What is it?
Melanoma is a type of cancer that begins in the skin. It is completely curable when detected early but can be fatal if allowed to progress and spread. Cancer is a condition where one type of cell grows without limit in a disorganized fashion, disrupting and replacing normal tissues and their functions, much like weeds overgrowing a garden. Melanoma is a cancer of the pigment-producing cells in the skin, known as melanocytes. Normal melanocytes reside in the outer layer of the skin and produce the brown pigment melanin, which is responsible for the color of our skin. Melanoma is a state in which melanocytes become cancerous, grow, and invade other tissues.

What causes it?
We are not certain how all cases of melanoma develop; however, it is clear that excessive sun exposure, especially severe, blistering sunburns during childhood, can promote melanoma development. There is also evidence that ultraviolet radiation used in indoor tanning equipment may also cause melanoma.

Who gets it?
Anyone can get melanoma, but fair-skinned, sun-sensitive people are at greater risk. Ultraviolet radiation from the sun is a major culprit, and people who tan poorly or burn easily are at the greatest risk. While too much sun is a bad idea throughout life, sunburns in children and teenagers seem to be the most damaging.

In addition to sunburns early in life, people with many moles are at greater risk of developing melanoma. Everyone has moles, usually around 30, and most are without significance. However, people with more than 50 moles are at an increased risk. In addition to the number of moles, some moles are unusual and irregular looking. These moles are known as dysplastic or atypical moles. People with atypical moles are at increased risk of developing melanoma.

Melanoma does run in families. If a person has a first-degree relative, such as a mother, father, brother, sister or child, who has had a melanoma, then that person has an increased risk of developing melanoma.

All of these features - fair-skinned, sun-sensitive, a history of sunburns, many moles, atypical moles, first-degree relative who has had melanoma -- allow us to identify those at risk for developing melanoma. Anyone, even those with none of the risk factors, can develop melanoma, but people with one or more of the risk factors are more likely to do so. If you have some of these risk factors, then periodic, routine skin examinations by your dermatologist and periodic self exams can truly be life saving.

What should I look for?
Almost always, melanoma begins on the surface of the skin, where it is easily treated. However, if given time to grow, it can eventually grow down into the skin, ultimately reaching the blood and lymphatic vessels and then spreading around the body, causing a life-threatening illness. Therefore, the goal is to detect melanoma early, when it is still on the surface of the skin. Melanoma can occur anywhere on the skin, even in places not directly exposed to sun. However, it is most common on the trunk of men and the legs of women. Melanoma is usually brown or black in color; but sometimes, though rare, it may be red, skin colored, or white. Melanoma may also arise from a pre-existing mole or appear on previously normal-appearing skin. Melanomas slowly get larger; therefore, growing, changing, or irregular lesions should arouse suspicion.

When looking at a spot on the skin, it is helpful to apply the ABCDE (see below) rules to decide if it is suspicious.

What treatment is available?
The best treatment is early detection. A quick look from the trained eye of a dermatologist can confirm whether or not a lesion is suspicious for melanoma. At Miramar Dermatology/Skin and Cancer Associates, a procedure called dermoscopy is utilized to evaluate questionable pigmented growths. This allows the dermatologist to evaluate the pigment pattern of the visibly questionable growth to determine if a biopsy is needed. Dermoscopy has proven very effective and has helped decrease the number of normal biopsies that are performed.

If a growth is determined to be suspicious by the dermatologist, the next step is to perform a biopsy. The area is made numb, and a portion of the lesion or the entire lesion is removed for examination under the microscope. This simple, quick procedure is performed in the office. If a melanoma is detected, treatment is guided by how deep in the skin the melanoma is.

Treatment for melanoma begins with the dermatologic surgical removal of the melanoma and some normal-appearing skin around the growth. Removal of the normal appearing skin is known as taking margins and is done to be sure that no melanoma is left behind. A person's outcome depends on how deep the melanoma is in the skin. Early melanoma limited to the outermost layer of the skin (the epidermis) is known as melanoma in situ (in place), and simple surgical removal produces virtually a 100% cure rate. However, if left untreated, the melanoma grows deeper in the skin. The deeper it goes, the more likely it is to reach a blood vessel or lymphatic channel. If it enters these vessels, it can spread away from the skin, producing a life-threatening situation. When a biopsy is performed and melanoma is detected, the depth of invasion into the skin will be measured and reported by a dermatopathologist. This will guide treatment.

Deeper melanomas are more likely to spread. If a melanoma does spread, it typically spreads first to the lymph nodes. The lymph nodes are part of the lymphatic system, a series of vessels throughout the body much like blood vessels that are responsible for cleaning the body's tissues. These lymph vessels drain to local lymph nodes, located at a variety of spots around the body. Different lymph nodes serve different parts of the body. If a melanoma has spread, it may be possible to find it at the lymph node before it goes any further. A procedure called a sentinel lymph node biopsy is a way of identifying and testing the first lymph node that drains the area at which the melanoma was located. The decision on whether to perform a sentinel lymph node biopsy is based on how deep the melanoma is in the skin and, in turn, how likely it is to have spread.

What can I do to protect myself?
Excessive exposure to ultraviolet (UV) radiation increases your chance of getting melanoma. Childhood and adolescent exposure seem to be the most damaging, so protecting young people is very important. Common sense dictates protection. Be "sun smart"! Avoid sun exposure from 10:00 a.m. through 4:00 p.m., when the sun is the strongest, whenever possible. Wear a broad-spectrum sunscreen (SPF 30) all the time on sun-exposed areas. The sun block should block both types of ultraviolet light (UVA and UVB), and you should reapply it frequently. Wear a hat and clothing with a tight weave that will block ultraviolet light. Remember, a white cotton T-shirt blocks only 50% of the sun's rays. Avoid indoor tanning machines. Keep in mind that UVA and UVB radiation is present even on cloudy and rainy days. Put a sun block on exposed skin every day!

Early detection remains the best treatment. Therefore, perform a monthly self-exam, looking for irregular lesions that are growing and changing, and use the ABCDE rules. If you have an atypical mole, see a dermatologist immediately. Finally, see a dermatologist at least once a year for a complete skin exam.

The ABCDEs of Melanoma

Asymmetry - One half of a mole or spot is different than the other. Draw an imaginary line through the middle of the lesion, either up and down or side to side. Are the two sides the same size and shape (symmetric)? Melanomas are usually asymmetric.

Border irregularity - The edge, or border, of melanomas are usually ragged, notched, or blurred.

Color - Benign moles can be any color, but a single benign mole will be only one color throughout. Melanoma often has a variety of hues and colors within the same lesion. Be alert for a mole that changes color.

Diameter - Melanomas continue to grow, while moles remain small. Is the lesion larger than a pencil eraser (6 mm)? If so, have it evaluated by a board-certified dermatologist.

Evolution - Any mole that changes or that you become more aware of should arouse suspicion. This could be a burning, an itching, or simply an increased awareness of one mole in particular. That mole is said to be evolving and should be evaluated promptly.