers make investigational new drugs available, under certain circumstances, to treat a patient(s) with a serious disease or condition who cannot participate in a controlled clinical trial.

American government agency responsible for approval of the use of certain drugs for therapies in America.

Technique in which a needle is inserted into the tissue or tumor to aspirate (take out) fluid and cells. This tissue/fluid is smeared onto a slide and is then looked at under a microscope. FNA can be performed in the office or under radiology guidance.

Treatment that alters a gene.

Passive immunization of an individual by administration of preformed antibodies (serum or gamma globulin) actively produced in another individual; by extension, the term has come to include the use of immunopotentiators, replacement of immunocompetent lymphoid tissue (e.g., bone marrow or thymus), etc

In its normal place; confined to the site of origin.

Technique in which a lesion is removed from the skin by cutting out the affected area. This technique is often used to remove larger lesions.

Having the quality of invasiveness. Involving puncture of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques.

Short for ipilimubab or the commercial name, Yervoy, the anti-ctla-4 immunotherapy.

A melanoma that has evolved from a lentigo malignant. They are usually found on chronically sun damaged skin such as the face and the forearms of the elderly. The nomenclature is very confusing to both patients and physicians alike.

Any pathological or traumatic discontinuity of tissue or loss of function of a part.

Any of the small, oval or round bodies, located along the lymphatic vessels, that supply lymphocytes to the bloodstream and remove bacteria and foreign particles from the lymph. Also called lymph gland, lymphoglandula, lymphonodus.

The interconnected system of spaces and vessels between body tissues and organs by which lymph circulates throughout the body.

Technique of injecting a small amount of radioactive material near the site of a primary melanoma and then scanning different lymph node areas (armpits and groin for example) to see which group(s) of nodes “light up.”

Type of white blood cell that plays an important part in immune reactions.

MRI’s provide detailed pictures of the soft tissue of the body using radio waves and strong magnets. MRI scans are very helpful in looking at the brain and the spinal cord.

Tending to become worse and end in death. Having the properties of anaplasia, invasiveness, and metastasis; said of tumors.

The edge or border of the tissue removed in cancer surgery. The margin is “negative” or clean when the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. The margin is “positive” or involved when the pathologist finds cancer cells at edge of the tissue, suggesting that all of the cancer has not been removed.

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

A MEK inhibitor is a chemical or drug that inhibits the mitogen-activated protein kinase kinase enzymes MEK1 and/or MEK2. They can be used to affect the MAPK/ERK pathway which is often overactive in some cancers. (See MAPK/ERK pathway#Clinical significance.) Hence, MEK inhibitors have potential for treatment of some cancers,[1] especially BRAF-mutated melanoma.

Commercial name for the MEK drug, trametinib.

The substance made by melanocytes that gives color to skin and eyes and that absorbs UV rays.

Cells in the skin and eyes that produce the pigment called melanin and that transfers it to surrounding skin cells.

A tumor arising from melanocytes within the skin or other organs; melanoma is often referred to as malignant melanoma.

Spread of cancer cells from one part of the body to another.

The term used to describe a secondary cancer, or one that has spread from one area of the body to another.

Mucosal melanomas are rare and account for approximately 1 percent of all melanomas. Mucosal melanomas arise primarily in the head and neck, anorectal, and vulvovaginal regions (55, 24, and 18 percent of cases, respectively). Rarer sites of origin include the urinary tract, gall bladder, and small intestine.

Mucosal melanomas are especially difficult to detect because they can easily be mistaken for other, far more common conditions. Nevus A benign growth on the skin, such as a mole.

This term describes the frequency of division within the melanoma. Higher mitotic rates are associated with more rapidly dividing cells, and therefore larger lesions with greater potential for metastasis.

A benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

A new growth of tissue in which cell multiplication is uncontrolled and progressive.

Mole.

Name for the PD1 immunotherapy commercially known as Opdivo.

No measurable evidence of melanoma in your body.

Is the most aggressive form of melanoma. It grows in vertical direction from the outset and grows very fast (months). Nodular melanoma has no known precursor. It is a small black, or if amelanotic, pink nodule that simply enlarges. The lesions tend to bleed.

The sum of knowledge regarding tumors; the study of tumors.

A nurse who specializes in treating and caring for people who have cancer.

A person with a master’s degree in social work who works with cancer patients. The oncology social worker/counselor provides counseling and assistance. Patient Navigators are health care professionals whose primary focus is to assist cancer patients, caregivers, and families in “bridging the gaps” within the health care system and decreasing barriers to care by utilizing resources.

Also known as uveal melanoma or melanoma of the eye. Melanoma of the uveal tract (iris, ciliary body, and choroid), though rare, is the most common primary intraocular malignancy in adults.

Science of diagnosing disease by such methods as microscopic analysis of tissue.

Care that prevents or relieves the symptoms of cancer or other diseases. Palliative care does not alter the course of the disease but can improve the quality of life.

