Melanoma

What you should know about Melanoma

More than one million Americans are diagnosed each year with skin cancer, the most common form of cancer.  Of these, about 54,200 people will be diagnosed with melanoma, the most serious form of skin cancer.

With careful inspection of the skin, most melanomas can be detected early and treated successfully.  These next few pages describe melanoma risk factors and important tips for early detection.

There are three main types of skin cancer.  Most are either basal cell or squamous cell carcinomas, which seldom become life threatening.

Malignant melanoma is much less common.  If not detected early and treated promptly, it can be very dangerous.  This year, about 54,200 people will be diagnosed with melanoma, and about 7,600 will die from it.  Incidence of melanoma increased more than tenfold over the past several decades but is now leveling off.  Since 1990, incidence has increased about 3%. 

When diagnosed early, melanoma can be cured.  But if it is not found soon enough, it can be very serious.  Therefore, it's important to recognize any changes in your skin, which could indicate melanoma, and to report them to your doctor without delay.

What is Melanoma?

Melanoma is a cancer that begins in melanocytes - the cells that produce the skin coloring or protective pigment called melanin.  Melanin helps protect the deeper layers of the skin from the harmful effects of the sun.  When you're exposed to sunlight, the melanin in your skin increases, and your skin darkens.

Melanoma consists of melanocytes, which have been transformed into cancer cells that grow abnormally.

Melanoma cells usually still produce melanin; this is why these cancers may have mixed shades of tan, brown, and black.

Unlike basal cell and squamous cell carcinomas of the skin, which do not commonly spread to other parts of the body, melanoma can spread if not detected at an early stage.  Once melanoma cells reach vital internal organs and grow, they are more difficult to treat and are much less likely to be cured.

While melanoma may appear in the skin without warning, it may begin in or near a mole or other dark spot in the skin.  That is why it's important to know the color, size, and location of the moles on your body, so you'll recognize any changes that might take place.

What Causes Melanoma?

Although the most important avoidable risk factor is unprotected exposure to the sun, melanoma may appear on skin that is not exposed to the sun.

Melanoma is also linked to certain types of moles.  Sometimes these are atypical moles that run in families.  These moles themselves may turn into melanomas, or they may serve as markers which identify the individual at higher risk for melanoma developing elsewhere in the skin.

Some birthmarks, otherwise called congenital moles, may also carry an increased risk of developing into melanoma.  Sometimes these moles should be removed before malignant changes can take place.

Who Is Likely to Get Melanoma?

Actually, no one is entirely free from the risk of melanoma.

People who have the highest risk of melanoma have many moles, irregular moles, or large moles.  Those with blood relatives who have had melanoma or who have previously had melanoma themselves are also at high risk.  Some dermatologists recommend that their patients with a history of melanoma in a first-degree relative have a skin exam to determine their risk of melanoma.

Other people who develop melanoma may have fair skin that burns and freckles easily and naturally red or blond hair.  They may have had sunburns as a child or as young adults, or other types of cancerous or precancerous spots on their skin at any age.  Although melanoma is less common among people with darker skin who seldom become sunburned, no one is immune to melanoma.

The risk is also higher in places where there is intense year-round sunshine.  As with most other cancers, the chance of developing melanoma increases as a person gets older.

It was once believed that dark brown or black skin prevented melanoma.  We now know that darker-skinned people can develop this cancer, especially on the hands, the soles of the feet, and under the nails. 

What Is the Difference Between a Melanoma and an Ordinary Mole?

An ordinary mole is an evenly colored brown, tan, or flesh colored spot in the skin.  It is either flat or raised.  Its shape is round or oval, and it has sharply defined borders.  Moles are generally less than six millimeters in diameter (about the size of a pencil eraser).  A mole may be present at birth, or it may appear later, usually in the first few decades of life.  Sometimes several moles appear at about the same time, especially on areas of the skin exposed to the sun.  Once a mole has fully developed, it normally remains the same size, shape, and color for many years.  Most moles eventually fade away as the person gets older.

