Melanoma

This skin cancer can develop in any previously existing mole or it can develop on previously normal looking skin and look like a new mole. Melanoma is one of the most serious types of skin cancer. If allowed to grow, melanoma can spread internally to other parts of the body and can be deadly. However, when found early, melanoma is highly treatable.

To diagnose melanoma, a dermatologist begins by looking at the patient’s skin. A dermatologist will carefully examine moles and other suspicious spots. To get a better look, a dermatologist may use a device called a dermatoscope. This device shines light into the skin and allows the doctor to see into the lesion, and evaluate the pigment patterns and other structures in the skin.
The dermatologist also may feel the patient’s lymph nodes, especially if you have a history of melanoma.

If the dermatologist finds a mole or other spot that looks like melanoma, the dermatologist will remove it (biopsy) and send it to a lab for microscopic evaluation. Melanoma cannot be diagnosed without a biopsy.
This biopsy is quick, safe, and easy for a dermatologist to perform. This type of biopsy should not cause anxiety. The discomfort and risks are minimal.
If the biopsy report says that the patient has melanoma, the report also may tell the stage of the melanoma. Stage tells the doctor how deeply the cancer has grown into the skin.

The melanoma stages are:
◦ Stage 0: in situ, confined to the top layer of the skin.
◦ Stage IA: up to 1.0mm thick; this lesion has grown thicker, but the overlying skin is intact without any cracks or sores.
◦ Stage IB: up to 1.0mm thick; this lesion has grown thicker, but the overlying skin has broken open.
◦ Stage II: between 1.01 and 4.0mm thick; this lesion has grown thicker.
◦ Stage III: Melanoma has spread to either 1+ nearby lymph nodes or to nearby skin (as a lump or nodule).
◦ Stage IV: Melanoma has spread to an internal organ, lymph nodes that are far from the original melanoma, or on the skin far from the original melanoma.

Sometimes, in order to determine which stage someone is, another type of biopsy called a sentinel lymph node biopsy (SLNB) may need to be recommended. A SLNB tells determines if the melanoma has spread to nearby lymph nodes. Other tests that a patient may need include x-rays, blood work, and a CT scan. The stage of melanoma will determine what treatment will need to be done.

Possible treatments for melanoma:
◦ Surgery: When treating melanoma, doctors want to remove all of the cancer. When the cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. If caught early, this may be the only treatment needed. The patient often remains awake during the surgical procedures. Types of surgeries:
◦ Excision: The dermatologist numbs the skin with a local anesthetic. Then, the dermatologist surgically cuts out the melanoma and some of the normal-looking skin around the melanoma. This normal-looking skin is called a margin. Most of the time, this can be performed in a dermatologist’s office.
◦ Mohs surgery: The Mohs surgeon numbs the skin with a local anesthetic. Then the Mohs surgeon removes the visible part of the melanoma and it is processed so that the surgeon can examine it under a microscope and look for cancer cells. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less
◦ Other treatments for melanoma include:
◦ Lymphadenectomy: Surgery to remove lymph nodes (to assess if the cancer has spread to the lymph node).
◦ Immunotherapy: This helps the patient’s immune system fight the cancer.
◦ Targeted therapy: Drugs that can temporarily shrink the cancer; however, some (not all) patients appear to be fully cured.
◦ Chemotherapy: Medicine that kills the cancer cells (and some normal cells).
◦ Radiation therapy: X-rays that kill the cancer cells (and some normal cells).
◦ Clinical trial/study: A clinical trial studies a medicine or other treatment. A doctor may recommend a clinical trial when the treatment being studied may help a patient.

Your risk of developing melanoma increases if you:
◦ Have a history of tanning bed usage; tanning beds before age 35 can increase your risk of melanoma by 59%, and increases with each use.
◦ Had 5 or more blistering sunburns between ages 15 and 20; this increases your melanoma risk by 80%.
◦ Live close to the equator.
◦ Live in a sunny area of the United States like Florida or Arizona.
◦ Are older than 65; you may experience melanoma more frequently because of UV exposure you’ve received over the course of your lifetime.

Other risk factors for developing melanoma:
◦ Fair skin.
◦ Red or blond hair.
◦ Blue or green eyes.
◦ Sun-sensitive skin.
◦ You rarely tan or burn easily.
◦ 50 or more moles.
◦ Large moles.
◦ A history of an atypical mole.
◦ Taking certain medications or having some medical conditions (that affect your immune system).
◦ Organ transplant recipients have a three- to fivefold increased risk for melanoma.
◦ Had melanoma or another type of skin cancer in the past.
◦ A close blood relative has or had melanoma.

Melanoma can show up on your body in different ways. You may see a:
◦ Change to an existing mole.
◦ New spot or patch on your skin.
◦ A spot that looks like a changing freckle or age spot.
◦ Dark streak or stripe under a fingernail or toenail.
◦ Band of darker skin around a fingernail or toenail.
◦ Slowly growing patch of thick skin that looks like a scar.
◦ A mole that starts to itch or bleed on its own.

Check your own skin (including all over the body, under the nails and scalp) can help you find melanoma early when it’s highly and easily treatable. When examining your skin, you want to look for the warning signs, which are called the ABCDEs of melanoma:
◦ Asymmetry, when one half of the lesion is different from the other half.
◦ Border irregularity.
◦ Colors: having multiple different colors (black, brown, blue, red, pink).
◦ Diameter: greater than that of a pencil eraser.
◦ Evolution: evolving or changing lesion (this is likely the most important sign).

What can you do to protect your skin:
◦ Seek shade when the sun is really strong. The sun's rays are strongest between 10 a.m. and 2 p.m. Another good rule of thumb is to look at your shadow. If it's shorter than you are, seek shade.
◦ Wear sun protective clothing, such as a long-sleeve shirt, pants, a hat with a wide brim that goes all the way around the hat, and sunglasses to protect your eyes.
◦ Always slather on sunscreen. No excuses. Always get a sunscreen that says these 3 things on the label: Sun Protection Factor (SPF) 30 (or higher), broad spectrum, and water resistant. When your outdoors, you'll need to reapply sunscreen every 2 hours, even on cloudy days and always after swimming or sweating. Even though some sunscreens say water/sweat resistant, you MUST reapply after getting wet.
◦ Be careful around water, sand, and snow: These things reflect, making the damaging rays of the sun stronger. You're more likely to get a sunburn.
◦ Stay away from tanning beds: Like the sun, tanning beds can cause skin cancer and wrinkled skin.