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Malignant Melanoma
It is especially important to
diagnose this type of skin
cancer as early as possible
since it can spread internally
to areas such as brain, liver
and lung.
4% of skin cancer cases - With
cases on the rise, early
detection of this deadly skin
cancer is more important than
ever. The risk of melanoma has
risen from one in 1500 in the
year 1935 to approximately one
in seventy. Melanoma is also the
most deadly form of skin cancer,
accounting for 75% of the deaths
(one death from melanoma occurs
each hour). While the most
dangerous, melanoma can also
have a 100% cure rate if
detected and surgically removed
at an early stage (i.e. melanoma
in situ). Some of the factors
that increase a person's risk
for developing melanoma are a
history of blistering sunburns,
personal or family history of
melanoma, more than 50 moles on
their body or certain dysplastic
(atypical) moles. Other risk
factors include fair skin and
light eye color. Melanoma may
occur in an existing mole or
with the appearance of a new
mole. Not only should patients
have a complete skin examination
by their dermatologist on a
regular basis, they should also
perform monthly
self-examinations. To do this,
they need to know their “ABCDs”...
Know your “ABCDs” Be
alert to irregularities in
shape, edges, color, and size.
A.
 Asymmetry
— moles that are not perfectly
round, one half does not equal
the other half in regard to size
and shape Most early
melanomas are asymmetrical: a
line through the middle would
not create matching halves.
Common moles are round and
symmetrical.
B.
 Border
— an irregular, jagged or
blurred border The
borders of early melanomas are
often uneven and may have
scalloped or notched edges.
Common moles have smoother, more
even borders
C.
 Color
— uneven or different colors in
a mole or any of the colors red,
white, blue or black Most
early melanomas are
asymmetrical: a line through the
middle would not create matching
halves. Common moles are round
and symmetrical.
D.
 Diameter
— moles larger than 5 or 6
millimeters, approximately the
size of a pencil eraserEarly
melanomas tend to grow larger
than common moles - generally to
at least the size of a pencil
eraser (about 6mm, or 1/4 inch,
in diameter
A pigmented lesion with one or
two or three of these
characteristics is not
necessarily a melanoma; however,
it would warrant evaluation by a
dermatologist. At the same time
melanomas may develop without
any of these characteristics. A
good rule of thumb is any mole
with any of the ABCDs or any
mole that has changed (i.e.
color, shape, size, itching, or
pain) should be evaluated by a
dermatologist. Another good rule
of thumb is that everyone should
have a complete skin examination
by a dermatologist at least
every three years between the
ages of 20 and 40 and every year
after age 40 (more often if you
have a personal or family
history of skin cancer or other
risk factors).
About Melanoma
Melanoma is the most serious
form of skin cancer. Even so, if
diagnosed and removed while it
is still thin and limited to the
outermost skin layer, it is
almost 100% curable. Once the
cancer advances and metastasizes
(spreads) to other parts of the
body, it is hard to treat and
can be deadly. During the past
10 years the number of cases of
melanoma has increased more
rapidly than that of any other
cancer. Over 51,000 new cases
are reported to the American
Cancer Society each year, and it
is probable that a great many
more occur and are not reported.
What is melanoma?
The answer to the question
asked by patients, their
families, and other concerned
people is that melanoma is the
most serious form of skin
cancer. To reach a more complete
understanding, it is necessary
to learn how the cells in the
body become malignant.
The Origin of Melanoma
Melanoma is a malignant tumor
that originates in
melanocytes, the cells which
produce the pigment melanin that
colors our skin, hair, and eyes
and is heavily concentrated in
most moles. The majority of
melanomas, therefore, are black
or brown. However, melanomas
occasionally stop producing
pigment. When that happens, the
melanomas may no longer be dark,
but are skin-colored, pink, red,
or purple.
Some Are More Dangerous
The physician will tell you
whether the melanoma is early or
advanced by describing it as
either in situ or
invasive. "In situ" is Latin and
means "in one site" or
"localized." Melanomas in
situ occupy only the
uppermost part of the epidermis,
the top layers of the skin.
