Signs and symptoms of melanoma
Melanoma is the most common cause of death from skin cancer. With early diagnosis, however, 85 percent of patients can be cured. The goal is to recgonize malanoma early when it’s potentially curable.
Melanoma begins in cells called melanocytes, which are pigment-producing cells. When melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma also may occur in the eye, a condition called ocular melanoma or intraocular melanoma. Rarely, melanoma may arise in the meninges, the digestive tract, lymph nodes or other areas where melanocytes are found.It can occur on any skin surface. In men, it is often found on the trunk or the head and neck. In women, the condition often develops on the lower legs as well as the upper back. The chance of developing melanoma increases with age, but it affects people of all ages and is one of the most common cancers in young adults.When melanoma spreads, cancer cells are found in the lymphatic system. If the cancer reaches the lymph nodes, cancer cells may have spread to other parts of the body such as the liver, lungs or brain. In these cases, cancer cells in the new tumor are still melanoma cells and the disease is called metastatic melanoma rather than liver, lung or brain cancer.Often, the first sign of melanoma is a change in the size, shape, color or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new, black, abnormal or “ugly-looking” mole. Rarely, melanoma is not pigmented and is more difficult to diagnose. It may appear as a non-healing ulcer or a new scar-like lump in the skin.The warning signs of melanoma sometimes are referred to as ABCDE:
- Asymmetry — Two halves of a lesion that are not the same
- Border — Borders of a lesion are irregular, scalloped or vague
- Color — Color varies from one area to another, including shades of tan or brown as well as black, blue, red and white
- Diameter — A lesion that is greater than 6 millimeters in diameter, about the size of a pencil eraser
- Evolution — Lesions that change or evolve
Melanoma diagnosis
If your doctor suspects that a spot on the skin is melanoma, you will need a biopsy, which is the only way to make a definite diagnosis. In this procedure, your doctor tries to remove all of the suspicious-looking growth. If the growth is too large to be removed entirely, your doctor may remove a sample of the tissue. A biopsy usually can be done in the doctor’s office using a local anesthetic. A pathologist then examines the tissue under a microscope to check for cancer cells.
Treatment for melanoma
- Surgery to remove melanoma is the standard initial treatment. It is necessary to remove not only the tumor but also some normal tissue around it to reduce the chance that any cancer remains. The width and depth of surrounding skin to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin. When the melanoma is very thin, enough tissue may be removed during the biopsy and no further surgery may be necessary. If the melanoma is not completely removed during the biopsy, your doctor will take out the remaining tumor. In most cases, additional surgery is performed to remove normal-looking tissue around the tumor, called the margin, to make sure all melanoma cells are removed. For thick melanomas, it may be necessary to take out a larger margin of tissue.Surgery generally isn’t effective in controlling melanoma that has spread to other parts of the body. In such cases, doctors may use other methods of treatment, such as chemotherapy, biological therapy or immunotherapy, radiation therapy or a combination of these methods.
- Chemotherapy is the use of drugs to kill cancer cells. It is generally a systemic therapy, meaning that it can affect cancer cells throughout the body. In chemotherapy, one or more anticancer drugs are given orally or by injection into a blood vessel. Either way, the drugs enter the bloodstream and travel through the body.Chemotherapy usually is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Usually a patient has chemotherapy as an outpatient — at the hospital, at the doctor’s office or at home. Depending on which drugs are given and your general health, a short hospital stay may be needed.
- Biological therapy, also called immunotherapy, is a form of treatment that uses the body’s immune system, either directly or indirectly, to fight cancer or to lessen side effects caused by some cancer treatments. Biological therapy also is a systemic therapy and involves the use of substances called biological response modifiers (BRMs). The body normally produces these substances in small amounts in response to infection and disease. Using modern laboratory techniques, scientists can produce BRMs in large amounts for use in cancer treatment. In some cases, biological therapy given after surgery can help prevent melanoma from recurring. For patients with metastatic melanoma or a high risk of recurrence, interferon-alfa and interleukin-2 may be recommended after surgery. Colony-stimulating factors and tumor vaccines are examples of other BRMs under study.
