Melanoma

Malignant Melanoma

What is malignant melanoma?

Melanoma is the most serious and potentially deadly form of skin cancer.  Melanoma is a malignant tumor caused by an uncontrolled growth of pigment cells, called melanocytes.

Normal melanocytes are found in the basal layer, the lowest layer of the epidermis.  Melanocytes produce a black pigment, called melanin that protects the skin by absorbing ultraviolet radiation.

The number of melanocytes is the same in all skin types, but in darker skin types, melanocytes produce much more melanin.

Moles and freckles are benign growths made up of melanocytes. Although melanomas can develop in moles, more than 50% of melanomas arise on normal skin.

The incidence of melanoma is increasing faster than any other cancer in the United States.  In 1930 1 in 500 people developed melanoma in his/her lifetime. In 2009 it was 1 in 59.  Melanoma is now the sixth most common cancer in the United States and is the leading cause of cancer deaths in women between the ages of 20 and 35. Every hour one person dies from melanoma in the United States.

Prevention and early detection of melanoma maximizes the best chances of a cure.  When found early, the cure rate for melanoma is very high.  When found late, it is deadly.

Melanoma vs Normal Moles

What are the warning signs of melanoma? ABCDE

A – asymmetry.  No matter how you divide the lesion in half, one side does not look like the other.
B – border irregularity.  The border is notched or scalloped, not smooth.
C – color irregularity. The majority of melanomas are black or brown, but they can also be pink, red, white, blue or purple.  Having multiple colors or different shades of the same color is also a danger signal.
D – diameter greater than the eraser on a pencil (about ¼ inch).  Melanomas can be smaller when detected early.
E – evolving.  Any change in size, shape or color of a mole or development of symptoms such as itching, pain, bleeding or crusting needs to be brought to a dermatologist’s attention immediately. Change is often the first sign of melanoma.

Who gets malignant melanoma?

Risk factors for developing melanoma include1:

  • Sun exposure
    • Intense, intermittent sun exposure and blistering sunburns in childhood and adolescence
    • Excessive sun exposure later in life is also a risk factor for melanoma
    • Chronic sun exposure in the head and neck regions
    • Melanoma risk is directly related to the amount of average annual ultraviolet light exposure.
  • Artificial UV light exposure from tanning beds
  • Personal history of melanoma
  • Family history of melanoma in a first or second degree relative
  • Dysplastic nevi (atypical moles) – markers for increased risk. 
    • Familial atypical mole syndrome, a condition where hundreds of abnormal moles are present in multiple members of the family, especially with a family history of melanoma confers an even greater risk.
  • Large congenital moles and a large number of moles
  • Age
  • Gender
    • Greater overall incidence in men.
  • Skin type/Ethnicity
    • Greater risk in those with fair skin, light-colored hair, light-colored eyes, those who burn easily, tan poorly and freckle
  • Occupation/Socioeconomic status
    • Greater incidence in people with indoor occupations, higher education and higher income
  • Immunosuppresion
  • Genetic predisposition, including certain gene defects and genetic diseases, like xeroderma pigmentosum.

What does melanoma look like?

Melanoma is usually a black or brown patch, papule or nodule that is asymmetric, has notched, irregular borders, has multiple colors or multiple shades of the same color and is many times larger than the eraser of a pencil.  Melanoma can also be red, white, blue or purple in color.
        

How is melanoma diagnosed?

When melanoma is detected before it spreads, it has a high cure rate.  Regular skin exams help find early skin cancers.
It is important to perform a skin self-examination once a month.  The Skin Cancer Foundation has excellent directions on how to perform a self-examination http://www.skincancer.org/Self-Examination/.
It is also essential to have full-body skin exams done regularly by a dermatologist.
The prognosis of a melanoma depends on its thickness at the time of diagnosis.  The thinner the melanoma, the better the chance of a cure.
A biopsy is required for the diagnosis of skin cancer.  A biopsy is performed by numbing the area of the skin suspected of being cancerous with a local anesthetic injection and, in the case of suspected melanoma, the entire lesion is removed with a small amount of normal tissue around it.  The pathologist examines the tissue specimen to determine if there is skin cancer.

Treatment of melanoma

  • Surgical excision
    • The margin of normal skin that is removed with the melanoma depends on the thickness of the tumor.
    • Guidelines for these margins are recommended by the National Institutes of Health and the American Academy of Dermatology Task Force on Cutaneous Melanoma
  • Other potential options for melanoma in situ (the earliest stage of melanoma) are
    • Mohs micrographic surgery
    • Topical imiquimod
    • Radiation therapy
    • Laser treatment
  • Treatments for advanced melanoma
    • Immunotherapy
    • Chemotherapy
    • Biologic targeted agents

Prevention of melanoma

Sun exposure is the most preventable risk factor for all skin cancers, including melanoma.

  • Avoid sun exposure between 10 am and 4 pm
  • Apply a broad-spectrum, water-resistant sunscreen with SPF 50 or higher to all exposed skin. Reapply every two hours, especially if swimming or sweating.
  • Wear sun-protective clothing
  • Protect children from sun exposure
  • Avoid tanning beds
  • Perform a monthly skin self-examination and get regular full-body skin examinations by a dermatologist

References:

  • Rigel, D. Epidemiology of Melanoma. Semin Cutan Med Surg 2010;29:204-209
  • American Cancer Society. Cancer Facts & Figures 2010. Accessed February 28, 2011. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance
    /documents/document/acspc-026238.pdf
  • The Skin Cancer Foundation Skin Cancer Facts.  Accessed February 28, 2011. http://www.skincancer.org/Skin-Cancer-Facts/#general
  • Lutzky J. New Therapeutic Options in the Medical Management of Advanced Melanoma. Semin Cutan Med Surg 2010;29:249-257
  • Torren KL, Parlette EC. Managing Melanoma in Situ. Semin Cutan Med Surg 2010;29:258-263
  • Miller AJ, Mihn MC. Mechanisms of Disease: Melanoma. NEJM 2006;355:51-65
  • Marghoob AA et al. The Most Common Challenges in Melanoma Diagnosis and How to Avoid Them.  Austral J Dermatol 2009;50:1-15

Summit Medical Group is proud to provide medical, surgical and cosmetic dermatology services to women and men in the Tri-State Area, New York and New Jersey, including the following counties and cities: Essex County, Morris County, Bergen County, Union County, Passaic County, Somerset County and Sussex County, NJ - Livingston, Millburn, Short Hills, West Orange, Berkley Heights, Caldwell, Cedar Grove, Cedar Knolls, Chatham, East Hanover, Englewood Cliffs, Essex Fells, Fair Lawn, Florham Park, Fort Lee, Glen Ridge, Jersey City, Kinnelon, Madison, Maplewood, Mendham, Montclair, Montvale, Morristown, New Providence, North Caldwell, Parsippany, Randolph, Roseland, South Orange, Springfield, Summit, Union, Verona, West Caldwell, Whippany and Westfield, NJ.

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