The most serious of all skin cancers is melanoma. Melanoma accounts for less than five percent of all skin cancer cases, but is responsible for the most skin cancer deaths.
According to the American Cancer Society, there will be more than 68,000 new cases of melanoma this year in the U.S.; 8,700 will die from the disease.
But there is some good news. People are more aware of the dangers of the sun than ever before and are more proactive in seeking help earlier.
Like other types of skin cancer, basal cell and squamous cell carcinomas, melanoma is almost always curable in its early stages.
Melanoma develops in melanocytes, cells that produce the dark protective pigment called melanin. Melanin produces sun-tanned skin, which acts as partial protection against the sun.
But when melanocytes grow unregulated or uncontrollably, they can become melanomas, which have a potential to spread, and therefore must be treated.
Melanomas may be associated with severe sunburns in childhood or adolescence. This is especially true among light-skinned people, although darker-skinned people can also develop it.
Heredity may play a role.
Atypical moles prevalent in families can serve as markers, and help identify those at higher risk for developing melanoma in a mole or other areas of the skin.
"A melanoma can often be as simple as a mole that is asymmetric, has multiple or changing colors, and irregular border or is growing," says Jerome Potozkin, MD, chair of dermatology at John Muir Health. "That is why you need to be aware of your body and have any unusual moles checked."
According to the American Cancer Society, spots on the skin that change in size, shape, or color should be seen by a board certified dermatologist right away. Any unusual sore, lump, blemish, marking, or change in the way an area of the skin looks or feels may be a sign of skin cancer.
"The earlier melanoma is detected, the better the survival rate," adds Dr. Potozkin.
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Surgery for melanoma includes removal of the melanoma lesion from the skin along a margin with of normal surrounding tissue. Some patients may require more extensive surgery to evaluate the lymph nodes and determine the stage of disease. This procedure is called sentinel lymph node biopsy and may be indicated based on the thickness of melanoma and certain pathologic features.
Melanomas with deep invasion or spread to the lymph nodes may require additional treatment such as adjuvant chemotherapy or more extensive surgery. However, the majority of patients with melanoma are cured after the initial surgical excision.
Adjuvant therapy refers to the use of chemotherapy, targeted therapy, immunotherapy or radiotherapy in addition to surgical resection in the treatment of cancer. The goal of adjuvant therapy is to improve the survival and control the cancer in patients with stage III and IV disease.
Malignant melanoma, squamous cell cancer, and basal cell cancer are skin cancers associated with ultraviolet (UV) radiation. Rates are much higher in places where there is a lot of sunshine year round. In our San Francisco Bay Area culture of swim team, soccer, golf, and tennis we have a very high rate of sun exposure and hence more skin cancers.
Skin cancers (skin neoplasms) are named after the type of skin cell from which they arise. Basal cell cancer originates from the lowest layer of the epidermis, and is the most common but least dangerous skin cancer. Squamous cell cancer originates from the middle layer, and is less common but more likely to spread and, if untreated, become fatal. Melanoma, which originates in the pigment-producing cells (melanocytes), is the least common, but most aggressive, most likely to spread and, if untreated, become fatal.
Avoid excessive sun exposure and use a sunscreen with an SPF of 30 or higher. Apply sunscreen 30 minutes before you plan to head outside and be sure to reapply every two hours or sooner if you are very active or swimming.
Stay out of the sun between 10 a.m. and 2 p.m. when the UV light is most intensive. And always wear a hat, protective clothing and sunglasses.
If you had excessive sunburns with blistering during your early years, precautions taken today may not make up for early skin damage. You must be especially alert to any significant skin changes.
Monthly self-examination can help you identify any new or developing lesion. It's important to thoroughly check all areas of the body. To do so, you need a full-length mirror, a hand mirror and good lighting.
If a lab test reveals an area of skin as cancerous, the dermatologist has an array of procedures to recommend. The techniques are chosen to meet the patient's needs.
Depending on the stage of the melanoma when diagnosed, surgery, chemotherapy, or biological therapy (immunotherapy) may be used. But as Dr. Potozkin notes, "If caught early, surgery is all that is needed in most cases of melanoma."
Surgery to remove the tumor and a margin of surrounding healthy tissue is the standard treatment for melanoma. If a large area is removed, a skin graft may be done at the same time, using skin from another part of your body.
A few lymph nodes near the tumor may be removed to see whether cancer has spread though the lymphatic system to other parts of the body. In advanced cases, radiation therapy is used to relieve some of the symptoms caused by melanoma.
"Treatment of melanoma continues to evolve as medicine advances, but today, the best plan remains prevention and early detection," notes Curtis Raskin, MD, dermatologist on staff at John Muir Health.
"The importance of protecting children from the sun's damage can't be overemphasized,” says Dr. Raskin. “Teach children to be sun-savvy and wear hats and sunblock when outdoors, even on hazy days."