Melanoma is the
deadliest form of skin cancer. Whether it's called malignant melanoma or simply
melanoma, this cancer can metastasize (spread) rapidly. With early detection
and proper treatment, melanoma has a high cure rate.
Early detection and treatment are possible because melanoma typically begins on
the surface of the skin. It develops when melanocytes (the cells that give
skin, hair, and eyes color) are damaged, which causes these cells to grow
uncontrollably. As melanoma develops where melanocytes occur, this cancer can
begin on the skin, under a nail, and even in an eye or on a mucous membrane
(mouth and genitals).
Melanoma begins on the surface, but it can grow deep into the skin and beyond.
It can reach the blood and lymphatic vessels, and from there it can spread
through the body, causing a life-threatening condition.
ANYONE CAN GET MELANOMA
Anyone can get melanoma, and the number of Americans who develop melanoma
continues to rise. Melanoma is diagnosed in people of all skin colors.
CAUSES
It is not clear how all melanomas
develop, but exposure to ultraviolet (UV) radiation clearly plays a role,
especially in fair-skinned people. A history of sunburns, especially blistering
sunburns as a child or teenager, has been shown to increase the risk of
developing melanoma. There also is evidence that exposure to UV radiation from
indoor tanning equipment increases the risk of melanoma.
Not all melanomas are due entirely to UV radiation exposure. Other risk factors
make a person more susceptible. Most melanomas, however, develop in areas that
have had exposure to the sun such as the upper back, torso, lower legs, head,
and neck.
RISK
FACTORS
Research has shown that the following risk factors increase the probability of
developing melanoma:
- Fair,
sun-sensitive skin that tans poorly or burns easily.
- Red or blond
hair, and blue or green eyes.
- Having 50 to
100 or more moles.
- Having
unusual or irregular-looking moles that are typically larger in size (may
be referred to as dysplastic or atypical moles).
- History of
sunburns or indoor tanning use.
- Blood
relatives (parents, children, siblings, cousins, aunts, uncles) who have
had melanoma.
- Immune
system weakness due to disease, organ transplant, or medication.
- Had melanoma
or another skin cancer.
- 50 years of
age or older.
Dermatologists strongly encourage everyone — especially those who have one
or more of these risk factors — to perform regular skin self-examinations.
These exams can help people recognize any changes to their skin that could
be a sign of melanoma.
WARNING SIGNS OF MELANOMA
A common warning sign of melanoma is change. Melanoma often begins in or
near an existing mole. A change to the shape, color, or diameter of a mole
can be a warning sign of melanoma. Other changes that could indicate
melanoma include a mole that becomes painful, or begins to bleed or itch.
Not all melanomas develop in or near an existing mole. Some melanomas
develop suddenly and without warning on normal skin. A sudden, new growth
could be melanoma.
Regular skin self-examinations can help people detect these changes. When
looking for a melanoma on the skin, it is helpful to apply the ABCDE
rules:
A stands for ASYMMETRY;
one half unlike the other half.
B stands for BORDER;
irregular, scalloped or poorly defined border.
C stands for COLOR;
varied from one area to another; shades of tan, brown, and black;
sometimes white, red, or blue.
D stands for DIAMETER;
melanomas are usually greater than 6mm (the size of a pencil eraser) when
diagnosed, but they can be smaller.
E stands for EVOLVING; a mole or skin lesion that looks
different from the rest or is changing in size, shape, or color.
During a skin self-examination, it is helpful to keep in mind that moles
are generally uniform in color, round to oval in shape, and have a
well-defined border. Melanomas tend to have one or more ABCDE traits; some
have several ABCDE traits. Melanomas can vary greatly in appearance.
Make an appointment to see a dermatologist who should examine any mole that
has one or more ABCDE traits and all new growths.
DIAGNOSIS
AND TREATMENT
Diagnosis begins with the dermatologist examining the suspicious lesion. If
this visual examination leads the dermatologist to suspect melanoma or another
type of skin cancer, the dermatologist will perform a biopsy. This is the only
way to know with certainty if the lesion is melanoma or another type of skin
cancer.
A biopsy is a simple procedure that a dermatologist can perform in the office.
To perform a biopsy, a dermatologist will numb the area and remove the entire
lesion, or a portion of it, so that the tissue can be examined under a
microscope. If melanoma cells are visible under the microscope, the diagnosis
is melanoma.
