Montefiore Insider - Issue 5 - June 2017

Melanoma Awareness: Know Your Risks and Get Screened

Katia Papalezova, MD, Director, Melanoma Program and Co-Director, IL2 Program, Montefiore Einstein Center for Cancer Care, authored an article in U.S. News and World Report offering important information about melanoma risks and signs, as well as guidance for skin exams and melanoma screening opportunities.

The incidence of melanoma of the skin, the most commonly fatal form of skin cancer, is increasing faster than any other potentially preventable cancer in the U.S. It is the fifth leading cancer in men and the sixth in women.

Melanoma commonly starts as a mole and changes shape and color over time. It’s one of three types of skin cancer; the others are basal and squamous cell skin cancers. Melanoma comprises only four to five percent of all skin cancers but results in the majority of deaths from skin malignancies.

Melanomas can develop anywhere on the body. Most commonly, melanoma begins in the skin (cutaneous melanoma) and is often found on the trunk or the head and neck in men and on the arms and legs in women. It may also occur in areas of your body with little or no sun exposure, such as the spaces between your toes and on your palms, soles, scalp, genitals, eyes, mouth, digestive tract, and urinary tract, as well as under the nails.

The American Cancer Society estimates 87,110 new melanomas will be diagnosed in the U.S. in 2017, and about 9,730 people are expected to die of melanoma. If you know your risk factors and get regular screenings, early detection can help save your life.

Risk Factors

Melanoma is more than 20 times more common in Caucasians than African-Americans. And the risk increases as people age; average age of diagnosis is 63. But melanoma isn’t uncommon even among those younger than 30. In fact, it’s one of the most common cancers in young adults (especially young women). Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma, but keep in mind that it can occur in any ethnic group, as well as in areas of the body without substantial sun exposure.

Risk factors for melanoma include:

  • Positive family history of melanoma
  • Prior melanoma
  • Multiple atypical moles or dysplastic nevi (often these are large and raised, with poorly defined borders and uneven colors)
  • Light complexion or fair skin that freckles and burns easily
  • Sun exposure
  • Ultraviolet exposure from tanning beds, especially with use before the age of 35
  • History of many blistering sunburns as a child

Signs of Melanoma

Possible signs of melanoma include a change in the appearance of a mole or pigmented area. These are often called the ABCDEs of skin cancer detection. You should consult a doctor if any of the following occur:

  • Asymmetry. One half can look different than the other half.
  • Border. It can have a jagged or uneven edge.
  • Color. It can have different colors.
  • Diameter. It’s larger than the eraser on the end of a pencil.
  • Evolution. Its size, color, or shape can change over time.

Screening

Screening examination of the total skin surface can increase the likelihood of detecting melanoma six-fold compared with partial examination. If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help detect and diagnose melanoma:

  • Skin examination: A doctor checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
  • Biopsy: If your doctor is concerned about a particular mole, he or she will perform a biopsy (usually under local anesthetic) to remove all or part of the growth. A pathologist then will look at the tissue under a microscope to check for cancer cells.

Total body skin examination for melanoma requires a source of bright light and, ideally, a magnifying lens and a dermatoscope for trained health care providers. Total body skin examination should be part of a dermatologist consultation. A dermatologist can use a special handheld lens, called a dermoscopy (or dermatoscopy), to better view a pigmented area. This technique can improve melanoma detection.

Total body skin examinations can also be integrated into a routine physical examination by adequately trained primary care providers.

Guidance

The American Academy of Dermatology provides guidance for dermatologists to hold public skin cancer screening and education events. They also encourage everyone to perform skin self-exams to check for signs of skin cancer, and they recommend a skin exam from a clinician. Dermatologists can make individual recommendations as to how often a person needs these exams based on risk factors including skin type, history of sun exposure, and family history.

When it comes to melanoma and other forms of skin cancer, prevention and early detection can save your life. Use sunscreen daily, limit your exposure to UV rays, wear protective clothing, avoid tanning beds and lamps, and examine your skin regularly for any new skin growths or changes in existing skin lesions.