Melanoma - What is it?
By Cynthia Bailey MD. This page was updated on Tue, Sep 19, 2017
ARE YOU AT HIGH RISKFOR MELANOMA?You are more likely to get melanoma if you:
- have fair skin, especially if you or your parents have red hair or are blond and/or have blue green eyes.
- have a history of blistering sunburns. 5 or more sunburns between ages 15-20 increases your risk by 80%.
- have many moles or if your moles are large and irregular (dysplastic nevi).
- have a history of unprotected sun exposure.
- have used a tanning bed.
- have a relative who has had melanoma.
- are in the upper middle-class (curious, right?!)
Screen for MelanomaWe teach to look for these 5 worrisome signs: ABCDE’s of Melanoma. A: Asymmetry
- This refers to when moles are irregularly shaped - not round or oval.
- A melanoma sign is when the mole’s edges are jagged, blends into skin, notched, or scalloped.
- Be wary when the color throughout a mole is not uniform.
- Measure if the diameter of a mole is greater than 6 mm (approximately the size of a pencil eraser).
- You may identify melanomas smaller than 6 mm.
- Examine if the mole is raised or not flush with your skin.
- Does the mole become tender or ulcerate?
- Watch if the mole changes over time in size or color (darker, lighter, red, blue, black, white – it all counts).
Do All Melanomas Come from Moles?The surprising answer is no! In a vital scientific study, it was found that only one-third of melanomas arise from existing moles. The vast majority of melanoma cancers appear on the skin as new spots according to the study published in the Journal of the American Academy of Dermatology. These investigators reviewed 38 published studies comprising 20,126 melanomas. They found that less than one-third of melanomas (29%) arose from an existing mole. The vast majority (71%) appeared as new spots. Melanomas that arose from existing moles were thinner, indicating that patients whose melanoma was associated with an established mole had a better prognosis. We don’t know why this is.
Melanoma Identification – Practical ExamplesHere is an example of how to identify melanoma using the ABCDE’s. Melanoma #1 A: Not perfectly oval. B: Poorly-defined margins. Some margins are very dark, while others are light and blend into the skin C: Color not uniform. Dark red in some areas, lighter in others. White area in the center. D: Diameter not given and unable to measure from photo. E: Elevation noted in the center with possible scab indicating possible bleeding. Melanoma #2 A: Asymmetrical. No clear shape. B: Border clearly defined but ragged. Scalloped in some areas. C: Distinct color variations. A dark reddish-purple border outlines the mole with a white center. It’s also paler than regular skin tone. D: Diameter not given and unable to measure from photo. E: Dark border appears slightly elevated, irregular, and texturized.
Contributing Factors That Increase the Risk of Melanoma?1. UV rays: We know UV rays damage DNA. Both regular and intermittent exposure to the sun contributes to sunburns and melanoma. Damaged DNA sometimes “turns on” an oncogene (a gene that causes a tumor cell) or “turns off” a tumor suppressor gene (a gene that usually stops the uninhibited growth of cells), which opens the door for cancer to develop. It’s essential to protect from UV damage by wearing sunscreen every day. 2. Geography: Since UV rays damage DNA, it makes sense that more intense sun would cause more severe damage. People who live close to the equator as well as those living at high altitudes get more intense sun exposure and have an increased risk of melanoma. 3. Family history: Melanoma can be labeled “familial” when two or more first-degree relatives have had melanoma. When there are alterations in one of two specific genes (named CDKN2A or CDK4), people are at risk for this type of melanoma. Individuals with familial melanoma often have “funny looking moles” which is known as “atypical mole syndrome,” a condition in which moles may appear irregular looking and are sometimes difficult to visually distinguish from melanoma. When melanoma runs in your family or you have many unusual looking moles, it is critical to see a board-certified dermatologist for regular skin checks. 4. The number of moles and freckles: Having many moles increases the risk of developing melanoma. Over 100 moles can increase your risk 10x. Having lots of freckles is also a risk factor. 5. Skin type: Melanoma is more common in Caucasians, particularly in fair-skinned people. Redheads with light eyes seem particularly susceptible. This does not mean that darker-skinned people can’t get melanoma, but it is less common.
Bottom LineAnyone can develop skin cancer, including melanoma. 1 in 50 Americans are estimated to develop melanoma during their lifetime.
- Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease.
- It kills an estimated 9,940 people in the US annually; one person dies of melanoma every hour (every 57 minutes).
- It is not the most common of the skin cancers but it causes the most deaths.
- Melanoma is one of only three cancers with an increasing mortality rate for men, along with liver cancer and esophageal cancer.
- Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.
- Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history of the disease.
Patient CareMy job as a dermatologist is to help prevent melanoma or early detection. I perform a full body exam and teach patients that most melanoma comes from new moles. New moles after the age of 30 need to be given attention as does any changes in existing moles. I teach patients to do monthly self-exams and become familiar with their general inventory of moles. This includes scalp, between toes etc. For the back, enlist the help of a loved ones. When a person has more moles than I can document on a written map, I capture total mole map photos and compare them during exams. I teach patients the foundation of assessing their moles and the Ugly Duckling Sign. If a mole itches, develops a white halo, or turns into a scab or sore, come show me. It is comforting to have a strategy and a healthy amount of suspicion. Pay attention to even a tiny change. In my years of dermatology practice, I have had patients detect their own melanoma simply because of a hunch. Because early detection is lifesaving, an open-mind during skin exams is essential. I also educate on effective sun protection techniques. Being outside is a pleasure and doing it without UV mutation is possible. Click here for my sun protection tips refined by my patients and I.