May is skin cancer awareness month, but beyond preaching about the obvious SPF protection, we wanted to take a deep – and serious – dive into the deadliest type of skin cancer, Melanoma. The reality is rates of melanoma are on the rise and have more than doubled since 1982. Right here at Modern Dermatology we diagnose and treat melanomas quite regularly, so we asked Dr. Klein to share more about what’s going on and what we can do.
What is melanoma?
Melanomas are characterized by an uncontrolled growth of melanocytes, which are the pigment-producing cells. Melanomas may appear on the skin suddenly without warning, but also can develop within an existing mole. The majority of melanomas arise de novo (meaning new, with no associated nevus) and are more aggressive in general than melanomas that arise within existing nevi.
What causes melanoma?
The number one factor is exposure to UV light from sun and tanning beds. Using a tanning bed just one time increases your risk for melanoma by 59% and that risk rises with each exposure.
Melanomas also have a genetic component. Familial malignant melanoma is a term usually referring to families in which 2 or more first-degree relatives, such as a parent, sibling, and/or child, have been diagnosed with melanoma. It’s important to share your personal health and lifestyle history with your dermatologist as well as your family history so that these factors can be taken into consideration when you’re being examined.
I have a darker complexion and tan vs. burn, so I’m good, right?
NO. A fact that usually gets my patients’ jaws to drop is that Bob Marley died from a melanoma on his toe at the age of 36! While melanoma is more common among Caucasians, it can affect anyone and appear anywhere on the body. Darker pigmented individuals are often diagnosed with melanoma in more advanced stages and have higher mortality rates.
Is melanoma always deadly?
NO. Melanoma is highly treatable when detected early, however advanced melanoma that has metastasized to the lymph nodes and internal organs is very aggressive and has high rates of mortality. It is estimated that more than 7,000 people will die from melanoma in 2019.
The average five-year survival rate for individuals whose melanoma is detected and treated before it spreads to the lymph nodes is 98 percent. The five-year survival rates for regional (lymph nodes) and distant (other organs/lymph nodes) stage melanomas are 64 percent and 23 percent, respectively.
How do I know my risk?
Your risk is also increased if you have:
More than 50 moles, large moles or atypical (unusual) moles.
A family history of melanoma.
Sun-sensitive skin (i.e., sunburn easily, red or blond hair, or blue or green eyes).
A history of excessive sun exposure or indoor tanning.
A history of previous melanoma or nonmelanoma skin cancer, which is more common than melanoma.
A history of other previous cancers, such as breast or thyroid cancer.
What does melanoma look like?
Melanoma can present in a variety of ways, the most important thing to watch for is change – either change to an existing spot, or the development of a new spot altogether. There is also a set of criteria to consider when looking over your own skin:
Asymmetry: One half does not match the other half.
Border irregularity: The edges are ragged, notched or blurred.
Color: The pigmentation is not uniform. Different shades of tan, brown or black are often present. Dashes of red, white, and blue can add to the mottled appearance.
Diameter: While melanomas are usually greater than 6mm in diameter (or greater than a pencil eraser) when diagnosed, they can be smaller.
Evolving: The mole or skin lesion looks different from the rest or is changing in size, shape or color. A mole that is flat and suddenly becomes elevated (“evolution”) can also be concerning.
If you notice a new mole, a mole different from others on your skin, or one that changes, itches or bleeds, even if it is smaller than 6mm, you should make an appointment to see a board-certified dermatologist as soon as possible.
The American Academy of Dermatology urges everyone to examine their skin regularly. This means looking over your entire body, including your back, your scalp, your palms, your soles and between your toes.
Can melanoma be prevented?
YES. Avoiding UV exposure is the most preventable risk factor for all skin cancers, including melanoma. Intermittent sun exposure (ie. Occasional high dose exposure, like a warm weather vacation) is one of the biggest risk factor for melanoma.
Avoid the sun between 10 a.m. and 2 p.m when UV rays are the strongest.
UPF clothing is a great, and I recommend it for the entire family
Apply a broad-spectrum (protection from UVA and UVB rays), water-resistant sunscreen with SPF 30+ at least 15 minutes prior to sun exposure
Use SPF 30+ even on cloudy days – the sun’s rays penetrate the clouds
When you apply your SPF you need to use at least 1 ounce (approximately a shot glass)
Reapply every 2 hours when outdoors, or immediately after swimming or sweating
Use caution around water, snow and sand as these reflect and intensify the sun’s rays
Never use tanning beds, I repeat NEVER!
In conclusion, melanoma is a real scary topic, but if you’re on top of your regular skin exams and daily sun protection you don’t have to become a part of the statistics. If it’s been a while since your last exam, please give the office a call to schedule a skin cancer screening.
Guy GP Jr, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: melanoma incidence and mortality trends and projections - United States,1982-2030. MMWR Morb Mortal Wkly Rep. 2015 Jun 5;64(21):591-6.
American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; doi: 10.3322/caac.21551
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018