Melanoma is a malignancy of the pigment-producing cells of the body, the “melanocytes.” It’s ironic that the melanocytes– which normally produce a protective pigment called melanin –at times go awry and become harmful or “malignant” after exposure to ultraviolet light. This change can occur in the skin of people with all skin types, from the very fair albinos of the world to very darkly-pigmented Asian-American and African-Americans. So all of us need to be aware of the significance of melanoma.
I’ve been practicing Dermatology for 28 years, and I remember citing statistics showing about 2700 fatalities from melanoma per year in the 1980s. Our hope then was that earlier detection and better public awareness would bring down that terrible number of fatalities.
The unfortunate reality is that melanoma has actually been increasing in incidence for over 20 years, both within the United States and throughout the world. Dermatologists feel that the cause is increased exposure to Ultraviolet light both through more time in the sun and through tanning salons. The American Cancer Society Facts and Figures estimate is that about 178,000 people will be diagnosed with melanoma this year in the U.S., with about 9700 American fatalities. That’s unfortunately about one fatality every hour!
Furthermore, no one is immune to melanoma, which affects all races, though it is substantially harder to detect in an early, curable stage in people with skin of color. For this reason, it’s an especially good move for African-Americans and Latinos to keep their moles and skin lesions under close observation – with regular skin checkups. But fair-complected people are at higher risk of melanoma - so they need to be cafeful about their moles, too. Furthermore, half of all people developing melanoma are younger than 52 years old, so it does affect young people. In fact, about 2,000 people in the U.S. below the age of 20 will develop melanoma this year, with about 250 cases below the age of 12. That amounts to about 5 children below the age of 12 for the state of Tennessee, with its 6.3 million people.
The good news about melanoma is the following:
We know what causes it: ultraviolet light. Sun protection is a must
We know how to detect and diagnose it in an early, curable stage: regular self-examinations of moles and growths, and regular check-ups by Dermatologists. A mole is a collection of pigment-producing cells in the skin. About 30% of cases of melanoma arise in a preexisting normal mole, but the rest of melanoma cases come out of pigment-producing cells with no mole present. So it’s best to get one’s entire body checked, not just sun-exposed areas.
We know what it looks like. The rule of thumb is to watch for the following warning signs, which are somewhat like red flags that a lesion is high risk. The A,B,C,D,Es, as described by Dr. Al Kopf of New York University’s Department of Dermatology:
stands for Assymmetry: one half of the lesion does not match the other half.
stands for Border: a jagged border, perhaps like the coast of Maine, rather than of Florida.
stands for Color change: different hues of brown or black within the lesion, or one mole that’s a darker color than the person’s other moles.
stands for an increasing Diameter of the lesion
stands for Evolving: if the lesion is changing, it’s best to bring it to the attention of a Dermatologist.
Furthermore, we know what action to take for high risk moles or skin lesions: generally a removal of “excision” of the lesion under local anesthetic is curative. This removal can often be done in the office, out-patient, under a local anesthetic shot. If the lesion turns out to be a precancerous lesion – such as an atypical mole – or a full-fledged skin cancer, the dermatopathologist will evaluate the margins, to try to ensure that lesion is completely out.
The mole in the photo above would best be removed for biopsy - of evaluation by the lab - because it's dark - and has a jagged edge - and more than one shade of brown within it. It could be an early melanoma, or a common mole, so it should be sent off for biopsy evaluation.
The mole in the photo below would best be sent off for evaluation by the laboratory - because it's quite dark and has different shades of brown within itself.
The bottom line is that early detection saves lives. See spot. See spot change. See a Dermatologist!