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Melanoma



Alternative Name

Skin cancer - melanoma

Overview

Melanoma may represent only approximately 4% of all skin cancers, but is responsible for more than 73% of skin cancer-related deaths.  It is the most common cancer among 25-29 year olds and its incidence has risen, particularly among certain subgroups of our patients with skin of color, as in our Hispanic population.  Melanomas are usually found on chronic sun exposed areas, but it is important to know that they can occur anywhere, particularly on the hands and feet of our patients with skin of color.  Early detection is very important as those with earlier melanoma do much better than those with advanced melanoma.

There are different types of melanoma. These are some types to consider:

Superficial spreading melanoma is found most commonly on the trunk in men, and on the legs in women.

Nodular melanoma is most common on the legs and trunk.  This subtype can grow rapidly and is responsible for most of the thick melanomas.

Lentigo maligna melanoma is found most commonly on the head, neck and arms on chronically sun damaged skin and can grow slowly for many years.

Acral lentiginous melanoma can be found on the palms, soles and nails and is more common in our African Americans, Hispanic and Asian persons.

Amelanotic melanomas are an unusual variant that is often not pigmented and often manifests as an ulcerated nodule. As these are not pigmented, these can be difficult to identify.


Review Date: 5/12/2011

Reviewed By: Sandra Osswald, MD



Risk Factors

There are many factors that may increase your risk. These are some factors to consider:

Sun exposure is a very important risk factor.  Chronic sun exposure, history of sunburns and indoor tanning may increase your risk of skin cancer.

Having fair skin and light hair/eyes such as blond or red hair and blue or green eyes may increase your risk.

Melanoma in a first degree relative

Personal history of a melanoma

Changing mole

Large numbers of common nevi (>100)

Clinical atypical/dysplastic nevi (>5-100)

Family history of atypical mole/melanoma syndrome

Prior non melanoma skin cancer; basal cell carcinoma and squamous cell carcinoma

Male sex

Age older than 50 years

Signs/Symptoms

Fortunately, the skin is part of our body that we can examine every day. Melanomas can occur on sun exposed areas, but depending on type, may be found anywhere on the body, arms and legs.  In people with skin of color, one should pay particular attention to the hands, feet and nails.  Although melanomas can arise from a pre-existing mole, many are new pigmented lesions.  So, one should pay attention to a mole that changes in size, shape or color, as well as new, changing moles.  A common tool to use is the ABCDE's that may help you detect melanoma early.

Illustration of the anatomy of the biliary system
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A= Asymmetry.  Is the lesion asymmetric with one side different than the other?
B= Border.  Is the border of the lesion very irregular?
C= Color.  Are there different colors of brown within the lesion, or areas that are blue, red or even white?
D= Diameter.  Is the lesion growing bigger, say greater than 6mm or much greater than the size of a pencil eraser? This does not mean it is melanoma, but should be looked at carefully.
E= Evolution.  Have you noticed the lesion to be changing or growing larger?

If you discover any worrisome findings, consider getting a professional full skin examination.

Illustration of the anatomy of the biliary system
Click Image to Enlarge
Illustration of the anatomy of the biliary system
Click Image to Enlarge
Illustration of the anatomy of the biliary system
Click Image to Enlarge
Diagnosis

Diagnosis begins with a skin examination. A specialized lighted device, called a dermatoscope, is sometimes used to examine certain lesions carefully. If there are any suspicious lesions noted on examination, your doctor may ask if you would agree to a skin biopsy. This procedure involves removing the lesion or a sample of the lesion of concern so that it may be sent for pathologic evaluation. Pathologic evaluation can determine if the lesion is a skin cancer and if so, what type of skin cancer it is. Biopsies can usually be performed as an outpatient office procedure under local anesthesia. When the pathology is reviewed, you are then notified of the results and if any further testing or treatment is recommended.

Treatment

Treatment for melanoma will depend on the size, location and pathologic features, such as depth of the melanoma.  Smaller, early melanomas may be treated by your Dermatologist, while certain melanomas on the face may require Mohs surgery.  Our Mohs surgeon is specially trained to use special immunohistochemical stains for melanoma during the Mohs procedure   If multidisciplinary care is recommended, we will often coordinate efforts among our many available subspecialties.  Specialties that we often coordinate with include our colleagues in Surgical Oncology, Medical Oncology, ENT, Ophthalmology, Plastic Surgery, Nuclear medicine and Radiation therapy.

Treatment options will be discussed with you.  Treatment options may include:
Surgery
Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor using the following operations:

  • Local excision: Taking out the melanoma and some of the normal tissue around it. The margin of tissue will depend on the type and extent of the melanoma.  Usually, this tissue is sent for pathologic evaluation.
  • Mohs surgery.  This procedure is used for skin cancers that need to be removed from areas such as the face or digits, where there is not a lot of normal tissue to spare.  This procedure allows skin cancer to be removed without taking an excessive amount of surrounding normal tissue.  Mohs surgery is particulary useful in the Lentigo maligna melanoma subtype on the face where special immunohistochemical markers can be used to mark the tumor for removal.
  • Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.
  • Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymphatic ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
  • Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

Chemotherapy

Chemotherapy may be recommended in advanced cases to help ensure as much of the tumor is destroyed as possible.

Radiation therapy

Radiation therapy may be used for certain types of melanoma.

Prevention

There are many ways you can help prevent melanoma.

Seek the shade, especially between 10am and 4pm

Cover up your skin with dark, tight woven clothing over your arms and legs; wear large brimmed hats and sunglasses

Wear sunscreen everyday that provides broad spectrum coverage, both UVA and UVB, and is at least SPF 30

Don't use tanning beds and don't burn

Examine your skin from head to toe every month and see your doctor every year for a professional skin examination

Dermatology

If you would like to request an appointment with a physician, or if there is a direct referral from a physician, please call:

Appointments: (210) 450-9840

Fax: (210) 450-6092