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Robert Tornambe, M.D.

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Malignant Melanoma: The Silent Killer

Posted: 04/24/2011 12:03 pm

Summer is just around the corner, and everyone is looking forward to vacation and lots of free time outdoors in the sun. That is why we must be aware of the most dangerous form of skin cancer: malignant melanoma.

Skin cancer is the most common of all types of cancer and melanoma accounts for just 5 percent of all skin cancers. However, melanoma is responsible for nearly all of the deaths from skin cancer. It is the most common form of cancer found in people 25 to 29 years old. According to the American Cancer Society, there were 68,000 new cases of melanoma reported and 8700 deaths in 2009. Experts expect to diagnose more than 100,000 new cases this year.

So what exactly is melanoma and who is more likely to get it? To understand this, here is a quick primer describing the anatomy of your skin, the body's largest organ. Melanocytes are cells found in the lower part of the outer layer of skin called the epidermis. These cells produce melanin, which gives skin it's color or pigment and increases production during exposure to the sun as a protective mechanism. Clusters of melanocytes may cause a mole, otherwise known as beauty mark, but the medical term is nevus. When something goes wrong within the cells of a pigmented nevus or mole, it is transformed into a cancerous melanoma. When left unchecked, it can spread to other parts of the body and cause death rather rapidly. Statistically, fewer people are getting other forms of cancer, yet more people are getting melanoma.

The primary culprit causing melanoma is UV light from the sun or tanning beds. Research shows indoor tanning increases a person's melanoma risk by 75 percent! Anyone can get melanoma, but there is a higher incidence in people with fair skin, sun-sensitive skin (tends to burn rather than tan) and a family history of the disease. Five or more sunburns during your lifetime double your risk of developing skin cancer. 80 percent of lifetime sun damage occurs during childhood. Sun protection is especially important in children because sunburns early in life can lead to skin cancer in adulthood. People who have had just one severe, blistering sunburn as a child or teenager has an increased risk for melanoma. Overall, the lifetime risk of acquiring melanoma is 1 out of 50 for Caucasians, 1 out of 200 for Latinos and 1 out of 1000 in African Americans.

Prevention is the key, but early detection and treatment can cure this deadly disease. Any suspicious lesion should be examined by a board certified dermatologist. "To determine if the lesion is suspicious; think about your ABC's," recommends Phillip Orbuch M.D., Clinical Associate Professor of Dermatology at NYU Medical Center.

A- Asymmetry; one portion of the lesion is different from the other.
B- Borders; the lesion will have raggedy or irregular borders.
C- Color; the lesion will have various colors within it, from red or tan to very black.
D- Diameter; a noted change in size of the lesion, i.e. it is getting bigger.
E- Evolving Change; change in color and shape of the lesion

Keys to early detection include careful inspection of your body for suspicious moles, checkup with a board certified dermatologist on a yearly basis and utilization of free skin cancer screenings available at work or other venues. To help prevent all forms of skin cancer, stop tanning and avoid tanning beds at all costs. On hot summer days, try to limit sun exposure when the sun is less intense, before 10 a.m. or after 4 p.m. Wear sunscreen daily, even on cloudy days! Wear sunglasses, because melanoma can even develop in the eyes. Prevention means complete sun protection if you have a higher risk factor for melanoma. I am talking about clothing that completely blocks sunlight, not just splashing on some sunblock. The advantages of using such clothing include that there is no need to reapply lotion and that they are waterproof and perspiration-proof.

Treatment of malignant melanoma requires excision of the malignant lesion with a healthy border of normal tissue to ensure complete removal. Sometimes local lymph nodes also need to be removed, as such nodes are utilized by the malignant cells to spread to other parts of the body. Early detection is so important because if the malignancy is excised in the early stages, meaning that it is still superficial and in the formative stage, the cure rate approaches 100 percent. Once the melanoma becomes thicker, the chance for cure and survival decrease rapidly. Often times the defect remaining after excision of the cancer is significant and reconstruction of that defect should be performed by a board certified plastic surgeon to minimize possible deformity.

I do understand that a deep bronze tan is quite appealing and attractive to some people. Unfortunately, acquiring malignant melanoma can be disfiguring and deadly. The choice may be that simple. Sometimes decisions are easier to make when put in such obvious, brutal terms. Sunblock anyone?

 
 
 

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