Invasive melanomas are the
more serious, as they have
penetrated more deeply into the
skin and may have travelled from
the original tumor through the
body.
The Four Basic Types
Melanomas fall into four
basic categories. Three of them
begin in situ and
sometimes become invasive; the
fourth is invasive from the
start. It is helpful to
recognize the names and be able
to define the characteristics of
each type.
-
Superficial spreading
melanoma is by far the
most common type, accounting
for about 70 percent of all
cases. As you might expect,
this melanoma travels along
the top layer of the skin
for a fairly long time
before penetrating more
deeply.
The first sign is the
appearance of a flat or
slightly raised discolored
patch that has irregular
borders and is somewhat
geometrical in form. The
color varies, and you may
see areas of tan, brown,
black, red, blue, or white.
Sometimes an older mole will
change in these ways, or a
new one will arise. The
melanoma can be seen almost
anywhere on the body, but is
most likely to occur on the
trunk in men, the legs in
women, and the upper back in
both. Most melanomas found
in the young are of the
superficial spreading type.
-
Lentigo maligna is
similar to the superficial
spreading type, as it also
remains close to the skin
surface for quite a while,
and usually appears as a
flat or mildly elevated
mottled tan, brown, or dark
brown discoloration.
This type of in situ
melanoma is found most often
in the elderly, arising on
chronically sun-exposed,
damaged skin on the face,
ears, arms, and upper trunk.
Lentigo maligna is the most
common form of melanoma in
Hawaii.
Lentigo maligna
melanoma is the invasive
form.
-
The third type of melanoma,
acral lentiginous
melanoma, also spreads
superficially before
penetrating more deeply. It
is quite different from the
others, though, as it
usually appears as a black
or brown discoloration under
the nails or on the soles of
the feet or palms of the
hands. This type of melanoma
is sometimes found in
dark-skinned people.
It is the most common
melanoma in
African-Americans and
Asians, and the least common
among Caucasians.
-
Unlike the other three
types, nodular melanoma,
is usually invasive at the
time it is first diagnosed.
The malignancy is recognized
when it becomes a bump. The
color is most often black,
but occasionally is blue,
gray, white, brown, tan,
red, or skin tone.
The most
frequent locations are the
trunk, legs, and arms, mainly of
elderly people, as well as the
scalp in men. This is the most
aggressive of the melanomas, and
is found in 10 to 15 percent of
cases.
Informational Links
What You Need to
Know About Melanoma
- Patient's
booklet
(National Cancer Institute, USA)
This site contains information
about the disease, diagnosis,
staging, and treatment options
Johns Hopkins Oncology Center -
Melanoma and Cutaneous Oncology
Clinic
(Baltimore, Maryland,
USA) a NCI designated
Comprehensive Cancer Center
Malignant Melanoma -
Skin Cancer and Benign Tumor
Image Atlas (Loyola
University, Chicago, USA)
Melanoma
(The Skin Cancer Foundation,
USA) This section has
information about melanoma with
pages on diagnosis, treatment,
an early warning system with
melanoma pictures and tips on
coping
Melanoma and Skin Cancer
Research Institute / Melanoma
Foundation / Sydney Melanoma
Unit
(Australia) a detailed guide
with pictures and detailed
informaton about the different
types of skin cancer,
prevention, treatment, research,
events, news etc
Malignant Melanoma
(CancerHelp UK)
Information about the cancer,
diagnosis, treatment and living
with the disease
Melanoma
Research Foundation
(USA) A non-profit
patient's organisation founded
in 1996 supporting research and
raising public awareness. The
site includes information about
MRF, news, grants, publications,
mailing list, a message board,
and other resources
Melanoma.com
An educational Web site of the
Schering Corporation with
information about melanomas,
prevention, diagnosis, treatment
and promotion of interferon
therapies
MelanomaNet
This Web site is part of
an educational programme of the
American Academy of Dermatology.
It includes patient information
and a section for dermatologists
Recognizing Melanoma
An illustrated guide
Sunscreens and Melanoma
(Medical Science Bulletin,
Pharminfo)
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