Most people have heard of malignant melanoma, because this type of skin cancer can be deadly. If not caught and treated before it gets advanced, the cancerous cells in melanoma can metastasize (spread to other organs), and cause death. The goal is to identify a melanoma in the early stages, when it can be more easily removed and prevent future metastasis. Deeper melanomas may warrant more extensive treatment, including lymph node examination, and we generally refer these patients to an oncologist or general or plastic surgeon. Although most melanomas occur in fair skinned individuals, they can affect patients of any skin type. Half of all melanomas occur in people under 57, including sometimes in children.
What makes a mole suspicious? This has been summarized as the “ABCDE” of melanoma.
• A = Asymmetry of outline
• B = Border irregularity
• C = Color irregularity
• D = Diameter greater than 6 mm (larger than a pencil eraser)
• E = Evolving (changing)
That is to say that most melanomas are fairly large and irregular in shape and color, while benign moles are generally small and symmetrically round or oval. A rapidly growing, itchy, bleeding or tender mole of any size should arouse suspicion but, conversely, most melanomas produce no symptoms. The average American has a one-in-50 lifetime risk of developing melanoma. Things that increase risk include:
• Two or more blistering sunburns before age 16
• Fair skin, freckles, blue eyes, and sensitivity to the sun
• Having more than 50 moles
• Having atypical moles
• Having a parent, brother, sister or child with a melanoma
• Having occasional intense sun exposure on weekends or on vacations
If you, a friend, or loved one has many moles or a spot that is irregular, a physician should be consulted. If the physician is even slightly suspicious, a biopsy can be done so the lesion can be examined under a microscope by a pathologist.
Even if you have no suspicious spots requiring a visit to the dermatologist, you should continue to examine your whole skin once a month using a hand mirror and a full-length wall mirror to better see your back. The sudden appearance of a fairly large, irregularly pigmented flat spot is the most common early sign of a melanoma and should alert you to make an appointment with your doctor. At the same time, as you look at your skin, perform a monthly breast exam if you are a woman or testicle exam if you are a man. This should take a total of five minutes a month or one hour a year---time well spent.