Melanoma

Malignant melanoma is cancer of melanocytes, the cells give the skin its color. Its incidence is rapidly increasing. Intermittent sun exposure greatly increases the risk of melanoma. Melanoma is the fifth most common type of cancer in men and the sixth most common type in women. Early detection greatly reduces the risk of both illness and death. Prognosis depends on disease stage.

Key melanoma skin cancer statistics from the American Cancer Society

• Melanoma accounts for about 1% of all skin cancer but causes a large majority of deaths from skin cancer.
• Melanoma is 20 times more common in whites than in blacks.
• Melanoma is more common in men over age 65.
• Melanoma is more common in women under age 50.
• Melanoma is NOT uncommon in people younger than 30.
• Risk increases with age.
• The average age at diagnosis is 65.

Who is at risk for melanoma?

The risk of melanoma correlates with genetic and personal characteristics including:

• Excessive exposure to UV radiation from the sun and tanning beds is the most important risk factor for melanoma. UV rays damage the DNA in skin cells. Though, melanoma can also occur on skin that has not been exposed or has only been exposed intermittently to the sun.
• Fair skinned individuals with red or blonde hair, light eye color, and low tanning ability
• The strongest risk factor associated with melanoma is fair skinned individuals with a large number of atypical moles
• A history of blistering sunburns especially at a young age is associated with development of malignant melanoma.
• A family history of melanoma. 10% of individuals diagnosed with melanoma have a family history of melanoma. If an individual has a first-degree relative with melanoma the risk increases to 50%.
• A weakened immune system.

What are the symptoms?

Melanomas can appear anywhere on the body and commonly appear on the back, legs, arms and face, but can also develop on the palms of the hands and soles of the feet, under a finger or toe nail,  in the eye, in the mouth, or on the genitals.

How is melanoma diagnosed?

Dr. Michael Sotiriou will listen to your concerns, review your medical history and conduct a thorough physical examination. . He has extensive training in the use of dermoscopy to assess suspicious lesions. Biopsy is the definitive diagnostic tool for melanoma.

The ABCDE’s of melanoma

1. Asymmetric Shape. Normal moles are round or oval, with smooth edges and are smaller than ¼ inch in size.  A suspicious mole has an irregular shape.
2. B Melanomas can have a notched or irregular border.
3. C Melanomas have a mix of two or more colors or shades of brown and black and may include pink, red and blue colorations.
4. D Melanomas can be larger than most moles. A mole that is larger than a pencil eraser (6mm) can suggest melanoma.
5. E A mole that changes shape, color, and size is more likely to be a melanoma. This is the most concerning sign of a suspicious mole that could be melanoma.
6. Other symptoms:
   • a sore that won’t heal
   • redness or swelling beyond the borders of the lesion
   • swollen lymph gland near the suspicious mole
   • a change in the surface of the lesion including scaliness, bleeding, oozing, crusting
   • changes in sensation including pain, itching, tenderness

When the lesion is identified as a melanoma, the biopsy will stage of the cancer from stage zero (the earliest stage) to stage four. Early-stage melanoma means the cancer is only locally cancerous. Stages I-II have a favorable diagnosis the cancer has not spread beyond the original location.  Stages III- IV have a poorer  prognosis.

What are the treatment options?

Treatment options depend on the stage of the melanoma. The mainstay of treatment for most melanomas is surgical excision. Depending on the location, size, and staging of a melanoma, a lymph node evaluation may be necessary. For very advanced melanomas, chemotherapy and immunotherapies can be an option. For patients diagnosed with stage I cutaneous melanoma the treatment is surgical excision and assessment of the lymph nodes.

Due to the aggressive nature of melanomas, early detection and surgical management is needed. Given Utah’s elevation, leading to more intense sun exposure, and Utahn’s love of the outdoors, we have a proportionately higher rate of melanoma compared to the rest of the country.

Contact Dr. Michael Sotiriou at Salt Lake Dermatology & Aesthetics immediately if you notice a changing mole. Schedule a total body skin exam today.