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Melanoma

Melanoma derives its name from the pigment cells in the skin called melanocytes. Melanoma is a malignant skin cancer that typically presents as a spot with irregular borders and colors of tan, blue, black, red or white. It usually starts small and changes over a time. Approximately 95% of melanomas originate from pre-existing moles.

Melanoma is one of the most serious types of skin cancer. In the United States, an estimated 62,000 new cases of melanoma will be diagnosed during the year 2006. An estimated 7,910 people will die from this disease in 2006. Melanoma accounts for nearly 80% of all skin cancer deaths. Approximately 1 in 75 Americans have a lifetime risk of developing melanoma. (Statistics provided by the American Academy of Dermatology.)





Melanoma

Family history and environmental exposure to ultraviolet light are two of the most important risk factors. It appears that the predisposition for melanoma can pass from one generation to another. Moles from birth or atypical-appearing moles also have a higher risk of melanoma. Melanoma usually occurs after puberty; however, it can arise at any age.

Fair skin individuals have an increased risk of skin cancer and melanoma, especially if the excess sun exposure occurred before the age of 18. Periodic short intense exposures with sunburn or blistering increases the risk of melanoma significantly.

Most melanomas present with irregular growth of pigmented areas. The mnemonic ABCDE has been established to identify concerning characteristics of skin pigmentation.

  1. Asymmetry
  2. Border irregularity
  3. Color variation (shades of gray, blue, black, red and white)
  4. Diameter greater than 6 mm (the size of a pencil eraser)
  5. Elevation or growth of a mole

Let's examine some photographs of melanomas that demonstrate the 5 worrisome features listed above. It is important to realize that not all 5 features need to be present for you to have a melanoma. Typically the more features that are present, the greater the likelihood of a melanoma.

Asymmetry

Most benign moles are symmetric circles or ovals. By this we mean that if you split them in half the two halves are more or less mirror images of the other half. By contrast, a melanoma has more of a geographic pattern with asymmetric halves.





Melanomas displaying asymmetric borders

Border Irregularity

Most benign moles and growths tend to have relatively smooth and sharp borders. Melanomas by contrast tend to have borders that are rough, erratic, scalloped, and irregular.





Melanomas displaying irregular, scalloped borders

Color Variation

Melanomas can often show striking variations in different hues of brown, black, and gray. Parts of the melanoma may be pink, red, or even white in color.





Melanomas displaying color variation





Melanomas displaying color variation

Although we typically think of melanomas as being darker in color, there are rare instance in which melanomas can lack the pigment melanin and appear flesh colored. This sub-type of melanoma is called amelanotic melanoma.





Amelanotic Melanomas displaying absence of brown-black pigmentation

Diameter

Although many benign moles and other lesions may be well over 6 mm in diameter (size of a pencil eraser) and some melanomas may be smaller than 6 mm, this does serve as a general rule to make us pay more attention to those moles that are larger, in particular if they happen to be changing in size, color, or elevation.





Melanomas displaying larger diameters

Elevation

Many normal moles will elevate over time. They typically do so at a slow and gradual rate. Any rapid change in elevation of a mole should be alarming in particular if other suspicious features are present. Elevations in thickness will often be subtle and not as obvious to detect as in the last set of photos below.





Melanomas displaying early stages of elevation and increased thickness





Melanomas displaying later stages of elevation and increased thickness





Melanoma displaying advanced stages of elevation and increased thickness

As you can tell by looking at these photos, melanomas can have a number of different appearances. If a pigmented area changes or shows irregular characteristics, it should be immediately examined by your physician and a biopsy (sampling) of the growth should be obtained.

Types of Melanoma

Superficial Spreading Melanoma

This is the most common of all melanomas. It is a flat, asymmetrical, irregularly pigmented area that usually grows more superficially and less vertically.





Superficial Spreading Melanoma has a flat appearance

Nodular Melanoma

This type of melanoma occurs when vertical (invasive) growth is present. This is seen as a changing pigmented area with various colors. The surface appears "lumpy" and irregular.





Nodular Melanoma has a raised appearance

Lentigo Maligna Melanoma

This is typically seen on sun-exposed areas in the elderly. The skin has a mottled, irregular pigmentation with blurry borders. This type of melanoma is slow growing and is easily mistaken for a benign sunspot.





Lentigo Maligna Melanoma is flat with indistinct borders

Diagnosis

Self-examination by the patient allows for early detection and diagnosis of melanoma. The sooner a melanoma is found, the better the likelihood successful treatment. The definitive way to diagnose a melanoma is by a biopsy (sampling of the suspicious mole).

A biopsy for a suspected melanomas is typically performed by primary care physicians, dermatologists, and plastic surgeons. Because knowing the thickness and depth of a melanoma is very important, the biopsy technique typically performed for a suspected melanoma (punch biopsy) is different than the one performed for basal cell carcinoma and squamous cell carcinoma (shave biopsy). During a punch biopsy, after numbing the skin, a small sharp circular cylinder is used to get a "core" sample of skin. A small stitch is often used to close the hole.





Punch biopsy technique for diagnosis of melanoma

Treatment

Surgery is the standard of care for melanoma treatment. If the melanoma is not too deep, the chance of cure is excellent. Usually, a punch biopsy is performed to confirm the diagnosis and to assess the depth and thickness of the melanoma. A subsequent wider surgical removal is then done to eradicate the melanoma. If indicated, lymph node biopsies are done at the time of the wide excision to help detect further spread. Other forms of concurrent treatment involve chemotherapy, interferon, experimental vaccines or possibly radiation therapy.

Remember, the best treatment and the highest chance for cure is early detection and prevention. Patients at high risk should be examined annually by their dermatologist.

What should i do if i think i have a melanoma?

The first and most important step is to perform a biopsy (sampling of the suspected growth) and have a pathologist confirm the diagnosis. This is a simple and quick procedure that is typically performed by the primary care provider, the dermatologist, or the plastic surgeon.

If you have a biopsy-proven melanoma on your face and would like to have Dr. Naficy assist you in removal of the melanoma and reconstruction of your face, you may contact us through our website. A member of our nursing staff will contact you at a convenient time and perform a telephone interview.


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