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
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 the brown pigment melanin, which
is responsible for the color of our skin. Melanoma is when
melanocytes become cancerous, grow, and invade other tissues.
What causes it?
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.
can get melanoma, but fair skinned sun sensitive
people are at greater 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
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.
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 the 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 saving.
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 reaching the blood and lymphatic vessels,
and then spreading 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 common on the backs of
men and the legs of women.
Melanoma is usually brown
or black colored, but sometimes, though rare, may
be red, skin colored, or white.
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 ABCD rules (see below) to decide
if it is suspicious.
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
is in the skin.
Early melanoma limited to the
outermost layer of the skin (the epidermis) is known as melanoma
in situ (in place), and simple surgical removal produces
virtually a 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 dermatopathologist.
This will guide treatment.Deeper melanomas are more likely
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 parts
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 lymph 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 lymph 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?
Excessive exposure to ultraviolet radiation is the known
cause of melanoma. Childhood and adolescent exposure
seem to be the most damaging, so protecting young people
is very important. Common sense dictates protection.
Avoid sun exposure from 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.
detection remains the best treatment. Therefore,
perform a monthly self-exam, looking for irregular lesions
that are growing and changing, and use the ABCD 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.
ABCDs of Melanoma
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.
Border Irregularity - The edge, or border, of melanomas are usually ragged,
notched, or blurred.
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.
continue to grow, while moles remain small. Is the
lesion larger than a pencil eraser (6mm)?
and photos on this page reprinted with permission from the American
Academy of Dermatology. All rights reserved.
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