|What is it?
| Melanoma is a type of cancer that begins in the skin. It is completely
curable when detected early, but can be fatal if allowed to progress
and spread. Cancer is a condition where one type of cell grows without
limit in a disorganized fashion, disrupting and replacing normal tissues
and their functions, much like weeds overgrowing a garden. Melanoma
is a cancer of the pigment producing cells in the skin, known as melanocytes.
Normal melanocytes reside in the outer layer of the skin and produce
brown pigment melanin, which is responsible for the color of our skin.
Melanoma is when melanocytes become cancerous, grow and invade other
|What causes it?
| We are not certain how all cases of melanoma develop; however it is
clear that excessive sun exposure, especially severe blistering sunburns
during childhood, can promote melanoma development. There is also
evidence that ultraviolet radiation used in indoor tanning equipment
may also cause melanoma
|Who gets it?
| Anyone can get melanoma, but fair skinned sun sensitive people are
at great risk. Ultraviolet radiation from the sun is a major culprit,
and people who tan poorly or burn easily are at the greatest risk.
While too much sun is a bad idea throughout life, sunburns in children
and teenagers seem to be the most damaging.
In addition to sunburns early in life, people with many moles are
at greater risk to develop melanoma. Everyone has moles, usually
around 30, and most are without significance. However, people with
more than 50 moles are at an increased risk. In addition to the
number of moles, some moles are unusual and irregular looking. These
moles are known as dysplastic or atypical moles. People with atypical
(dysplastic) moles are at increased risk of developing melanoma.
Melanoma does run in families. If a close relative, such as a parent,
aunt or uncle, has had melanoma, then other blood relatives are
at increased risk for melanoma.
All of these features, fair skinned, sun sensitive people, a history
of sunburns, many moles, atypical moles, and close relatives who
had melanoma, allow us to identify those at risk for developing
melanoma. Anyone, even those with none of to risk factors, can develop
melanoma, but people with one or more of the risk factors are more
likely to do so. If you have some of these risk factors, periodic
routine skin examinations by your dermatologist can truly be life
|What to look for
| Almost always, melanoma begins on the surface of the skin where it is easily
treated. However, if given time to grow, it can eventually grow down
into the skin, ultimately reach the blood and lymphatic vessels and
spread around the body, causing a life threatening illness. Therefore,
the goal is to detect melanoma early, when it is still on the surface
of the skin. Melanoma can occur anywhere on the skin, even in places
not directly exposed to sun. However, it is most commonly located
on the backs of men and the legs of women. Melanoma is usually brown
or black colored, but sometimes, though rare, may be red or skin colored.
Melanoma may also arise from a pre-existing mole, or appear on previously
normal appearing skin. Melanomas slowly get larger; therefore, growing,
changing, or irregular lesions should arouse suspicion.
When looking at a spot on the skin, it is helpful to apply the
ABCDE rules to decide if it is suspicious.
A. Asymmetry - meaning one half is different than another. Draw
an imaginary line through the middle of the lesion, either up and
down or side to side. Are the two sides the same size and shape
(symmetric)? Melanomas are usually asymmetric.
B. Border irregularity- the edge or border. Or melanomas are usually
ragged, notched, or blurred.
C. Color- benign moles can be any color, but a single mole will
be only one color. Melanoma often has a variety of hues and colors
within the same lesion.
D. Diameter- melanomas continue to grow, while moles remain small.
Is the lesion larger than a pencil eraser (6mm)?
E: Evolving- Any change in an existing mole such as an increase in size or change in shape or color.
| The best treatment is early detection. A quick look from the trained
eye of a dermatologist can confirm whether or not a lesion is suspicious
for melanoma. If so, the next step is to perform a biopsy. The area
is made numb, and a portion, or the entire lesion is removed for examination
under the microscope. This simple, quick procedure is performed in
the dermatologist’s office. If a melanoma is detected, treatment
is guided by how deep in the skin the melanoma is.
Treatment for melanoma begins with the dermatologic surgical removal
of the melanoma and some normal appearing skin around the growth.
Removal of the normal appearing skin is known as taking margins,
and is done to be sure no melanoma is left behind. A person’s
outcome depends on how deep the melanoma has grown into the skin.
Early melanoma limited to the outermost layer of the skin (the epidermis)
is know as melanoma in situ (in place), and simple surgical removal
produces virtually 100% cure rate. However, if left untreated, the
melanoma grows deeper in the skin. The deeper it goes, the more
likely it is to reach a blood vessel or lymphatic channel. If it
enters these vessels, it can spread away from the skin, producing
a life threatening situation. When a biopsy is performed and melanoma
is detected, the depth of invasion into the skin will be measured
and reported by a dermatologist. This will guide treatment.
Deeper melanomas are more likely to spread. If a melanoma does
spread, it typically spreads first to the lymph nodes. The lymph
nodes are part of the lymphatic system, a series of vessels throughout
the body much like blood vessels that are responsible for cleaning
the body’s tissues. These vessels drain to local swellings
known as lymph nodes, located at a variety of spots around the body.
Different lymph nodes serve different part of the body. If a melanoma
did spread, it may be possible to find it at the lymph node before
it goes any further. A procedure called a sentinel node biopsy is
a way of identifying and testing the first lymph node that drains
the area the melanoma was located at. The decision on whether to
perform a sentinel node biopsy is based on how deep the melanoma
is in the skin, and in turn, how likely it is to have spread.
|What can I do
to protect myself?
| Childhood and adolescent exposure seem to be the most damaging, so
protecting young people is very important. Common sense dictates protection.
Avoid sun exposure form 10:00 a.m. through 4:00 p.m. when the sun
is the strongest. Wear a broad-spectrum sunscreen, one that blocks
both types of ultraviolet light (UVA and UVB), and reapply frequently.
Wear a hat and clothing with a tight weave that will block ultraviolet
light. Remember, a white cotton T-shirt only blocks 50% of the suns
rays. Avoid indoor tanning machines.
Early detection remains the best treatment. Therefore, perform
a monthly self-exam, looking for irregular lesions that are growing
and changing, and use the ABCDE rules. If you have an atypical mole,
see a dermatologist immediately. Lastly, see a dermatologist at
least once a year for a complete skin exam.