Melanoma

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Q.  What is melanoma?
A.  Melanoma, the most serious form of skin cancer, is characterized by the uncontrolled growth of pigment-producing cells. Melanomas may appear on the skin suddenly without warning, but also can develop on an existing mole. The overall incidence of melanoma continues to rise.  

Q.  Is melanoma a serious disease?
A.
  Melanoma is highly curable when detected early, but advanced melanoma spreads to the lymph nodes and internal organs and can result in death. On average, one American dies from melanoma every hour.1 

Q.  What causes melanoma?
A.  Excessive exposure to the ultraviolet radiation of the sun and indoor tanning devices is the most important preventable cause of all skin cancers, including melanoma. People who live close to the equator where the sunlight is more intense are more likely to develop melanoma than those in other regions. Exposure to tanning beds increases the risk of melanoma, especially in women aged 45 years or younger.2 Not all melanomas are exclusively sun related — other possible influences include genetic factors and immune system deficiencies.  

Q.  Who gets melanoma?
A.
 Melanoma can strike anyone. Caucasians are more likely to be diagnosed with melanoma than other races. However, even among Caucasians, certain individuals are at higher risk than others.1 For example:

  • You have a substantially increased risk of developing melanoma if you have greater than 50 moles, large moles or atypical (unusual) moles.
  • Your risk is increased if a blood relative (e.g., your parents, children, siblings, cousins, aunts, uncles) has had melanoma.
  • If you are a Caucasian with light skin, your risk is higher than a Caucasian with olive skin.
  • Redheads and blondes have a higher risk of developing melanoma. Blue or green eyes also increase your risk of developing melanoma.
  • Your chances increase significantly if you’ve already had a previous melanoma, but also increase if you have had either basal cell carcinoma or squamous cell carcinoma, the more common forms of skin cancer.3-6  
  • Your risk for melanoma may also be increased if you have had other previous cancers, such as breast or thyroid cancer.7-10
  • Your risk for melanoma increases if you have a history of sunburn.11
Q.  What are atypical moles?
A.
 Most people have moles (also known as nevi). Atypical moles are unusual moles that are generally larger than normal moles, variable in color, often have irregular borders and may occur in far greater number than regular moles. Atypical moles occur most often on the upper back, torso, lower legs, head and neck. It is important to recognize that atypical moles are not limited to any specific body area — they may occur anywhere. The presence of atypical moles is an important risk factor for melanoma developing in a mole or on apparently normal skin.

Q.  What does melanoma look like?
A.
 Recognition of changes in the skin is the best way to detect early melanoma. They most frequently appear on the upper back, torso, lower legs, head and neck.4,12 In females 15-29 years old, the torso/trunk is the most common location for developing melanoma, which may be due to high-risk tanning behaviors.4,12 If you have a changing mole, a new mole, or a mole that is different, make an appointment to see a board-certified dermatologist.

If you notice a mole on your skin, you should follow the simple ABCDE rule, which outlines the warning signs of melanoma: 
  • Asymmetry: One half does not match the other half. 
  • Border irregularity: The edges are ragged, notched or blurred. 
  • Color: The pigmentation is not uniform. Different shades of tan, brown or black are often present. Dashes of red, white, and blue can add to the mottled appearance.
  • Diameter: While melanomas are usually greater than 6mm in diameter when diagnosed, they can be smaller.  
  • Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color. 

The American Academy of Dermatology urges everyone to examine their skin regularly. This means looking over your entire body, including your back, your scalp, your palms, your soles and between your toes.

If you notice a mole different from others, or which changes, itches or bleeds even if it is smaller than 6mm, you should make an appointment to see a board-certified dermatologist as soon as possible.  

Q.  Can melanoma be cured?
A.
 When detected in its earliest stages, melanoma is highly curable. The average five-year survival rate for individuals whose melanoma is detected and treated before it spreads to the lymph nodes is 98 percent. Five-year survival rates for regional (lymph nodes) and distant (other organs/lymph nodes) stage melanomas are 62 percent and 15 percent, respectively.1    

Early detection is essential. Dermatologists recommend a regular self-examination of the skin to detect changes in its appearance. Additionally, patients with risk factors should have a complete skin examination by a board-certified dermatologist annually. Anyone with a changing, suspicious or unusual mole or blemish should be examined as soon as possible. Individuals with a history of melanoma should have a full-body exam at least annually and perform monthly self-exams for new and changing moles.13

Q.  Can melanoma be prevented?
A.
  Sun exposure is the most preventable risk factor for all skin cancers, including melanoma.1,14  You can have fun in the sun and reduce your risk of skin cancer. In 2010, new research found that daily sunscreen use cut the incidence of melanoma, the deadliest form of skin cancer, in half.15 Here’s how to prevent skin cancer: 
  • Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating.  
  • Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
  • Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 2 p.m.  If your shadow is shorter than you are, seek shade.
  • Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
  • Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling.  If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
Learn more about skin cancer:
Dermatology A to Z: Melanoma 
Skin cancer detection 
Skin cancer prevention 
Skin cancer fact sheet

1 American Cancer Society. Cancer Facts and Figures 2013.    http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013 
2 Ting W, Schultz K, Cac NN, Peterson M, Walling HW. Tanning bed exposure increases the risk of malignant melanoma. Int J Dermatol. 2007 Dec;46(12):1253-7.
3 Bower CP, Lear JT, Bygrave S, Etherington D, Harvey I, Archer CB. Basal cell carcinoma and risk of subsequent malignancies:  a cancer registry-based study in southwest England.  J Am Acad Dermatol 2000;42:988-91.
4 World Health Organization, Solar ultraviolet radiation:  Global burden of disease from solar ultraviolet radiation. Environmental Burden of Disease Series, N.13. 2006.
5 Hemminki K, Dong C. Subsequent cancers after in situ and invasive squamous cell carcinoma of the skin.  Arch Dermatol 2000;136:647-51.
6 Rosenberg CA, Greenland P, Khandekar J, Loar A, Ascensao J, Lopez AM. Association of nonmelanoma skin cancer with second malignancy. Cancer 2004;49:81-5.  
7 Grenader T, Goldberg A, Shavit L. Second cancers in patients with male breast cancer: a literature review. J Cancer Surviv. 2008;2(2):73-78. 
8 Satram-Hoang S, Ziogas A, Anton-Culver H. Risk of second primary cancer in men with breast cancer. Breast Cancer Res. 2007;9(1):R10.
9 Auvinen A, Curtis R, Ron E.  Risk of subsequent cancer following breast cancer in men. J Natl Cancer Inst. 2002;94(17):1330-1332.
10 Canchola A, Horn-Ross P, Purdie D. Risk of secondary primary malignancies in women with papillary thyroid cancer. Am J Epidemiol. 2006;163(6):521-527.
11 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005 Jan;41(1):45-60.
12 Cancer Epidemiology in Older Adolescents & Young Adults. SEER AYA Monograph Pages 53-57.2007. 
13 Berg, A. US Preventive Services Task Force. Screening for skin cancer. http://archive.ahrq.gov/clinic/ajpmsuppl/skcarr.htm 
14 Robinson, JK. Sun Exposure, Sun Protection and Vitamin D. JAMA 2005; 294:1541-43.  
15 Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up J Clin Oncol Jan 20, 2011:257-263; published online on December 6, 2010.









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