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Malignant Melanoma

What is Melanoma?

Melanoma is a type of cancer that forms from melanocytes. Melanoma is the most serious form of skin cancer. Other more common, but usually less serious, types of skin cancer include basal cell carcinoma and squamous cell carcinoma.

Of the many different types of melanoma, most are seen in the skin (this also includes nail beds, soles of the feet, and scalp), but melanoma can also occur in the eye, or on mucosal surfaces which include the anal canal, rectum, and vagina.

In 2008, there will be an estimated 62,480* new cases of invasive melanoma diagnosed in the United States, accounting for 5% of all new cancer diagnoses in men and 4% of new cancer diagnoses in women. The number of new cases of melanoma has steadily increased for 30 years. The increased number of cases of melanoma being diagnosed is also associated with increased survival due to early detection.
* Source Melanoma Research Project

What is a melanocyte?

A melanocyte is a normal cell found in the skin that produces melanin. Melanin is a black or dark brown pigment that is seen in the skin, hair, and parts of the eye. Melanin is transferred from the melanocytes into nearby skin and hair cells. The concentrated areas of color seen on the skin are known as moles or nevi.

ABCDE’s Of Melanoma

torrance melanoma asymmetry

Asymmetry
In which one half does not match the other half

torrance melanoma border irregularity

Border irregularity
with blurred, notched, or ragged edges

torrance melanoma color irregularity

Color irregularity
pigmentation is not uniform. Brown, black, tan, red, white, and blue can all appear in a melanoma.

torrance melanoma diameter

Diameter
greater than 6 mm (the size of a pencil eraser). Growth in itself is also a sign.

torrance melanoma elevation

Elevation
a raised surface can also be a sign

Photo Source Dermis – University of Heidelberg

What are the signs of melanoma?

Melanoma usually presents as an irregular mole, with the “ABCDE” characteristics exampled above. This can be a preexisting mole that has changed or a newly developed mole. More advanced lesions may have inflammation, oozing, crusting, itching, ulceration or bleeding.

“ABCDE” characteristics.

  • “A” is for asymmetry. If an asymmetric mole were divided in half, one side would not look like the other.
  • “B” is for border irregularity. The border of the mole may appear blurry and uneven.
  • “C” is for color. This can be a change in the color the mole has always been, the development of a black mole, or color variation within a mole, meaning that a single mole may have red, brown, and black colors within it.
  • “D” is for diameter. You should have a mole that has changed in size or color, particularly those greater than 6mm in diameter, checked by a physician.
  • “E” is for evolution/elevation – meaning that a mole has changed in appearance over time, color, shape, or elevation. These rules are not set in stone, which is why you should be aware of your own moles, and report any changes in moles to a physician.

What screening tests are available?

The best screening is a skin examination. Your physician should examine your skin during routine physicals, but you should also examine your skin routinely at home. Because you see your skin everyday, you are most likely to notice any changes early on. Prognosis is best when lesions are found early, making skin examination very important. Be aware of the shapes and coloring of any moles you have. Melanoma often develops from an existing mole, causing its appearance to change. Examine your skin routinely in a mirror, including your back, bottom of your feet, nail beds, and scalp. Look for changes in existing moles, or the development of new ones.

The staging is based on these measurements, and is classified as follows:

  • Melanoma in-situ – the melanoma is present only in the epidermis; a Breslow thickness and Clark’s level are not determined for this early stage lesion
  • Stage I – less than 1 mm thick
  • Stage II – greater than 1 mm thick or Clark’s level IV-V (invasion into reticular dermis or subcutaneous tissue)
  • Stage III – has spread to local lymph nodes (may or may not have known of a primary lesion) or Clark’s level V (invades subcutaneous tissue)
  • Stage IV – presents with distant metastasis (most commonly liver, lung, and brain)

Depending on the stage of the melanoma, patients will have a chest x-ray and liver function studies to assess for metastases. In patients with stages II-IV, further evaluation for metastases is needed; this may include cat scans, PET scans, and lymph node dissection (with or without sentinel node biopsy). Learn about Melanoma Staging

What are the treatments for melanoma?

