Most people have multiple moles, and they come in lots of different shapes and sizes.

大多數人有多個痣，而且它們的形狀和大小都差很多。

Usually they're harmless, but occasionally they could be a sign of a very serious disease:

通常它們是無害的，但有時它們可能是一種非常嚴重的疾病的跡象：

melanoma.

黑色素瘤。

So, when is a mole just a mole, and how does it turn into a deadly form of cancer?

那麼，什麼時候痣只是痣，它又如何變成致命的癌症呢？

Now, not all melanomas start from a mole, but all moles are made up of the type of cells

並不是所有的黑素瘤都是從痣變成的，而是所有的痣，都是由可以變成黑素瘤的細胞

that can become melanomas: melanocytes.

所組成的：黑素細胞。

Hi, my name is Aaron Mangold.

嗨，我叫 Aaron Mangold。

I'm an assistant professor of dermatology at the Mayo Clinic in Arizona.

我是亞利桑那州《梅約醫學中心》皮膚病學的助理教授。

I specialize in cancer genomics as well as utilizing advanced forms of genetics to prognosticate

我專門研究癌症基因，並利用先進的遺傳學方法來預測

cancers for spread to other areas of the body, as well as for therapeutic interventions.

癌症是否擴散到身體的其他部位，以及進行干預性治療。

Melanocytes primarily protect skin cells from ultraviolet damage through the production of pigment called melanin.

黑色素細胞透過產生黑色素，來保護皮膚細胞免受紫外線傷害。

Melanocytes deliver melanin to the surrounding keratinocytes, or skin cells in the epidermis, giving our skin its color.

黑色素細胞將黑色素傳遞到周圍的角質細胞，或表皮細胞，使我們的皮膚變色。

When we come in contact with ultraviolet light from the sun, this melanin protects our skin

當我們接觸來自太陽的紫外線時，這種黑色素可以保護我們的皮膚免受傷害

from damage, while also signaling to the body to produce more melanin.

同時還可以向身體發出信號，來製造更多的黑色素。

This is why you might tan when you go out in the sun.

這就是為什麼你出去曬太陽時會曬黑的原因。

And this system works pretty well, but it's not perfect.

這套機制運行良好，但並不完美。

So melanocytes really have evolved over time to be extremely resistant to ultraviolet light.

黑色素細胞的確已經隨著時間的演進，進化成對紫外線具有極強的抵抗力。

They've become extremely resistant to acquiring mutations that in normal cells might lead

它們已經變得對於正常細胞中，為防止突變而產程的自毀功能

to apoptosis, or cell death.

產生了強大的抵抗力。

And they also are able to circulate innately throughout the body.

而且它們還能夠在體內自然循環。

Since melanocytes aren't as likely to die due to DNA damage from UV light, they obtain

由於黑素細胞不太可能因紫外線破壞 DNA 而死亡

mutations and can continue to grow and may cluster together, forming non-cancerous growths

因此它們會發生突變，並且可以繼續生長並聚集在一起，形成非癌性生長

called "nevi," or moles.

稱之為「痣」。

Those damaged melanocytes can then acquire additional mutations and continue to proliferate

那些受損的黑素細胞可轉為其他的突變，並繼續增殖

forming a precancerous lesion or eventually a melanoma.

形成癌前病變，或最終形成黑素瘤。

One mutation that almost all moles have is in the gene BRAF, a protein that is part of

幾乎所有突變的痣都有一種 BRAF 基因 ，是細胞生長中有關於

cell signaling involved in cell growth.

細胞信號傳遞地的一種蛋白。

But, a single BRAF mutation is not enough to cause cancer.

但是，單個 BRAF 突變不足以引起癌症。

And not all melanomas even come from moles.

而且並非所有黑色素瘤都來自痣。

So the way that melanoma, or the way that a melanocyte becomes a melanoma, occurs through a fairly long process.

因此，黑色素瘤，或黑色素細胞變成黑色素瘤，是經過相當漫長的過程後才形成的。

There's not one specific change that happens that leads to it.

並非是一個特定的變化導致它的發生。

It's a series of changes.

而是一連串的變化。

Additional mutations in genes can be caused by things like further damage due to UV light.

基因中的其他突變，可能是由於像是紫外線等造成的損壞所致。

These changes prevent natural cell death and lead to uncontrolled growth of the cancerous melanoma cells.

這些變化防止了細胞死亡，卻也導致黑色素瘤的癌細胞不受控制地生長。

Fortunately, melanomas can be removed if discovered early enough.

幸運的是，如果發現的夠早，可以將黑色素瘤切除。

And there are ways to check if a mole is irregular, which we'll talk about a little later.

還有一些方法可以檢查痣是否異常，我們稍後再討論。

But, what happens if melanoma isn't caught?

但是，如果沒有發現黑色素瘤怎麼辦？

...the melanoma cells, they're able to acquire certain properties that make them not want

... 黑色素瘤細胞能夠獲得某些特性，從而使其不再願意

to stay in the skin any more.

