Malignant Melanoma and hair loss.

Melanoma is an aggressive and potentially deadly form of skin cancer that typically arises initially on the skin and can be readily recognizable. It can also initially manifest in the eye or mouth.

Hair loss related to Melanoma typically is a result of the treatment of the condition, either as a direct result from surgery, If the lesion is on the scalp, or more commonly from the medication that are sometimes used for the advanced stages of Melanoma.

Melanoma is broken down into four basic types,
•    Superficial spreading melanoma, which is the most common type of melanoma.
•    Nodular melanoma
•    Lentigo maligna melanoma
•    Acral lentiginous melanoma

The stage of the cancer is what determines the type of therapy. The stages are shown below with some appropriate illustrations.

Stage I     Stage I melanoma. In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration (break in the skin). In stage IB, the tumor is either not more than 1 millimeter thick, with ulceration, OR more than 1 but not more than 2 millimeters thick, with no ulceration. Skin thickness is different on different parts of the body.

Stage II  . In stage IIA melanoma, the tumor is either more than 1 but not more than 2 millimeters thick, with ulceration (break in the skin), OR it is more than 2 but not more than 4 millimeters thick, with no ulceration. In stage IIB, the tumor is either more than 2 but not more than 4 millimeters thick, with ulceration, OR it is more than 4 millimeters thick, with no ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with ulceration. Skin thickness is different on different parts of the body.

Stage II is divided into stages IIA, IIB, and IIC.
•    Stage IIA: In stage IIA, the tumor is either:
o    more than 1 but not more than 2 millimeters thick, with ulceration; or
o    more than 2 but not more than 4 millimeters thick, with no ulceration.
•    Stage IIB: In stage IIB, the tumor is either:
o    more than 2 but not more than 4 millimeters thick, with ulceration; or
o    more than 4 millimeters thick, with no ulceration.
•    Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.

Stage III:  In  Stage III melanoma. The tumor may be any thickness, with or without ulceration (a break in the skin), and (a) cancer has spread to one or more lymph nodes; (b) lymph nodes with cancer may be joined together (matted); (c) cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes; and/or (d) very small tumors may be found on or under the skin, not more than 2 centimeters away from the primary tumor

The medicines used to treat later stages of melanoma are immune modulators, which is a fancy way of saying that they manipulate the immune system. The treatment is very difficult and includes intravenous administration of the drug typically five days a week for a year. Many patients have reported moderate to severe loss of their hair during this time frame.  This type of hair loss is what we call Telogen Effluvium. Which is a slow steady loss of hair over a 3-6 month time frame? Telogen effluvium is the most common form of drug-induced hair loss. It This condition causes the hair follicles to go into their resting phase (telogen) and fall out too early. People with telogen effluvium usually shed between 100 and 150 hairs a day.  The good news is that the hair almost always grows back after the treatment.

There are many drugs that are in common use today for many different illnesses that are known to cause r hair loss.

Below is a chart that shows just a few of them.

•    Acne medications containing vitamin A (retinoids)
•    Antibiotics and antifungal drugs
•    Antidepressants
•    Birth control pills
•    Anticlotting drugs
•    Cholesterol-lowering drugs
•    Drugs that suppress the immune system
•    Drugs that treat breast cancer
•    Epilepsy drugs (anticonvulsants)
•    High blood pressure medications (anti-hypertensives), such as beta-blockers, ACE inhibitors, and diuretics
•    Hormone replacement therapy
•    Mood stabilizers
•    Nonsteroidal anti-inflammatory drugs (NSAIDs)
•    Parkinson’s disease drugs
•    Steroids
•    Thyroid medications
•    Weight loss drugs

Chemotherapy drugs often lead to the anagen effluvium type of hair loss. The hair typically starts to fall out within two weeks of starting chemotherapy and progresses more rapidly after 1-2 months, according to the American Cancer Society. Hair loss is more common and severe in patients taking combinations of chemotherapy drugs than in those who take just one drug.
Chemotherapy drugs that tend to cause hair loss include:
•    adriamycin
•    cyclophosphamide
•    cactinomycin
•    docetaxel
•    doxorubicin
•    etoposide
•    ifosfamide
•    irinotecan
•    paclitaxel
•    topotecan
•    vinorelbine

Hair loss related to Melanoma is of course not desirable but compared to the alternative it is typically tolerated by most patients.

Malignant Melanoma as a standalone entity accounts for very little hair loss issues.
The treatment as noted above though is another story all together..

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