Treatment typically begins with complete surgical removal of the melanoma and
some normal-looking skin around the growth. Removing some normal-looking skin
is called "taking margins." This helps ensure that cancerous cells
are removed.
With early detection, surgical removal might be all the treatment that is
required. In its earliest stage, melanoma is limited to the epidermis (outer
layer of skin). Your dermatologist might refer to this type of melanoma as
"melanoma in situ" or "stage 0." In this stage, the
cure rate with surgical removal is virtually 100 percent.
Treatment for melanoma depends on knowing the stage. If the stage cannot be
determined during the biopsy, the dermatologist might perform a physical
examination and refer the patient to another doctor for additional testing. If
the cancer has spread to the lymph nodes or other internal organs, treatment
will be more involved.
Determining how far the cancer has spread is called staging. The melanoma
stages are:
|
STAGE
|
DESCRIPTION
|
|
Stage 0; in situ
|
Melanoma is confined to the epidermis (top
layer of skin).
|
|
Stage I-II
|
Melanoma is confined to the skin, but has
increasing thickness and the skin may be intact or ulcerated (top layer of
skin is absent).
|
|
Stage III
|
Melanoma
has spread to a nearby lymph node and is found in increasing amounts within
one or more lymph nodes.
|
|
Stage IV
|
Melanoma has spread to internal organs,
beyond the closest lymph nodes to other lymph nodes, or areas of skin far
from the original tumor.
|
|
|
|
To stage
melanoma, imaging techniques may be used. These include the x-ray, ultrasound,
computed tomography (CT scan), magnetic resonance imaging (MRI), positron
emission tomography (PET scan), and radio-isotopic bone or organ scan.
Sometimes a surgical procedure known as a sentinel lymph node biopsy (SLNB) is
recommended to stage melanoma. When melanoma spreads, it frequently travels to
the closest lymph nodes first. A SLNB tells doctors if the melanoma has spread
to nearby lymph nodes.
If testing indicates that melanoma has metastasized (spread) to the lymph nodes
or other areas on the body, treatment may include additional surgery to remove
the cancer, immunotherapy, radiation therapy, chemotherapy, or even clinical
trials. If the melanoma is advanced, the patient often receives a combination
of treatments.
FOLLOW-UP IS CRITICAL
Melanoma patients have a life-long risk of developing new melanomas. If a
melanoma was thick or had spread to nearby lymph nodes before treatment, there might
be a risk of recurrence (melanoma returns) or metastasis (original melanoma
spreads to surrounding skin or to other areas of the body). These risks make
follow-up appointments with your dermatologist essential. Be sure to keep all
appointments for regular check-ups. The earlier melanoma is detected, the
better the prognosis.
You can help with early detection by performing regular skin self-examinations.
Make sure you know the warning signs of melanoma and follow the ABCDE rules. If
you notice a changing mole or detect any other warning sign of melanoma, see
your dermatologist immediately.
PROTECT
YOURSELF
Avoiding excessive sun exposure may prevent many melanomas. Excessive exposure
to UV radiation is one contributing factor, so it makes sense to protect your
skin. Here's how you can Be Sun SmartSM:
- Generously
apply a broad-spectrum, water-resistant sunscreen with a Sun
Protection Factor (SPF) of 30 or more to all exposed skin. Broad-spectrum
provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB)
rays. Reapply approximately every two hours, even on cloudy days, and
after swimming or sweating.
- Wear
protective clothing,
such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses,
where possible.
- Seek shade when
appropriate, remembering that the sun's rays are strongest between 10 a.m.
and 4 p.m. If your shadow is shorter than you are, seek shade.
- Protect
children from
sun exposure by playing in the shade, using protective clothing, and
applying sunscreen.
- Use extra
caution near water, snow, and sand because they reflect the damaging rays
of the sun, which can increase your chance of sunburn.
- Get vitamin
D safely
through a healthy diet that may include vitamin supplements. Don't seek
the sun.
- Avoid
tanning beds.
Ultraviolet light from the sun and tanning beds can cause skin cancer and
wrinkling. If you want to look like you've been in the sun, consider using
a sunless self-tanning product, but continue to use sunscreen with it.
- Check your
birthday suit on your birthday. If you notice anything changing,
growing, or bleeding on your skin, see a dermatologist. Skin cancer is
very treatable when caught early.
This information comes from the
American Academy of Dermatology website and should be attributed as such
(www.aad.org)
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