The M Word: Everything You Need to Know About Melanoma
Melanoma rates in the US have doubled from 1982 to 2011. Melanoma is the most serious type of skin cancer.
What You ABSOLUTELY Need to Know:
Even one blistering sunburn during childhood or adolescence can nearly double a person's chance of developing melanoma.
Experiencing five or more blistering sunburns between ages 15 and 20 increases one’s melanoma risk by 80% and nonmelanoma skin cancer risk by 68%
Daily sunscreen use cut the incidence of melanoma, the deadliest form of skin cancer, in half.
Researchers estimate that indoor tanning may cause upwards of 400,000 cases of skin cancer in the U.S. each year.
Having 5 or more blistering sunburns between ages 15 and 20 increases your risk of getting melanoma by 80%
Using tanning beds before age 35 increases your risk of melanoma by 59% and the risk increases with EACH use.
What is Melanoma?
Melanoma can affect any skin color or ethnicity, and if allowed to grown, can spread to other parts of your body. However, if found early, melanoma is highly treatable.
Melanocytes are the cells that make the color (melanin) to protect the skin from UV radiation. Non-cancerous growths of these melanocytes are called moles (nevi). When melanocytes grow unregulated, they are called melanoma.
The most important factor in survival is the depth of melanoma.
The skin is made of two layers: the epidermis (which is about 3 saran-wrap layers thick) and the dermis (pink/white stuff you see after a bad burn or fall).
If the melanoma is in the epidermis (the top layer), it is called a melanoma in situ
If the melanoma has spread into the dermis (the deep layer), it is called an invasive melanoma
If the melanoma has spread to other parts of your body, including the lymph nodes (these are centers throughout the body where the immune cells cluster), it is called metastatic melanoma
Melanoma is thought to be caused by both with UV exposure, as well as genetics. Each case is different so it is important to talk to your dermatologist who may do additional screening.
Can I Get Melanoma?
Melanoma can happen in ANY skin color or ethnic background. In 2012, it was the third most common cancer in males and females. There are some risk factors associated with developing melanoma
Increasing age (>50% occur after age 65) though there is an increasing incidence of melanoma being detected in young adults
Prior history of melanoma
Prior history of other skin cancer
Having many moles (>50 moles or having large moles)
Having a history of >5 abnormal moles (known as “dysplastic nevi”)
Strong family history of melanoma. Melanomas can be associated with certain gene defects that run in family. These families may have breast cancer (BRAF mutation), thyroid cancer, or pancreatic cancer.
History of sunburns
History of sun exposure (can be intermittent or lifelong accumulated): Did you know that pilots and cabin crew have approximately twice the incidence of melanoma compared with the general population?
History of tanning bed use
What Does a Melanoma Look Like?
Melanomas can happen anywhere on the body (can happen in the skin, under the nails, in the eyes, in the gut, in the genital area etc). The most common site of melanoma in men is the back and in women is the leg.
I like the ABCDE’s of melanoma. If you see any of these signs, talk to your dermatologist
A: Asymmetry (anything that looks uneven, lopsided)
B: Border (uneven, scalloped, or notched border)
C: Color (having more than one color)
D: Diameter (anything more than the diameter of a pencil eraser or ¼ inch)
E: Evolution (anything that is change, including but not limited, shape, color, starts bleeding, itching or is tender. Anything that is changing should be evaluated by a dermatologist)
What Do I Do If I Am Concerned:
Your dermatologist will be able to evaluate the lesion further. Using both clinical expertise and visual cues, your dermatologist can talk to you about the nature of the lesion you are concerned about. Many dermatologist use special hand held microscopes called dermatoscopes to further classify lesions into if they are malignant (dangerous).
If your dermatologist is concerned, your dermatologist may perform a biopsy. The skin biopsy will be sent to a pathologist (a doctor that is trained on looking at human tissue) for diagnosis. The pathologist will be able to characterize the type of melanoma, how deep the lesion is, how fast the cells are growing (“mitotic index”) and how aggressive the lesion is (has it invaded into blood vessels or nerves).
If you are diagnosed with a melanoma, additional surgery with a safety margin will likely be needed (the safety margin can range from 0.5 cm to 2 cm on each side of the lesion). Depending on the depth of the lesion, your surgeon may recommend sentinel lymph node biopsy (sampling of a nearby collection of tissue where immune cells live).
For metastatic disease, there are many, many, many therapeutic options. The traditional therapy consists of chemotherapy until a few years ago. However, the last five years, the use of immunotherapy (using the body’s immune system to fight disease) has changed the field of melanoma and the survival of my patients. These are being used for not only melanoma but other cancers as well.
Some immunotherapy options include:
Interleukin-2, interferon alfa 2b
BRAF inhibitors: dabrafenib and vemurafenib
MEK inhibitors: trametinib
C-KIT inhibitors: imatinib, nilotinib
CTLA-4 antagonist: ipilimumab PD-1 blocking antibodies: nivolumab, pembrolizumab *** This is what my residency research at MD Anderson was on! ***
A discussion with your medical team, including your dermatologist, surgeon, and oncologist will help you understand your disease, prognosis, and treatment options.
Follow up after your diagnosis of melanoma is especially important. 5-10% of melanoma patients will develop a second invasive melanoma. 20% of melanoma patients will develop a melanoma-in-situ. During the follow up, your dermatologist will perform screening questions and check your skin for any suspicious lesions.
Dermatology Pearls (Tips)
If you see something, say something. Learn the warning signs of melanoma. If you are concerned about a skin lesion, talk to your dermatologist
The earlier you catch your skin cancer, the easier it is to treat. Another reason you should talk to your dermatologist about your skin concerns
Melanoma can affect any skin color and ethnicity
STOP tanning bed use.
Wear your sunscreen. Protect yourself from UV radiation. Seek shade when appropriate (especially between 10 am and 2 pm)
Ask for help! The Melanoma Foundation (see link below) has resources for financial assistance, travel assistance, lodging assistance, and support organization
THIS IS THE MOST IMPORTANT: Don’t be afraid to talk to your dermatologist if you want more information or need explanation if anything is unclear. YOU are part of the team. Ask questions. Bring a family member if you are too stressed to listen well or take notes.
Happy Reading!
Dr. Z
Further Blog Reading
Resources
Works Cited
Photography ABCDE: https://www.aad.org/public/diseases/skin-cancer/melanoma
CDC. Sunburn and sun protective behaviors among adults aged 18–29 years—United States, 2000–2010. MMWR Morb Mortal Wkly Rep 2012;61:317–22.
Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014;70:847–57.
Dennis, Leslie K. et al. “Sunburns and Risk of Cutaneous Melanoma, Does Age Matter: A Comprehensive MetaAnalysis.” Annals of epidemiology 18.8 (2008): 614–627.
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.
Jemal A, Saraiya M, Patel P, et al. Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992–2006. J Am Acad Dermatol 2011;65:S17.
Sanlorenzo M, Wehner MR, et al. The risk of melanoma in airline pilots and cabin crew: a meta-analysis. JAMA Dermatol. 2015 Jan;151(1):51-8. doi: 10.1001/jamadermatol.2014.1077. Review.
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.
Wehner M, Chren M-M, Nameth D, et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150(4):390-400. Doi: 10.1001/jamadermatol.2013.6896.
Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909.
Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev; 2014. 23(6); 1080-1089.
Remember, this blog just provides general information and is not intended and should not be construed as medical advice. If the you or any other person has a medical concern, he or she should consult with an appropriately licensed physician or other health care worker. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog or in any linked materials. Full Disclaimer.
