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MALIGNANT MELANOMA
Melanoma derives its name from the pigment cells in the skin called melanocytes. Melanoma is a malignant skin cancer that presents as a spot with irregular borders and
colors of tan, blue, black, red or white. It usually starts small and changes over a time. Approximately 95% of melanomas originate from pre-existing moles.
Melanoma is one of the most serious types of skin cancer. In the United States, approximately 47,300 new cases of melanoma will be diagnosed during the year 2000. An estimated 7,700 people will die
from this disease. Approximately 1 in 75 Americans have a lifetime risk of developing melanoma. (Statistics provided by the American Academy of Dermatology.)
Family history and environmental exposure to ultraviolet light are two of the most important risk factors. It appears that the predisposition for melanoma
can pass from one generation to another. Moles from birth or atypical-appearing moles also have a higher risk of melanoma. Melanoma usually occurs after puberty; however, it can arise at any age.
Fair skin individuals have an increased risk of skin cancer and melanoma, especially if the excess sun exposure occurred before the age of 18. Periodic
short intense exposures with sunburn or blistering increases the risk of melanoma significantly.
Most melanomas present with irregular growth of pigmented areas. The mnemonic ABCD has been established to identify concerning characteristics of skin pigmentation.
A - asymmetry
B - irregular borders
C - colors of gray, blue, black, red and white
D - diameter greater than 6 mm (the size of a pencil eraser)
If a pigmented area changes or shows irregular characteristics, it should be examined immediately by your dermatologist.
Types of Melanoma:
Superficial Spreading Melanoma: This is the most common of all melanomas. It is a flat, asymmetrical, irregularly pigmented area that usually grows without invasion. This is the most curable.
Nodular Melanoma: This type of melanoma occurs when vertical (invasive) growth is present. This is seen as a changing pigmented area with various
colors. The surface appears “lumpy” and irregular.
Lentigo Maligna: This is seen on sun-exposed areas in the elderly. The skin has a mottled, irregular pigmentation with indistinct borders. This tumor is slow
growing and is almost exclusive on sun-exposed areas in the elderly.
Acral Lentiginous Melanoma: This type of melanoma is rare and is most common among African-American and Asian people. This type of tumor
usually presents as a dark area on the palms, soles, fingers and toes, or under fingernails and toenails. It is also seen in the mucous membranes of the mouth or genital region.
Diagnosis:
Self-examination leads to early detection and diagnosis of melanoma. The sooner a melanoma is found, the better the prognosis and likelihood successful treatment.
If a growth is suspicious, consult your dermatologist immediately. The growth should be biopsied and examined under a microscope to establish the diagnosis.
The appearance under the microscope determines the seriousness and extent of involvement with melanoma. The stages of melanoma are classified in
terms of Clark level and Breslow thickness. The thicker the lesion, the greater the possibility of spread to lymph nodes and internal organs.
Management:
Sun protection, self-examination and early detection are consistent and effective methods to help protect against and prevent deaths from melanoma.
Melanomas do occur on non-sun exposed areas; however, they are more prevalent on sun exposed skin. In men, the most common area is the back;
while in women, melanomas occur more frequently on the legs. Intense ultraviolet exposure, such as sunbathing and tanning, is believed to be one of
the primary factors contributing to melanoma. Sun protection is essential. Avoid excessive sun exposure between the hours of 10:00 AM and 4:00 PM. If
out in the sun, wear sunscreen with SPF 15 or above, with both UVA and UVB protection. A 3-inch wide-brimmed hat along with sunglasses and protective clothing should be used in the sun.
Treatment:
Surgery is the standard of care for melanoma treatment. If the melanoma is thin, the prognosis is excellent. Usually, a biopsy is performed to confirm the
diagnosis and staging of melanoma. A subsequent wider surgical excision is then done, based on the initial biopsy results. If indicated, lymph node
biopsies are done at the time of the wide excision to help detect further spread. Other forms of concurrent treatment involve chemotherapy, interferon,
experimental vaccines or possibly radiation therapy. These treatment options should be discussed with your dermatologist and oncologist.
Remember, the best treatment is early detection and prevention. Patients at high risk should be examined annually by their dermatologist.
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