待在皮膚中。

And once they acquire those, they can actually go into things called lymphatics in the bloodstream and then can spread.

一旦獲得了這些特性，它們實際上就可以進入血液中的淋巴組織，然後傳播開來。

Once melanoma has reached this stage and has spread from the lymph nodes to other parts

黑色素瘤一旦達到這一階段，並從淋巴結擴散到身體的其他部位

of the body, it's very hard to cure.

就很難治愈。

It also has a high mortality rate, only 23% of patients survive past five years.

它也有很高的死亡率，在過去五年中只有 23％ 的患者存活。

So it's important to identify an abnormal mole soon so that it can be removed.

因此，儘早發現異常的痣是很重要的，以便及時將其除去。

Fortunately, there is an easy ABCDE rule to follow, which checks for asymmetry, irregular

幸運的是，有一個容易遵循的 ABCDE 法則，該規則檢查痣是否不對稱，邊緣是否不規則

borders, uneven color, increasing diameter and an evolution or change in the mole.

顏色是否不均勻，直徑是否增大，以及痣是否持續發展或變化。

An individual might say that this lesion is just different.

某個人可能會說，這這顆痣長得很不一樣。

This doesn't look like everything else on me.

這不像我身上長的其他東西。

That ugly duckling sign I think is also very useful in having some form of self body awareness

我認為這個醜的小鴨標誌，某種程度上對自我身體察覺也非常有用

and say, "I want this looked at."

而會說：「我希望檢查一下這顆痣。」

Specialists like Dr. Mangold are also starting to use immunotherapy to combat later stage

像 Mangold 博士這樣的專家，也開始使用免疫療法來對抗後期的黑色素瘤

melanoma, using the body's natural defenses to fight the disease.

利用人體的自然防禦力來抵抗這種疾病。

Normally our immune system will travel throughout the body, the immune cells will, and those

通常，我們的免疫系統遍及整個身體，免疫細胞會巡遍全身

immune cells will look at individual normal cells and say, "How abnormal are you?”

這些免疫細胞會盯著個別的個正常細胞，然後說：「你的異常達到何種程度？」

...And when they have those signals telling them that they've acquired too much damage,

…… 當免疫細胞接受到細胞受損太嚴重的信號時

the immune system then kills them….

免疫系統就會殺死它們 ……

Well, cancer cells have figured out how to use certain proteins like that that will say,

癌細胞已經弄清楚如何使用某些蛋白質，釋放出這樣的訊息

"Don't worry about it.

「不要 擔心。

Everything is okay.

沒事。

We're doing fine.

我們很好。

Leave us alone."

不用管我們。」

Recently, they figured out how to block those, how to block those signals that quiet the immune system.

最近，專家們發現如何阻止這些信號，如何阻止那些使免疫系統失效的信號。

And it's really revolutionized not just the care of cancer as it pertains to melanoma,

它不僅對黑素瘤的癌症治療，而且對所有癌症治療

but cancer in general.

都是一項重大的突破。

But immunotherapy is still an emerging science.

但是免疫療法仍是一門新興科學。

Doctors have to avoid making the immune system too active.

醫生必須避免使免疫系統過於活躍。

This would result in an autoimmune disease, or an immune system that attacks healthy cells.

這將導致自身免疫疾病，或免疫系統去攻擊健康細胞。

It's really analogous to playing a musical instrument or playing a piano.

這很像是演奏樂器或彈鋼琴。

You have all the keys that are there.

有的音符都已經在那兒了。

Yet, you can make good music, or you can make bad music.

你可以奏出好聽的音樂，你也可以奏出難聽的音樂。

And we're trying to figure out now, how do we make good music and how do we avoid that kind of bad music?

而且我們現在正努力弄清楚，我們如何奏出好聽的音樂，如何避免奏出難聽的音樂？

While immunotherapy is still developing, there is one treatment that everyone can take part in.

儘管免疫療法仍在發展，但有一種治療方法每個人都可以參與。

You don't want people to lose sight of what's important, and I think it was Bert Vogelstein

你不希望人們忽略了重要的事情，我想是 Bert Vogelstein 這麼說的

who said this, that if you could give someone a pill and tell them, "This pill that I give

那就是，如果你可以給某人一種藥，並 告訴他們：「我給你的這種藥

you is going to reduce your risk of cancer by 50%,"

將使你罹癌的風險降低 50％」

that it would be across every news organization, every magazine cover.

這將會登上所有媒體、雜誌的封面。

Someone would get a Nobel Prize for it.

有人將因此而獲得諾貝爾獎。

And we do have that pill.

我們確實有這種藥。

That pill is primary prevention through healthy behaviors, healthy eating, different things

這種藥就是透過健康的行為，健康的飲食來做預防，每個人都管好自己

that we can do as individuals that will reduce those risks.

就可以降低這些罹癌風險。