Melanoma

Malignant melanoma can be the more worrisome of all skin cancers. Excessive exposure to the sun and sensitivity to the sun are considered risk factors that have contributed to the rising incidence of melanoma in this country, but sun exposure is probably not the whole story. Researchers are becoming increasingly aware of the profoundly important role that inheritance, or genetic makeup, has to do with the risk of getting cancer. While melanoma may not be totally preventable because of genetic factors, it can be fully treated if diagnosed early. 

Cancer researchers believe that atypical cells are on a journey toward becoming true cancer cells. Not all atypical cells finish the march. From the point of view of cancer prevention, the trick is to identify those cells or growths that are atypical and remove them before they do become cancerous. Regular total body skin checkups and skin self-exam help. When caught in time, malignant melanoma is, in most cases, curable. Self examination, early diagnosis, and immediate treatment can literally save your life.

Once the diagnosis of melanoma has been made it is important to know its Breslow depth. The risk that you will develop serious problems with melanoma is directly related to how deep the melanoma is. Any melanoma that is up to 1 millimeter in depth has an excellent chance for cure. The cure rate following simple excision is in the range of 96 to 99 percent. Because it is not 100 percent, it is important to emphasize the need for regular monitoring and follow-up examination.

In order to determine how to treat a patient with melanoma and to make some predictions about prognosis, we categorize melanoma in stages. When a melanoma is up to 1 millimeter in depth, excision with 1 centimeter margins down below the level of fat is all that is required. This procedure can be performed in the doctor's office under local anesthesia.

When the melanoma is between 1 and 4 millimeters thick it is classified as intermediate and may require margins of 2 centimeters when definitive treatment by excision is done. If the melanoma is more than 4 millimeters deep, the margin of safety around the melanoma should be 2-4 centimeters, if it is technically feasible. In some cases smaller margins may be acceptable. Individual circumstances can vary, and there are certainly situations where it is necessary to be more aggressive than the thickness of the cancer alone would suggest.

Checking for Melanoma

What to Look for on your Skin

The ABCD method of checking for melanoma has been widely touted for public health purposes. The problem is that some of the changes described in it do not occur early, and we want to catch melanoma early. Nevertheless, we recommend you learn these ABCDs and know them cold. In addition, we include ways to become suspicious of growths even earlier, when the cure rate is potentially higher.

A: Asymmetry If you fold the mole over in your mind's eye, the halves do not match.
B: Border Irregularity The edges of the mole are ragged, notched or blurred, not smooth like normal moles.
C: Color The coloration of the mole is irregular. There are shades of tan, brown, and black. Even red, white, and blue can add to the mottled appearance.
D: Diameter Any diameter greater than a pencil eraser (about 5-6 millimeters) should raise suspicion.
In addition to these broad guidelines, two more, a "C" and an "s"
C: Concern Even if you don't know why, if you sense there is something of concern about a mole, insist your doctor biopsy it.
S: Suspicion This is one time when it's okay to be suspicious. Doctors call it having a "high index of suspicion." We call it being vigilant. But whatever you call it, when it comes to melanoma, the best rule is "When in doubt, check it out."

Melanoma Checks

  • Every adult over forty should have an annual full-body skin exam.
  • Public skin cancer screenings at which only sun-exposed areas are examined ARE ABSOLUTELY UNACCEPTABLE if that is the only melanoma check you are getting. Melanoma can and does develop where the sun doesn't shine.
  • If you are at high risk for melanoma you should perform a full-body self-exam on a regular basis.