A specialist in pathology; one who interprets and diagnoses the changes caused by disease in tissues and body fluids.

Colored by deposit of pigment.

Skin spot that has color—brown, black, or blue.

A surgeon who specializes in reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases.

For a PET scan, the patient is injected with glucose that contains a radioactive atom. The cancer cells in the body will absorb the radioactive sugar. The camera will then capture the areas of radioactivity in the body, helping the doctor determine how much the melanoma has spread.

Initial tumor or the body site where it forms.

A forecast of the probable course and outcome of a disorder.

Relatively rare phenomenon seen when using immunotherapies where tumors initially grow but then later respond. This is thought to be secondary to immune infiltrate increasing the size of the tumor. It is a challenge to determine the difference between pseudo progression versus real progression.

Technique in which a lesion is removed from the skin using a cookie cutter type device. This is used to remove small lesions or to sample a portion of a larger lesion.

Earliest step in the development of melanoma, in which the disease is confined to the epidermis or barely penetrates the dermis. No cluster of melanoma cells forms and no metastases result.

Treatment of disease by means of ionizing radiation; tissue may be exposed to a beam of radiation, or a radioactive element may be contained in devices (e.g., needles or wire) and inserted directly into the tissues, or it may be introduced into a natural body cavity.

The return of symptoms after a remission.

Therapy in which a whole limb is infused with cancer-killing drugs. The drugs are introduced into the artery supplying the limb and are taken out through the vein. The technique may be used for melanoma when there are multiple skin metastases that are apparently confined to the arm or leg that was the site of the primary tumor.

Regression is described as either being present or absent. If it is present the extent of regression is identified. Regression describes an area within the melanoma where there is absence of melanocytic growth. When regression is present the total size of the melanoma is hard to characterize.

Anything that increases a person’s chance of developing a disease.

Satellite lesions are nodules of tumor/melanoma located more than 0.05 mm from the primary lesion. Satellites are described as being present or absent.

Benign skin lesion associated with ageing and sun exposure; not precancerous.

The first lymph node to which cancer is likely to spread from the primary tumor.

Removal and examination of the first lymph node(s) to which cancer cells are likely to spread from a primary tumor.

Technique in which a portion of a lesion is cut off the surface of the skin using a scalpel in most cases. This is often performed by a dermatologist in the office.

A common, non-melanoma skin cancer that begins in squamous cells, which are thin, flat cells that look like fish scales.

Measure of the extent of a malignancy, arrived at by examining features of the primary tumor and searching for evidence of metastasis.

Layer of fat located under the dermis.

SSM is usually characterized as the most common form of cutaneous melanoma in Caucasians. The average age at diagnosis is in the fifth decade, and it tends to occur on sun-exposed skin, especially on the backs of males and lower limbs of females.

Surgeon is a person who performs surgery.

A doctor who performs biopsies and other surgical procedures in cancer patients.

Care given to relieve the problems associated with a disease or its treatment.

Newer therapies based on knowing how cancer cells function. These therapies work to stop cancer cells from growing and/or make other therapies work better. some may work by preventing the growth of new blood vessels needed to nourish the cancer. Others work to block the action of molecules on the surface of cancer cells.

Australian government agency responsible for approval of the use of certain drugs for therapies in Australia.

TILs describes the patient’s immune response to the melanoma. When the pathologist examines the melanoma under the microscope he/she looks for the number of lymphocytes, or white blood cells, within the lesion. This is usually described as brisk, non-brisk, or absent, although occasionally it can be described as mild or moderate. The presence of these cells may be a sign of an immune response.

One of the cardinal signs of inflammation; morbid enlargement.

Having the capacity to produce spherical collections of cancer cells.

Ulceration is the sloughing of dead tissue. This can sometimes occur in the center of a melanoma lesion. The presence of ulceration may alter the stage classification of a melanoma. Ulceration is thought to reflect rapid tumor growth, leading to the death of cells in the center of the melanoma.

Ultraviolet radiation with wavelengths between 320 and 400 nm, comprising over 99 percent of that reaching the surface of the earth. It enhances the harmful effects of UVB, is responsible for some photosensitivity reactions, and is used therapeutically in the treatment of various skin disorders.

Ultraviolet radiation with wavelengths between 290 and 320 nm, comprising 1 percent of that reaching the surface of the earth. It causes sunburn and a number of damaging photochemical changes within cells, including damage to DNA leading to premature ageing of the skin, premalignant and malignant changes, and various photosensitivity reactions; it is also used therapeutically in the treatment of skin disorders.

A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. A cancer vaccine can help the body recognize and destroy cancer cells or microorganisms.

Step in the development of melanoma in which the disease shows evidence of growth as a lump in the dermis (see tumorigenic, above). This phase of melanoma may metastasize.

Re-excision of the primary site after the biopsy results have been interpreted.

Commercial name for Ipilimumbab (IPI) or anti-CTLA 4 (See Anti-CTLA 4).