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Skin Cancers

Home > Skin Cancers > Melanoma

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.

  1. 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.

  2. 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.

  3. 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.
  4. 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
An educational Web site of the Schering Corporation with information about melanomas, prevention, diagnosis, treatment and promotion of interferon therapies
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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Know your ABCDs

A=Asymmetry - moles that are not perfectly round

B=Border - irregularly shaped border

C=Color - different color mole

D=Diameter - moles larger than a pencil eraser

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Robert J Weiss, MD PC
The Skin Wizard