Today is Melanoma Monday - May is Melanoma Awareness Month

by Jane Ashley

Spring is here, and all of us are ready for warmer weather and sunshine. But wait just a minute. While we need sunshine for Vitamin D production, too much sun is linked to melanoma and other skin cancers. Moderation and liberal use of sunscreen help protect us from skin damage by the sun.



What is melanoma?

Our skin is considered an organ of our body. It is the largest organ and serves several purposes:
• Protects against infection and injury
• Helps regulate our temperature
• Stores water and fat
• Produces Vitamin D

Skin is comprised of three layers — 1) the epidermis, the outer layer of skin, 2) the dermis, the inner layer of skin, and 3) the hypodermis, the layer of fat.

In the deepest part of the epidermis, we have cells called melanocytes. Melanocytes produce the pigments of our skin — the cells that give our skin its color. However, sometimes the melanocytes change and begin to grow out of control, producing a cancerous tumor in the form of a mole. Melanomas can occur anywhere on our bodies. They can appear under our fingernails, on the soles of our feet, on our scalp, and the genitals. We can develop melanoma in our eyes or our anus or vagina.

Just over 100,000 people (about 60,000 men and 40,000 women) in the U.S. are diagnosed with melanoma annually. It is the 5th most common cancer in men and the 6th most common cancer in women. It is 20 times more like to occur in white people than black people. Between 6,800 and 6,900 people succumb to advanced melanoma annually.

How can I tell if it’s melanoma?

Melanomas follow the ABCDE rule.

Irregular Edges

• Asymmetry. Half of the mole is different in shape than the other half.
• Border. The edge of the mole is irregular and/or ragged in appearance.
• Color. Melanomas may be brown, tan, black, blue, white, or faintly red.
• Diameter. The diameter is over 1/4 inch, about the size of a pencil eraser. It may have started smaller but has grown more rapidly than other moles.
• Evolving. The mole changes with time, in shape and/or color. It might become firmer. It might also bleed or ooze. However, melanoma rarely causes pain.

Doctors recommend that everyone perform regular self-exams to check to melanoma. Barbers and hairdressers are often the first to spot a melanoma on the scalp.

Be sure to schedule an appointment with a dermatologist if you have a suspicious-looking mole or a bleeding lesion that doesn’t heal within a couple of weeks.

How is melanoma diagnosed and staged?

A dermatologist diagnoses and treats most melanomas. The dermatologist removes the suspicious lesion and sends it to a pathologist. The pathologist determines if it is melanoma. If it is melanoma, the pathologist measures the thickness, determines if there is ulceration, calculates the rate that the cells are dividing (called the mitotic rate), looks for the presence of immune cells called tumor-infiltrating lymphocytes, and examines the margins.

Melanoma On Bottom Of Foot

The pathology report helps determine the treatment. Melanomas can contain several genetic mutations, including:

• BRAF. About half of all melanomas have this mutation.
• NRAS. This mutation is found in about 20% of melanomas.
• NF-1. This mutation accounts for 10-15% of patients.
• KIT. These mutations often occur in melanomas located on mucous membranes, the hands or feet, or on sun-damaged skin.

The thickness of the lesion can be thin (less than 1 mm), medium (1-4 mm), or thick (over 4 mm). Ulcerations and thick lesions are most likely to have spread. Patients may have an ultrasound, CT scans, a PET scan, or MRI exams to determine if the melanoma has spread to other parts of the body. Stage 0, I, and II are localized. Stage III melanomas have spread locally or to the lymphatic system. Stage IV melanomas have spread through the bloodstream to other parts of the body.

How is melanoma treated?

The most frequent treatment for melanoma is surgery. Surgery is used for local and regional melanomas. The majority of melanomas are less than 1 mm thick (the diameter of lead in a pencil) — the surgery for these types of melanomas is usually performed on an out-patient basis. A wide margin around the melanoma is removed.

During the surgery, dye, with a radioactive tracer, is injected into the area to determine if any cancer cells have spread to the lymph nodes. The surgeon usually removes one or more lymph nodes for biopsy.

If cancerous cells are found in the sentinel node, doctors may decide to remove the remaining lymph nodes in the area. This decision should be made between the patient and their oncologist.

Radiation therapy can be used if the melanoma has spread to the patient’s skin or lymph nodes and can’t be removed by surgery.
If the melanoma has spread, patients may be treated with immunotherapy, targeted therapy, or chemotherapy. Immunotherapy and targeted therapy have produced major progress in the treatment of Stage III and Stage IV melanoma in recent years.

The Jimmy Carter Story

President Jimmy Carter

You may remember that in August 2015, former President Jimmy Carter announced that his melanoma had recurred in his liver and his brain. He had a liver resection. Patients with brain metastasis face a discouraging prognosis. His physicians at Emory University in Atlanta decided to use a recently approved immunotherapy drug, Keytruda. Radiology oncologists blasted his brain tumor with radiation. His medical team followed up with Keytruda (pembrolizumab), an anti-PD-1 checkpoint drug.

After three months of therapy, there was no evidence of the brain tumor. It’s been almost five years since Jimmy Carter’s metastatic melanoma experience. He’s now 95 and hopes to celebrate his 96th birthday on October 1st of this year.

The Bottom Line …

Melanoma is not “just skin cancer.” Although melanoma only represents 1% of all skin cancers, melanoma can be life-threatening. Regular self-exams before your shower can help save your life. If you spot an oddly-shaped or colored mole, schedule an appointment with your dermatologist.

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