Melanoma is the most deadly of the skin cancers. About 50% develop from a preexisting mole and 50% develop on normal appearing skin. This tumor develops at the most productive time in a person’s life (20-50 years). If undetected or if there is a delay in seeking medical attention, the tumor can invade deeply and eventually metastasize to other organs, with death resulting. Melanoma can appear as multicolored or brown-black papules, patches, or nodules, with irregular borders. They can crust over and bleed. They occur commonly on sun exposed parts of the body, but may develop anywhere on the body. Warning signs to look for are ABCDE: Asymmetry, Border irregularity, Color variation, Diameter (bigger than a pencil eraser), and Evolving or changing.
Melanoma is usually seen in fair skin individuals, blond or red heads, freckled skin and people exposed to excessive ultraviolet radiation. Dark skinned individuals can also develop melanoma. When this happens, it is usually found on the palms and soles.
Ultraviolet radiation comes from the sun, tanning beds, sun lamps, and tanning booths. People with fair skin that freckles and burns easily, and light colored eyes are more at risk for sun burns. People who live in areas closer to the equator (Texas and Florida) are more exposed to ultraviolet light and are at increased risk for skin cancer, compared to the northern states like Minnesota. It is important to keep in mind higher altitudes and people who ski can burn at these altitudes and are also at increased risk for skin cancer.
Other risk factors include an increased number of common moles, the presence of large moles, a family history of melanoma, history of previous dysplastic moles removed, and the presence of a giant congenital melanocytic nevus at birth.
The diagnosis of melanoma is made after your dermatologist takes a sample of your skin and sends it for pathological examination.
The best protection against developing a melanoma is to photo protect. Avoid exposure between 10am and 4pm, when the sun’s cancer causing rays are the most intense. Apply a broad-spectrum sunscreen of at least SPF 15 to sun exposed parts of the body 30 minutes before going outdoors. UV radiation can be direct, or reflected from sand, snow, water, and ice. It can affect you on a rainy, windy, and cloudy day. It can go through clothing, windshields, and windows. Photo protective clothing can also offer benefit. Look for specific fabrics that have a UPF50 designation. Reapply sunscreens every 2 hours when outdoors, and if you are in and out of the water or are sweating excessively. Avoid tanning beds, booths, and using sun lamps. Tanning beds increase your chance for melanoma four times.
Melanoma can be cured if detected early. Survival rate is about 99% if detected early. Survival falls to 15% for those patients with advanced disease. Early surgical excision with an appropriate margin is the mainstay of treatment. Patients with advanced disease or deeper tumors may benefit from surgical excision, along with radiation, chemotherapy, and immunotherapy.