Melanoma is the most dangerous and life-threatening form of skin cancer, killing an estimated 10,000+ people in the US annually according to the Skin Cancer Foundation. Melanomas develop when unrepaired DNA damage to skin cells triggers mutations that lead the skin cells to multiple and rapidly form malignant tumors. The DNA damage is most often caused by exposure to ultraviolet radiation from sunshine or tanning beds.
Melanomas often resemble moles, and the majority are black or brown, but can present as skin-colored, pink, red, purple, blue or white. If melanoma is found and treated early, it is usually curable, but if not, it is very aggressive and can spread and metastasize and become deadly.
Beyond your annual skin cancer check by a board-certified dermatologist, it is recommended that patients examine their own skin at home once a month in order to quickly identify any new moles or growths. When examining your skin, use the following techniques:
Know your ABCDEs….
A- Asymmetry: if the two halves of a mole do not match in appearance (color, shape or size) it is a warning sign
B – Border: the borders of an early melanoma tend to be uneven, the edges may even appear scalloped or notched
C – Color: a mole with a variety of colors is a red flag. These could be a range of brown, tan, black, red, white or blue.
D – Diameter: melanomas are often larger in diameter than a pencil eraser (1/4 inch).
E – Evolving: any change in size, color, shape, elevation, texture or symptom (bleeding, itching, crusting) is a reason to be seen by your Dermatologist right away.
The Ugly Duckling…melanomas tend to look different from a patient’s other moles. This analogy compares a patient’s “normal” moles that resemble each other, while the potential melanoma is the “outlier” – it looks and feels different and overtime may change differently than the patient’s other moles.
When a melanoma has been established it is next classified based on its degree of severity. The classifications for melanoma are called stages, each stage correlates to its thickness, depth of penetration, and how much it has spread.
Stage 0 is in situ, which means it has not penetrated below the outer layer of the skin (the epidermis).
Stage I tumors have gone more deeply below the epidermis into the skin’s next layer, the dermis, but are small and have no traits that indicate they are at high risk for spreading.
Stage II while still localized these tumors are thicker and may have traits such as ulceration that put them at higher risk for spreading.
Stages III and IV have metastasized to lymph nodes or other parts of the body.
Surgical excision (cutting the melanoma out) is the most common method of treatment. For stage 0 and 1 melanomas, removal can usually be handled in the office under local anesthesia and closed with stitches that remain in place for 1-2 weeks. The surgical excision removes the mole plus a “safety margin” of surrounding skin, so pathology can confirm if the borders of the tissue are clear. If lesions are greater than 0.75mm in depth or have other worrisome features, patients may be referred to a surgical oncologist for evaluation and possible excision with lymph node examination (sentinel lymph node mapping). If sentinel lymph node is positive, patients may be offered adjuvant treatment with immunotherapy or chermotherapy. Current studies have not shown sentinel lymph node analysis to improve mortality rates, but they may help with prognosis and treatment plan. Mohs microscopic surgery has also been used for melanoma, but this is not standard care at this time in most practices. Imiquimod and other topical immunotherapies are also an option for very superficial melanomas in patients not able to have surgery.