- In some cases, radiation therapy, also called radiotherapy, is used to relieve some of the symptoms caused by melanoma. Radiation therapy is the use of high-energy rays to kill cancer cells. Radiation therapy is a local therapy. It affects cells only in the treated area. Radiation therapy is most commonly used to help control melanoma that has spread to the brain or bones, and other parts of the body.
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The biopsy of a spot removed from Sen. John McCain’s right cheek was negative, indicating no presence of cancer, doctors at the Mayo Clinic said in a statement released by McCain’s presidential campaign Tuesday evening.
A spot had been noticed on his cheek during a routine exam Monday and a biopsy was ordered. McCain has battled skin cancer for years, undergoing surgery in 2000 to remove lymph nodes after a malignant growth was discovered on his temple.
Tuesday’s statement by Michael Yardley, Chair of Public Affairs at the Mayo Clinic, said that “no further treatment is necessary.”
McCain, who has suffered from skin cancer in the past, had a spot removed from his face during a routine checkup in Scottsdale, Arizona, on Monday and had it checked to ensure it was not cancerous.
The spot, visible on the Arizona senator’s face and not covered by a bandage, appeared to be about the size of a small coin.
McCain, who turns 72 in August, has had four malignant melanomas — a potentially lethal type of skin cancer — surgically removed since 1993. Three of them were limited to the top layers of the skin and were not invasive.
The fourth melanoma, removed from his left temple in 2000, was invasive. During that surgery, doctors also took out lymph nodes to see if the cancer had spread. The lymph nodes showed no evidence of cancer.
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The American Cancer Society estimates more than 11,000 Americans will die from skin cancer in 2008. That’s why everyone needs to use common sense when navigating a sunny climate.
Doctors say you can still enjoy the beach, but the days of baking in the sun should be banished.
“You don’t have to pack up and move to Alaska,” said Dr. Matt Leavitt, a board-certified dermatologist from Orlando. “But there are certainly things you can do to protect yourself. Just something as simple as staying out of the sun in the middle of the day and using sunscreen properly can help you avoid problems.”
Skin-cancer rates have leveled off in recent years after rising steadily from the 1980s through 2000. But skin cancer remains the most common malignancy in the world. The good news? It’s usually curable.
Most cases fall into two categories named for the type of skin cell that’s affected: basal cell and squamous cell carcinomas. These cancers tend to appear on sun-exposed skin, from the top of a balding head to the ears, face, arms and chest. Surgery is most often the preferred treatment. It’s most typically performed in a dermatologist’s office under only local anesthesia.
But don’t underestimate them. Basal and squamous cell cancers can be painful, recurring and disfiguring, depending on where they appear.
“Many people who get basal or squamous cell carcinoma will get more over the course of their lives,” said Dr. Gregory Pennock, an oncologist and skin cancer expert with M.D. Anderson Cancer Center Orlando. “It’s not uncommon, actually, that they will have many” additional lesions as time goes on.
Basal cell cancers rarely spread. Squamous are a little more likely to take flight and can become “really, super aggressive,” Leavitt said. People with a history of these cancers need regular skin exams at least every six months to a year. And, they should reduce their sun exposure for the rest of their lives.
Overall, melanoma is the most dangerous type of skin cancer because of its ability to spread. About 63,000 Americans will be diagnosed with the illness this year, according to the American Cancer Society, and an estimated 8,400 will die from it.
Melanoma can appear anywhere on the body, though it often shows up on sun-exposed areas. When found early, melanoma responds well to treatment. The cancer society says 99 percent of patients reach the five-year survival mark if the cancer is localized.
“We’re seeing more and more melanoma in Florida, but we’re diagnosing more cases early, and most patients end up being fine,” Pennock said.
Valerie Fredericks counts herself among the lucky. The Orlando resident noticed a strange black spot on the inside of her right thigh. She wasn’t concerned initially because it didn’t have any of the telltale signs of cancer — an irregular border, uneven color, etc.