Surgery is the mainstay of treatment for melanoma. After a melanoma is diagnosed by a biopsy, the next step is to have a “surgical excision”. This surgical procedure removes an area of normal tissue around where the lesion was located. The amount of tissue removed is based on the depth of the melanoma. This area of normal skin is referred to as the “margins”.

Am I at Risk for Melanoma?

Risk factors for melanoma that arises in the skin, include fair skin or complexion, a history of sunburns and/or prolonged exposure to ultraviolet light (both sun and artificial UV light), multiple moles, older age, a personal or family history of non-melanoma skin cancer and a personal or family history of melanoma. As we age, our years of sun exposure increase, and therefore the risk of melanoma increases.

Family Connection

Researchers have found that the risk of melanoma is 2.24 times higher in people with a first-degree relative with the diagnosis; therefore it is important to be aware of your family history. If you have been diagnosed with melanoma, it is important to share this information with your relatives so that they can undergo appropriate screening.

Moles
Certain types of moles, called dysplastic nevi, are associated with a higher incidence of melanoma. These moles are typically large (over 5mm in diameter) and have uneven pigmentation and borders. A single dysplastic nevi is associated with a 2-fold increased risk, while 10 or more nevi indicate a 12-fold increased risk of developing melanoma.

Ethnicity and Skin Type
People with fair skin, light eyes, or those who have a tendency to freckle or burn easily are all at higher risk. Melanoma rates are 20 times higher in Caucasians than in Blacks. The melanin in dark-skinned people has been found to have a natural sun protection factor (SPF) and can filter twice as much ultraviolet light as that of a light-skinned person. This protection, however, is not complete, and melanoma can develop in dark-skinned people. Melanoma is more commonly found on soles, palms, or nail beds in dark-skinned people.

The Sunburn Connection
sunburn melanoma los angelesA history of 3 or more sunburns, particularly blistering sunburns, before age 20 greatly increases risk. A history of severe sunburns in childhood and adolescence may actually double the risk of melanoma in adulthood. For many years, the tanning industry has promoted tanning salons as a safe alternative to natural sun, or a way to prevent sunburn. This is because the tanning machines were said to produce only UVA rays, without producing UVB rays, which are responsible for most sunburns. (Photo Source DermnetNZ)

Researchers have since learned that tanning beds do produce UVB rays in varying amounts, depending on the machine. They have also learned that UVA is not as safe as once thought. Despite the fact that UVA is less likely to cause sunburn, it has many biologic effects that can cause long-term damage. As for using tanning beds to prevent sunburn on a vacation, this is also untrue. A visit to a tanning bed, followed by natural sun exposure, causes a cumulative effect on skin cells and can cause an unexpected burn. Bottom line: Tanned skin is not healthy and actually indicates that the skin has been damaged.

How can I prevent melanoma?

The best way to prevent melanoma is to protect the skin from sun exposure (both natural and artificial). Avoid sun exposure between 10am and 4pm, wear protective clothing (including a hat) when in the sun, and use sunscreen with a sun protection factor (SPF) of 15 or greater everyday, even in the winter! Sunscreen use is especially important for children due to the fact that sunburns during childhood greatly increase the risk of melanoma in adulthood. Consistent use of sunscreen has even shown the ability to reduce further skin damage in people with a history of extensive sun exposure.

Follow-up testing

About 5 percent of patients with a history of melanoma will develop a second melanoma in their lifetime, while others may develop metastases from the original tumor, and therefore all patients require follow-up. Patients should be evaluated every 3 to 6 months for the first 3 years after diagnosis, then every 6 to 12 months for 2 years, and then annually.

Related Site Links

Actinic Keratosis
Photo Dynamic Therapy
Skin Cancer – Non Melanoma
MiXto Laser for Post Excision Scar Reduction

Melanoma and Skin Cancer Resources

* University of Iowa
* University of Michigan
* University of Virginia
* University of California San Diego
* University of Washington Medical Center
* Melanoma Patients’ Information Page
* Melanoma International Foundation
* San Diego Cancer Center
* Shade Zone Net
* St. Lukes Episcopal Hospital
* Texas Cancer Institute

*For any procedure and service described on this website, individual results may vary and may not be applicable in all cases.