As a dermatologist in clinical practice since 1991, I have had many opportunities to make a positive impact on patients’ lives by being the first to diagnose and treat skin cancers, above all nonmelanoma skin cancers.
Fortunately, almost every patient has had a good outcome, primarily because of early diagnosis and intervention. Like most dermatologists, I understand that if I encounter high-risk melanoma or advanced disease, clinical management will most often become the responsibility of surgical and medical oncologists, while I will navigate shallower waters, such as screening family members and reviewing pertinent but often confusing literature to assist the patient and family in making important decisions regarding treatment.
I have gained quite a new perspective on melanoma, however, since becoming an advanced melanoma patient myself in 2006.
Please Read Surviving Advanced Melanoma: A Dermatologist's Personal Perspective, by Vivian W. Bucay, M.D.
Melanoma is a type of skin cancer. It is the most serious type of skin cancer because melanomas have a tendency to spread quickly to other parts of the body (metastasize).
Melanoma begins when melanocytes (pigment cells) in the skin become more abnormal and start to divide without control or order. These abnormal cells can invade and destroy the normal cells around them. The abnormal cells form a growth of malignant tissue (a cancerous tumor) on the surface of the skin.
Most melanomas appear as dark growths similar to moles, but some may be skin-colored.
Melanoma can begin as a new growth on the skin, or develop from an existing mole (nevi) that changes size, shape, feeling, or color.
What are the signs and symptoms of melanoma?
Often, the first sign of melanoma is a change in the size, shape, color, or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new mole. It may be black, abnormal, or “ugly looking.”
In more advanced melanoma, the texture of the mole may change. For example, it may become hard or lumpy. Melanomas may feel different from regular moles. More advanced tumors may itch, ooze, or bleed. But melanomas are not usually painful.
Changes in the skin, such as a change in a mole, should be reported to the health care provider right away. The person may be referred to a dermatologist.
A monthly skin self-exam is very important for people with any risk factors of developing skin cancer, but routine skin self-exams are a good idea for everyone.
ABCDs of melanoma detection
Note: Do not use the following pictures to try to diagnose melanoma yourself. Pictures are useful examples, but they cannot take the place of a doctor’s examination.
A for Asymmetry: Does one half of a mole look different from the other?
B for Border: Is the edge (border) of the mole ragged, notched, or blurred?
C for Color: Does the mole have a variety of hues or colors within the same lesion? (The color is uneven. Shades of black, brown, and tan may be present. Areas of white, grey, red, pink, or blue also may be seen.)
D for Diameter: There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 millimeters).
Melanomas can vary greatly in how they look. Many show all of the ABCD features. However, some may show changes or abnormalities in only one or two of the ABCD features.
If you notice a mole that is different from others, or which changes, itches, or bleeds even if it is smaller than 6 millimeter, see your doctor.
Who’s at risk for melanoma?
No one knows the exact causes of melanoma. Doctors can seldom explain why one person gets melanoma and another does not.
However, research has shown that people with certain risk factors are more likely than others to develop melanoma. Still, many people with melanoma have no known risk factors.
Studies have found the following risk factors for melanoma:
- Dysplastic nevi: Dysplastic nevi are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles.
- Many (more than 50) ordinary moles: Having many moles increases the risk of developing melanoma.
- Fair skin: Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes) than in people with dark skin.
- Personal history of melanoma or skin cancer: People who have been treated for melanoma have a high risk of a second melanoma. Some people develop more than two melanomas. People who had one or more of the common skin cancers (basal cell carcinoma or squamous cell carcinoma) are also at increased risk of melanoma.
- Family history: Melanoma sometimes runs in families. Having two or more close relatives who have had this disease is a risk factor. When melanoma runs in a family, all family members should be checked regularly by a doctor.
- Weakened immune system: People whose immune system is weakened by certain cancers, by drugs given following organ transplantation, or by HIV are at increased risk of developing melanoma.
- Severe, blistering sunburns: People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma.
- Ultraviolet (UV) radiation: Experts believe that much of the worldwide increase in melanoma is related to an increase in the amount of time people spend in the sun. This disease is more common in people who live in sunny climates. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can damage the skin and increase the risk of melanoma.
What are the stages of melanoma?
If the diagnosis is melanoma, the doctor needs to learn the extent, or stage, of the disease before planning treatment. Staging is a careful attempt to learn how thick the tumor is, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body.
The following stages are used to describe melanoma:
- Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.
- Stage I: Melanoma in stage I is thin and has not spread to nearby lymph nodes.
- Stage II: The tumor is at least 1 millimeter thick and may be ulcerated; the melanoma cells have not spread to nearby lymph nodes.
- Stage III: The melanoma cells have spread to nearby tissues.
- Stage IV: The melanoma cells have spread to organs, lymph nodes, or skin far away from the original tumor.
- Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may have come back in the original site or in another part of the body.
How is melanoma treated?
Your doctor can describe melanoma treatment options and discuss the results expected with each. Factors such as the stage and location of the disease and the person's general health must be taken into account.
People with Stage III or Stage IV melanoma are often treated by a team of specialists. The team may include a dermatologist, surgeon, medical oncologist, radiation oncologist, and plastic surgeon.
Where can I learn more?
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© 2011, Dr. Vivian Bucay. Last updated March 24, 2011.