“It was as if someone had taken a black marker and tapped me with it,” said Fredericks, 50.
A biopsy showed it was melanoma. Fortunately for Fredericks, the cancer had not spread. She underwent surgery in April.
“I think [sunbathing] is a lot like smoking; people know it’s not good for them, but they don’t think anything will happen to them,” she said.
So what can you do to protect yourself against skin cancer? Avoid the sun when it’s most intense during the middle of the day, and use a PABA-free sunscreen whenever outdoors. Also, know your spots. Check your skin for existing moles and inspect it regularly for changes. Get someone else to look at areas you can’t see easily.
Change is the key — as Fredericks discovered, not all cancers are textbook examples.
“Basically, I tell my patients to look for anything different,” said Dr. Andrew Jaffe, a Naples dermatologist. “If there’s a new spot or a spot you’ve had forever that suddenly changes, you need to see your dermatologist.”
Someone who has spent a lot of time in the sun may need an annual exam with a dermatologist starting in their 20s. Others may wait until their 30s or later. Talk to your doctor to develop a plan.
And here’s a special note about tanning beds from Leavitt. Don’t use them. Ever. He said some beds provide up to 15 times the amount of radiation you get from the sun itself. That means more skin damage and a greater risk for cancer.
“Even occasional use of tanning beds almost triples the risk of melanoma,” Leavitt said.
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A study in The Journal of the American Academy of Dermatology finds that patients seeking to have a potentially cancerous mole evaluated by a dermatologist are waiting longer than patients seeking Botox injections for the removal of wrinkles.
The researchers report that dermatologists in more than 10 cities offered a typical waiting time of 26 days for a patient requesting an evaluation of a changing mole, compared to only 8 days for a patient seeking Botox for wrinkles.
The lead author, Dr. Jack. S. Resneck, Jr., says, “We need to look further and figure out what is leading to shorter wait times for cosmetic patients.” This study did not examine the causes.
One explanation, as offered by the The New York Times, could be that the demand for medical dermatologists outstrips the supply. Several dermatologists in the article said that financial incentives plus obstacles in receiving payment from insurance companies could also be playing a role in varying wait times.
The study, in which a researcher posing as a patient called every board-certified dermatologist in the 12 cities, including Miami, Cleveland and Lansing, Mich., did not examine the possible causes for the varying times.
Dr. David M. Pariser, president-elect of the American Academy of Dermatology, said it seemed clear that cosmetic patients in the studied cities had faster access to dermatologists than did medical patients.
“It doesn’t make me proud to say it, but it is true,” Dr. Pariser, a dermatologist in Norfolk, Va., said.
Dr. Alexa B. Kimball, an associate professor of dermatology at the Harvard Medical School, said a simple explanation might be that the demand for medical dermatologists outstrips the supply.
At a time of increased awareness about skin diseases like melanoma and psoriasis, more people seek medical appointments with dermatologists, Dr. Kimball said. Meanwhile, a wider array of doctors like plastic surgeons and even some internists offer Botox shots, she said.
“The study shows that the Botox needs of the United States are being met,” said Dr. Kimball, who has conducted studies showing that dermatologists nationwide spent an average of three to four hours a week on cosmetic treatments. “If dermatologists stopped providing cosmetic care, it would not necessarily have an impact on medical dermatology patients.”
Other dermatologists said financial incentives to perform cosmetic treatments coupled with bureaucratic obstacles in obtaining insurance reimbursement for medical treatments might also have a role in the varying wait times.
Dr. Michael J. Franzblau, a dermatologist in San Francisco, said doctors typically charged $400 to $600 for a Botox antiwrinkle treatment, for which patients pay upfront because insurance does not cover it.
Meanwhile, doctors have to wait for health insurance to reimburse them for mole examinations, for which they receive an average of $50 to $75, Dr. Franzblau said.
Dr. Resneck, the lead author of the study, said dermatologists should better monitor how their patients are scheduled.
Read more at the New York Times.
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