Melanoma

SIGNS AND SYMPTOMS

Melanoma, the most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin — the pigment that gives your skin its color. Melanoma can also form in your eyes and, rarely, in internal organs, such as your intestines. Melanoma can also occur rarely in non-pigmented lesions (i.e. non-colored lesions) referred to as amelanotic melanoma.

Melanomas can develop anywhere on your body. They most often develop in areas that have had exposure to the sun, such as your back, legs, arms and face. Melanomas can also occur in areas that don’t receive much sun exposure, such as the soles of your feet, palms of your hands and fingernail beds. These hidden melanomas are more common in people with darker skin.

The first melanoma signs and symptoms often are:

• A change in an existing mole
• The development of a new pigmented or unusual-looking growth on your skin

Melanoma doesn’t always begin as a mole. It can also occur on otherwise normal-appearing skin.

NORMAL MOLES

Normal moles are generally uniform in color, such as tan, brown or black, and have a distinct border separating the mole from your surrounding skin. They’re oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter — the size of a pencil eraser.

Most people have between 10 and 45 moles. Many of these develop by age 40, although moles may change in appearance over time — some may even disappear with age.

UNUSUAL MOLES THAT MAY INDICATE MELANOMA

To help you identify characteristics of unusual moles that may indicate melanomas or other skin cancers, think of the letters A-B-C-D-E:

• A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves.
• B is for irregular border. Look for moles with irregular, notched or scalloped borders — characteristics of melanomas.
• C is for changes in color. Look for growths that have many colors or an uneven distribution of color.
• D is for diameter. Look for new growth in amole larger than 1/4 inch (about 6 millimeters).
• E is for evolving. Look for changes over time, such as a mole that grows in size or that changes color or shape. Moles may also evolve to develop new signs and symptoms, such as new itchiness or bleeding.

Other suspicious changes in a mole may include:

• Scaliness
• Itching
• Spreading of pigment from the mole into the surrounding skin
• Oozing or bleeding

Cancerous (malignant) moles vary greatly in appearance. Some may show all of the changes listed above, while others may have only one or two unusual characteristics.

HIDDEN MELANOMAS

Melanomas can also develop in areas of your body that have little or no exposure to the sun, such as the spaces between your toes and on your palms, soles, scalp or genitals. These are sometimes referred to as hidden melanomas, because they occur in places most people wouldn’t think to check. When melanoma occurs in people with darker skin, it’s more likely to occur in a hidden area.

Hidden melanomas include:

• Melanoma under a nail. Subungual melanoma is a rare form that occurs under a nail and can affect the hands or the feet. It’s more common in blacks and in other people with darker skin pigment. The first indication of a subungual melanoma is usually a brown or black discoloration that’s often mistaken for a bruise.
• Melanoma in the mouth, digestive tract, urinary tract or vagina. Mucosal melanoma develops in the mucous membrane that lines the nose, mouth, esophagus, anus, urinary tract and vagina. Mucosal melanomas are especially difficult to detect because they can easily be mistaken for other, far more common conditions.
• Melanoma in the eye. Eye melanoma, also called ocular melanoma, occurs in the uvea — the layer beneath the white of the eye (sclera). An eye melanoma may cause vision changes and may be diagnosed during an eye exam.

WHO GETS IT AND CAUSES

The exact cause of all melanomas isn’t clear, but exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds increases your risk of developing melanoma. Limiting your exposure to UV radiation can help reduce your risk of melanoma.

The risk of melanoma seems to be increasing in people under 40, especially women. Knowing the warning signs of skin cancer can help ensure that cancerous changes are detected and treated before the cancer has spread. Melanoma can be treated successfully if it is detected early.

DIAGNOSIS, TREATMENT AND OUTCOME

Sometimes cancer can be detected simply by looking at your skin, but the only way to accurately diagnose melanoma is with a biopsy. In this procedure, all or part of the suspicious mole or growth is removed, and a pathologist analyzes the sample. Biopsy procedures used to diagnose melanoma include:

• Punch biopsy. During a punch biopsy, your doctor uses a tool with a circular blade. The blade is pressed into the skin around a suspicious mole and a round piece of skin is removed.
• Excisional biopsy. In this procedure, the entire mole or growth is removed along with a small border of normal-appearing skin.
• Incisional biopsy. With an incisional biopsy, only the most irregular part of a mole or growth is taken for laboratory analysis.

The type of skin biopsy procedure you undergo will depend on your situation.

MELANOMA STAGES

If you receive a diagnosis of melanoma, the next step is to determine the extent (stage) of the cancer. To assign a stage to your melanoma, Dr. Feinstein will:

• Determine the thickness. The thickness of a melanoma is determined by carefully examining the melanoma under a microscope and measuring it with a special tool (micrometer). The thickness of a melanoma helps Dr. Feinstein decide on a treatment plan. In general, the thicker the tumor, the more serious the disease.
• See if the melanoma has spread. To determine whether your melanoma has spread to nearby lymph nodes, your surgeon may use a procedure known as a sentinel node biopsy. During a sentinel node biopsy, a dye is injected in the area where your melanoma was removed. The dye flows to the nearby lymph nodes. The first lymph nodes to take up the dye are removed and tested for cancer cells. If these first lymph nodes (sentinel lymph nodes) are cancer-free, there’s a good chance that the melanoma has not spread beyond the area where it was first discovered. Cancer can still recur or spread, even if the sentinel lymph nodes are free of cancer.

Other factors may go into determining the aggressiveness of a melanoma, including whether the skin over the area has formed an open sore and how many dividing cancer cells are found when looking under a microscope.

Melanoma is staged using millimeter depths as a prognostic indicator. A stage I melanoma is small and has a very successful treatment rate. But the higher the number, the lower the chances of a full recovery. There are 5 stages in this system called Breslow’s Depth Indicator, ranging from stage I being less than or equal to 0.75mm to Stage V being greater than 3.0 mm with three other stages in between.

TIPS FOR MANAGING

Even if you have carefully practiced sun safety all summer, it’s important to continue being vigilant about your skin in fall, winter, and beyond. Throughout the year, you should examine your skin head-to-toe once a month, looking for any suspicious lesions. Self-exams can help you identify potential skin cancers early, when they can almost always be completely cured.

When your health and results matter, contact Feinstein Dermatology & Cosmetic Surgery.
Call our Delray Beach office at (561) 498-4407 and schedule an appointment today.