Take Charge Of Your Health - The Bad News: Melanoma
It’s not just skin cancer, when it’s the largest organ in our body.
Skin cancer affects one in five Americans over their lifetime and melanoma is considered the deadliest type of skin cancer. Although melanoma accounts for only 1% of all skin cancers (the others being basal cell or squamous cell growths that can usually be removed easily), melanoma causes the great majority of skin cancer-related deaths. According to the American Cancer Society, approximately 100,000 Americans are diagnosed with melanoma each year. It is widely accepted that increasing levels of ultraviolet (UV) exposure, most commonly from sunlight, tanning beds, or tanning lamps, are contributing factors to the dramatic increase of melanoma over the past 30 years.
The good news? There are ways to protect yourself, reduce the risk of melanoma, and detect it early when it is most curable. The increase in self monitoring combined with the new therapies that have been developed over the past 15 years have transformed the treatment of melanoma and increasing patient longevity.
The first melanoma signs are often a change in an existing mole or a new unusual growth on the skin. Areas with the greatest exposure to the sun, including the face, arms, back, hands, and legs are most vulnerable, although sometimes melanoma appears in places that are well hidden like on the soles of the feet, in between the toes, and even inside the body.
Characteristics to look for in existing moles or freckles include: unusual shape with scalloped edges, changes in color, new growth, and symptoms such as bleeding or itching. The American Academy of Dermatology provides an "ABCDE" memory device to help identify spots on the skin that should be checked:
Asymmetry: One half of the spot does not match the other half
Border: The edges are not smooth
Color: The color is mottled and uneven, with shades of brown, black, gray, red, or white
Diameter: The spot is greater than the tip of a pencil eraser (6.0 mm)
Evolving: The spot is new or changing in size, shape, or color
While melanoma is typically caused by genetic and/or environmental factors, other factors that can increase the risk of melanoma include:
History of severe sunburns
Exposure to UV light (sunlight, tanning booths/lamps)
Having lots of moles (50 or more) or moles that are not typical
Living closer to the equator or at a higher elevation with exposure to more direct sun
People with fair skin, blond or red hair, light-colored eyes, and freckles who tend to sunburn more easily
A weakened immune system
The best way to reduce the risk of melanoma is to:
Avoid unnecessary exposure to UV light (Since the sun’s rays are strongest between 10 a.m. and 4 p.m., it is best to limit time outside during these hours.)
Avoid tanning beds or tanning lamps
Wear protective clothing, hats, and sunglasses
Use sunscreen with SPF 30 or higher and apply at regular intervals
Do self exams of the skin to check for abnormalities
Schedule annual visits to a dermatologist
To diagnose any suspicious moles or growth, a dermatologist will likely suggest a biopsy - a procedure to remove a sample of tissue for testing in a lab. (Again most often these results reflect basal or squamous cell changes that can be treated easily with excision.) If a diagnosis of melanoma is made, the next step is to determine “the stage”. To assign a stage to the melanoma, and in turn, develop the most effective treatment plan, the healthcare team will determine the thickness of the melanoma, see if the melanoma has spread to lymph nodes, and look for signs of cancer in other areas of the body.
Melanomas are grouped into the following stages:
Stage 0 (Melanoma in situ): The melanoma is only in the top layer of the skin
Stage I: Low-risk primary melanoma with no evidence of spread (Typically curable with surgery)
Stage II: Features are present indicating higher risk of recurrence, but no evidence of spread
Stage III: The melanoma has spread to nearby lymph nodes or nearby skin
Stage IV: The melanoma has spread to more distant lymph nodes, skin or internal organs
Once the stage has been identified, the most effective treatment plan can be developed.
Treatment methods include:
Melanoma surgery: In the early stages, surgery has a high probability of cure. In some cases the doctor can simply numb the skin with a local anesthetic and remove the melanoma and a margin of healthy skin.
Lymphadenectomy: If the melanoma has spread, removal of the lymph nodes may be required to prevent spreading to other areas of the body.
Metastasectomy: This treatment is used to remove small melanoma bits from organs.
Targeted cancer therapy: Drugs are used to target and attack specific cancer cells, while leaving healthy cells untouched.
Radiation Therapy: High-energy rays are used to attack cancer cells and shrink tumors.
Immunotherapy: Medicine to stimulate the immune system to help fight the melanoma cancer.
Chemotherapy: This can be an option to help control melanoma that does not respond to other treatments.
After treatment, follow up care is critical for melanoma patients. Monthly self exams and follow-up doctor visits are important to monitor any changes in the skin and lymph nodes and identify areas of concern early. A typical follow-up schedule for patients with early-stage melanomas (that were removed completely) can be physical exams every 6 to 12 months. If these exams are normal, the time between doctor visits may be extended over time. For thicker melanomas (or those that have spread beyond the skin), physical exams with the dermatologist every 3 to 6 months can be required. For patients with more advanced stage cancer, follow-up imaging tests such as ultrasounds or CT scans may also be appropriate.
It is important to note that feeling depressed, anxious, or worried is normal when melanoma is a part of one’s life. Some people are affected both physically and emotionally more than others, but most everyone can benefit from encouragement provided by caring friends and family, cancer support groups, professional counselors, and spiritual groups. Complementary therapies such as healing touch, acupuncture, or meditation can also be helpful for stress/anxiety reduction, greater comfort and a positive outlook.
Prevention and early detection cannot be overstated and Taking Charge of Your Health is vital.