Malignant melanoma is the third most common skin cancer after basal and squamous cell carcinomas. Unlike many other cancers such as breast cancer and prostate and colon, the frequency of melanoma continues to rise. It is the most common cancer of any in women in their late 20s. Melanoma can develop from a previously present mole. But more often than not, it begins as a new growth, usually with a brown or yellow or black color on previously normal looking skin.
Melanoma has visually apparent features that help aid in the diagnosis. Follow the ABCD self-examination guide to determine if an unusual looking mole needs further evaluation by a dermatologist.
A is for asymmetry. If one part of the mole is different from the rest in color or elevation.
B is for border irregularity. The borders of the mole may be notched or scalloped.
C is for color variation. A normal mole should be one shade of color throughout.
D is for diameter. If a mole increases in diameter (usually over several months), even if there are no other changes, it should be examined by a dermatologist.
Most normal moles are less than a pencil eraser size - 6mm. If one mole is significantly larger, especially if it has any of these other features, it should be examined by a dermatologist.
The diagnosis of a melanoma is always upsetting. However, the good news is that over 90% of melanomas are cured with simple surgery. However, if a melanoma is not detected early, it does have potential to spread internally leading at times to death.
There are some people who are at increased risk for melanoma. Those individuals who have an increased number of moles, those with unusual or atypical looking moles, those with family histories of melanoma, and those with heightened sun sensitivity are at increased risk. In addition, extensive sun exposure over the years or use of tanning beds also further increases an individual’s risk.
The best intervention for curing melanoma is to diagnose it early. Thus all individuals should do periodic self-examination and react to any of the above noted changes. Those individuals at increased risk may benefit from periodic examinations by a dermatologist. EARLY diagnosis allows early treatment with cure rates as noted in the 90% and above range.
The treatment for melanoma in most cases is to undergo what is called a wide local excision. This is an outpatient surgical procedure in which a cuff of normal looking skin is removed along with the melanoma to ensure all roots are removed.
Some melanomas, especially on the face, require a 2 or a 3-step procedure for removal in which the edges of the melanoma are first tested to obtain tumor free margins and then the necessary reconstructive procedure carried out.
Because most melanomas are diagnosed early, they do not require blood tests or scans such as MRIs or CAT scans. Most melanomas do not require surgical testing of the lymph nodes. A special test known as a sentinel lymph node biopsy, is sometimes performed for situations where the melanoma has gone deeper into the skin and where testing of the lymph nodes might offer additional helpful information.
Once diagnosed with the melanoma, the risk for second melanoma is increased. Patients with melanoma must limit sun exposure, eliminate tanning bed exposures, carry out regular self-examination, and have periodic physician examinations for the rest of their lives.
We will treat over 300 melanomas in our office this year.