Warning Signs

Almost everyone has moles.  The vast majority of moles are perfectly harmless.  A change in a mole's appearance is a sign that you should see our doctor.  Here's the simple ABCD rule to help you remember the important signs of melanoma and other skin cancers: 

A.   Asymmetry:   One half of the spot does not match the other half.

B.   Border irregularity:   Normal moles are round or oval.  The borders of a melanoma may be uneven or notched.

C.   Color:   Common mole are usually one color throughout.  Melanomas may have several colors or an irregular pattern of colors.

D.   Diameter:   Common moles are generally less than ¼ inch in diameter (the diameter of a pencil eraser).  Melanomas may be 1/8 to ¼ inch but are often larger.

The Most Important Warning Sign Is Change

  A change in size, shape, or color of a spot on your skin

Other warning signs are:

• A sore that does not heal
• A new growth

Most of us have spots on our skin.  A benign (noncancerous) growth may sometimes look like a skin cancer.  Check with our doctor.

Other Warning Signs of Melanoma

Other warning signs include the spread of pigment from the border into surrounding skin; redness or a new swelling beyond the border; and change in sensation - itchiness, tenderness, or pain.  Change in the surface of a mole - scaliness, oozing, bleeding, or the appearance of a bump or nodule - is also an indication.

How is Melanoma Diagnosed?

If the doctor suspects that a change in your skin is a sign of melanoma, a sample of the tissue is removed.  This procedure is called a biopsy and usually can be done quickly and easily in the doctor's office.  The tissue sample is then sent to a pathology laboratory for examination under a microscope to confirm the diagnosis.

Can Melanoma Be Treated?

Surgery is the best way to treat early melanomas.  For some melanomas, medications may also be recommended.  Later stages may require more extensive treatment.  For advanced melanoma, treatment must be individualized.  Again, the best weapon against melanoma is early detection and prompt removal.

Is There Any Way to Prevent Melanoma?

By avoiding exposure to intense sunlight, you can reduce your risk.  This is especially true for light-skinned people and those with a tendency to develop many moles or atypical moles, or who are at increased risk for any reason.  Avoid unprotected sun exposure, especially when the sun is high in the sky.  Wear protective clothing, sunglasses, and a hat.  Use a sunscreen with a sun protection factor (SPF) of 15 or higher.  Remember, sunscreen doesn't provide total protection from ultraviolet (UV) rays, although it does help.  Also, you will need to reapply sunscreen after swimming or sweating.  Indoor sunlamps and tanning beds may increase the risk of skin cancer.

Check Your Skin Thoroughly Once a Month

Get familiar with your skin and your pattern of moles, freckles, and beauty marks.  Be alert to changes in the number, size, shape, or color of spots on your skin.  The best way to do this is to thoroughly examine your skin.  It may also be helpful to have someone else who can check the skin on your back.  Call your doctor if you find any unusual changes.  Make prevention and early detection of melanoma part of your life.

Examining Your Skin

The best time to do this simple monthly exam is after a bath or shower.  Mark the date on your calendar.  Use a full-length and a hand mirror so you can check any moles, blemishes, or birthmarks from the top of your head to your toes, noting anything new - a change in size, shape, or color, or a sore that does not heal.  

Face the mirror:

  1.  Check your face, ears, neck, chest, and belly.

  2.  Check both sides of your arms, the tops and palms of your hands, and your nail

        beds .

Sit down:

  3.  Check the front of your thighs, shins, tops of your feet, in between your toes,

        and toenail beds.

  4.  Now look at the bottom of your feet, your calves, and the backs of your

       thighs - first one leg, then the other.

      You will need a hand mirror for the backs of your thighs.

Stand up:

    5.  Use the hand mirror to check the buttocks, genital area, lower back,

       upper back, and the back of the neck.

      It may be helpful to look at your back in a wall mirror by using a hand mirror.

 
If you do the exam regularly, you will know what is normal for you and can feel confident. 
Remember the warning signs and check with your health care professional or dermatologist if you find something.