Medical & Surgical Dermatology

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Malignant Melanoma

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 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 Water’s Edge Dermatology practitioner who should examine any mole that has one or more ABCDE traits and all new growths.


DIAGNOSIS AND TREATMENT

Diagnosis begins with the Water’s Edge Dermatology practitioner examining the suspicious lesion. If this visual examination leads the Water’s Edge Dermatology practitioner to suspect melanoma or another type of skin cancer, the Water’s Edge Dermatology practitioner 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 Water’s Edge Dermatology practitioner can perform in the office. To perform a biopsy, a Water’s Edge Dermatology practitioner 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 Water’s Edge Dermatology practitioner 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 Water’s Edge Dermatology practitioner 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 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 Water’s Edge Dermatology practitioner 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.