Melanoma is the most dangerous form of skin cancer. It accounts for 75% of all deaths from skin cancer even though it only represents 5% of all cancerous skin tumors. UV exposure (especially from sunburn and tanning beds) is the biggest risk factor for this disease. People with fair skin and lots of moles are most likely to develop melanoma. This cancer can almost always be successfully treated when it is caught while the lesion has not penetrated into the tissues below the skin. Early detection and removal are simple and highly effective ways to prevent death from this disease.
Self Skin Exam
You should check your skin every month to see if there are any new moles on your skin, or if any spots have changed in appearance. Use a mirror or have a trusted friend/partner check areas such as your back that you may not be able to see. Use a skin chart to record the location and size of any moles. That way, you can easily monitor them over time for changes. Moles that crust over, bleed, ooze, or cause pain should be inspected immediately by a dermatologist. You should also have moles examined if they have any of the following characteristics:
A: Asymmetry – If you draw a line through the mole either vertically or horizontally, both sides should look roughly identical.
B: Irregular Borders – The borders of the mole should be round, very smooth, and well-outlined. Suspicious features include jagged, scalloped, or spiky borders.
C: Color Variation – The color of the mole should be similar throughout. There should be no mixture of black, white, blue, or red present.
D: Diameter – Generally speaking, the diameter of the lesion should be smaller than a pencil eraser (approximately 5mm).
E: Enlarging – If a lesion is enlarging in any way, this should be viewed as suspicious.
You can take pictures of your skin! For example, take a picture of each quadrant of your back and put these pictures on your hard drive. Have someone label each quadrant of your back with your initials, the date, and the back label (right upper back, etc) with an eyebrow pencil and take the digital picture with NO background except your skin. Put a ruler next to any moles you want to keep a closer eye on and take a closer picture. There is no limit to how many pictures you can take. If a mole changes or your are unsure, compare this with your pictures, print it out, and bring it to your dermatologist.
A suspicious mole should be evaluated immediately and biopsied. If melanoma is a diagnosed by biopsy, the mole should be removed as soon as possible. The standard of care for melanoma treatment is surgical excision with a wide, clear margin to ensure complete removal.
The type of surgery and the margins required for removal are dependent on the depth of melanoma invasion into the layers of the skin (Breslow depth). For superficial in situ melanomas with no evidence of invasion, Mohs surgery is a possible treatment possibility. For melanomas < 1cm of invasion, wide surgical excision is recommended, but for those with > 1cm of invasion, surgical excision + sentinel lymph node biopsy is recommended. For deeper tumors, an even wider margin is taken.
Sentinel lymph node biopsy is the removal of the primary draining lymph node at the site of the tumor. This primary lymph node is identified by injecting a radiographic dye at the tumor site at the time of the surgical excision, and using an x-ray to find to which lymph node that dye drains. That “sentinel” lymph node is then removed, sectioned, and evaluated for the presence of melanoma. If melanoma is present, then the entire lymph node group for that draining area is removed and examined.
Further melanoma treatment is based on staging. Staging is the process where a number of tumor factors and tumor spread is used to determine the prognosis of survival and best treatment options. This often includes laboratory work, chest x-rays / CT / PET scans to determine how far the tumor as spread. For tumors involving lymph nodes or metastatic spread, chemotherapy or immunotherapy options are used to fight the tumor.
Routine screening for patients with a history of melanoma and melanoma treatment is essential. This screening should be with the dermatologist +/- surgical oncologist every 3 months for the first 2-3 years, then 6 months for 2-3 years, the 6-12 months thereafter. The dermatologist will do full body skin exams for evaluation of other suspicious lesions while the surgical oncologist will do routine blood testing, chest x-rays, CT/PET scans as indicated.
For more information on melanoma, staging, and treatments, please also visit:
- Melanoma overview on Emedicine.com
- Melanoma overview from Pubmed Health
- Melanoma staging from the AJCC
On a special note, two more treatments have recently been approved for melanoma that have garnered much excitement. Click on the links below to learn more:
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