Melanomas only account for only 4 % of all skin cancer. However, they comprise of 74% of skin cancer related deaths! They are more common the older you get and the more sun exposure you have. Even one or two blistering sunburns as a child or adolescent increase the risk several times. The skin remembers and accumulates sun damage over a life time. And there are no such things as a safe tanning booth. The sad truth is melanomas happen at any age. It is the second most common cancer in women in their thirties behind breast cancer. Melanomas are increasing in the United States. Much more common in fair skinned people, they are infrequent in people of color but seem to be more severe and aggressive when they do occur.
Melanomas originate from normal skin cells, melanocytes that are on the outer layer of skin. These cells provide the pigmentation to the skin. The cells can go through rapid growth in a disorganized fashion. This occurs most of the time in sun exposed areas but is possible any place on the body even where the sun doesn't shine. Nonetheless this is a potentially dangerous cancer that is visible by simple inspection of the skin surface. The best treatment is early detection and removal. It can be very curable. If ignored, most of these have dangerous potential to spread to other organs and can be fatal. This is a contrast with other skin cancers which are slow growing and don't spread to distant sites aggressively.
Early detection is best done by being a good observer for the characteristics of a malignant melanoma: "ABCDE" & "the ugly duckling"
Asymmetry: an uneven appearance. If you draw a line down the middle, one half does not resemble the other half.
Border: irregular, scalloped, uneven, poorly defined edge, almost smudged border that seems a bit indistinct.
Color: usually dark or pigmented. However a lot of variation in shades of brown, black, blue, or even red. Variation in dark colors within a single mole would be suspicious.
Diameter: Greater than the size of a pencil eraser (6mm) is suspicious, but they can start out smaller.
Evolving: "Change" is very important. Any mole that is growing or changing should be closely monitored or evaluated.
Ugly Duckling: This refers to the mole that is simply different than the others. If one mole is significantly different than others it's a greater risk of being a melanoma and should be evaluated.
Prevention is liberal use of sunscreen and avoiding excessive sun exposure. No lying out in the sun or a tanning booth to get tan. Get over yourself! Success of treatment is early detection and removal. It's curable if you pay attention, use some common sense and be a good observer
Physician with over thirty years experience in both family practice and emergency medicine in both rural and urban settings. Dr Kaler is also author of the medical mystery thriller Turnabout by Bruce Kaler. Visit my website at http://seattledoc.com
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