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Melanoma

 San Diego Malignant Melanoma Skin Cancer

Melanoma is the most dangerous and serious form of skin cancer.  The incidence of melanomas has increased significantly, in part, because of the rise in sun exposure.  It occurs most frequently in light-skinned individuals with light-colored hair and eyes.  The incidence is lowest among Asians.

Melanoma can strike individuals who have reached the age of puberty and beyond.  Melanoma is rare before puberty.

Approximately half of melanomas develop from pre-existing nevi (moles) while the other half develop de novo (from normal skin).

Risk factors for melanoma include:

  • Blistering sunburns in childhood
  • Large numbers of nevi
  • Presence of atypical (dysplastic) nevi
  • Giant congenital nevi
  • PUVA (a form of light therapy)
  • Tanning lamps
  • Burn scars
  • Immunodeficiency

Melanomas mostly present as changing, dark, and/or multicolored growths.  A certain form of nonpigmented melanoma called amelanotic melanoma is particularly difficult to diagnose.

Melanoma metastasis:
Melanoma spreads through the lymph nodes.  Swellings of lymph nodes of the neck, underarms or groin may be the first sign.  The skin is the most common organ of melanoma metastasis involvement.

Melanoma prognosis:
When caught early and treated, melanoma carries an excellent prognosis and is highly curable.  For melanomas that have not metastasized, prognosis is based on melanoma thickness.  Prognosis is otherwise based on staging which accounts for the presence or absence of nodal involvement and metastases.

The ABCDE criteria for malignant melanoma:
The ABCDE mnemonic for melanoma can be useful for the detection of melanoma since melanomas and dysplastic nevi usually have one or more of the following features.

  • Asymmetry (both in color and in shape)
  • Border irregularity (scalloped, uneven borders)
  • Color variation (more than one color, e.g. light and dark-brown tones)
  • Diameter (>6 mm)
  • Evolution (changes in the mole over time)

A
ASYMMETRY in shape and color
B
BORDER irregularity: ragged, scalloped or blurred borders

C
COLOR variation: when the color of the mole is not uniform in color but has multiple shades of brown, black, red, white and/or blue.
D
DIAMETER greater than 6 mm (this criterion is less important)

EEVOLUTION: any changes in the ABCDs over time

Individuals should check their moles on a monthly basis for changes over time.  Recognizing the warning signs of malignant melanoma is important, since the earlier a melanoma is treated, the better the prognosis.  If a particular mole displays one or more of these signs or changes over time, you should consult a dermatologist for evaluation.

Melanoma treatment:

  • Patients with melanoma in situ (involvement of the most superficial layer of skin only) can be cured with excision alone.
  • Patients with deeper tumors often require additional laboratory studies and imaging for staging purposes in addition to excision.
  • A special mapping procedure called sentinel lymph node biopsy is indicated for melanomas of 1 mm or greater in thickness.  This procedure is used to detect the presence of tumor in the lymph nodes.
  • Adjuvant therapies are available for patients with thick melanomas or lymph node involvement.
  • Metastatic disease may be treated with chemotherapy, immune-based therapies, radiation and/or additional surgery.

Melanoma prevention:
Of course, prevention of melanoma and early detection are the best approaches to the management of melanoma.  Monthly self-exams using the ABCDE criteria and periodic screening examinations by your doctor can aid in the early detection of malignant melanoma.  If you notice a suspicious lesion which meets any or all of the ABCDE criteria, seek the evaluation of a dermatologist.  Sun protection and use of sunscreens are important preventative measures for all the major forms of skin cancer, including malignant melanoma.