It seems like every month is dedicated to awareness for some particular illness these days. Often, a month is dedicated to more than one disease, since there are many more diseases than there are months. May is the official month for melanoma awareness. Unlike many of the other diseases focused on in these monthly awareness campaigns, melanoma can be prevented if detected early enough.
What is melanoma?
Malignant melanoma is the most severe form of skin cancer.
While it is not the most common, it is the most likely to metastasize and result in death. If not detected early enough, the prognosis is bleak. “The median life expectancy in patients with advanced melanoma is less than one year.” If detected early enough, it can be removed and treated before it can cause damage in other parts of the body.
Though it can sometimes present in areas of the body that are not easily detectable, like “the eye, digestive tract, brain or spinal cord, or other areas where melanocytes (pigment forming cells) are found”, it is most often seen on the skin where it can be detected and treated early if proper screening and self exams are done.
Screening for melanoma
Melanoma can develop at the site of existing moles and can resemble moles, but this is not always the case. Though people with moles have a substantially higher risk of developing melanoma, the moles themselves are not the actual cause.
It is very important to have an annual full body skin check done by a dermatologist or other healthcare provider who specializes in skin cancer or diseases of the skin. A doctor will know exactly what to look for, and can check in areas that you cannot always access to check yourself. The doctor will document any existing benign moles or freckles at baseline, so any changes can be tracked at subsequent exams, and give you the necessary information on what to look for in self exams.
After the full body check is done by the doctor, it is then important to do your own self exams at home. Have someone you trust help you check areas that you cannot easily see. Don’t forget to check places like the scalp, between the fingers and toes, soles of the feet, and other easily missed areas.
When performing regular self exams for melanoma, it is very helpful to use the ABCDE checklist to help differentiate normal, benign moles or freckles from possible skin cancer lesions. According to Melanoma Research Foundation, the ABCDE checklist stands for Asymmetry, Border, Color, Diameter, and Evolution. I have seen the E also listed as Elevation, so I now refer to the checklist as ABCDEE:
- Asymmetry: regular moles and freckles are typically round and symmetrical. Malignant melanomas are irregularly shaped and asymmetrical.
- Border: Benign moles and freckles have borders that are smooth and well defined. Malignant lesions have borders that can appear and feel jagged, scalloped, or vague/blurry.
- Color: Noncancerous moles and freckles are most often a single shade of tan or brown. If you have a dark spot that has more than one color, or a variegation of colors such as blue, black, white, red or dark brown, it should definitely be checked out by a dermatologist.
- Diameter: Healthy moles and freckles should be no larger than a pencil eraser (6mm). Anything larger is suspicious and should be checked.
- Elevation: Many benign moles are raised, but the surface is always smooth. Any spots on your skin that have uneven or bumpy surfaces are red flags.
- Evolution: You should always be aware of the normal state of the moles and freckles on your body. Benign moles and freckles typically stay the same for long periods of time. Changes in any of the above criteria, in addition to any scaliness, oozing, flaking, change in consistency, etc. must be checked by a dermatologist or other appropriate healthcare professional.
If something is suspicious…
If either the doctor’s comprehensive skin check or your own self exam finds a lesion that has any one or combination of the above criteria, the lesion must be tested for cancer. The method of testing depends on the characteristics of the lesion in question. For some, needle aspiration is a sufficient method. Some may just need to be razored off, and then sent to a lab; while others may need to be biopsied in other ways such as “punching”, excision, or incision, which all cause scarring.
A new, non-invasive type of test for melanoma is currently underway. According to Jeffrey Benabio, MD, FAAD “melanomas have DNA (messager-RNA to be exact) that differentiate them from normal moles, so testing the mole for melanoma requires only a tiny sample of skin.” This new test would obtain this tiny sample by sticking a piece of special tape on it, and then removing it with the adequate amount of DNA samples attached to it. No needles, no pain, no potential for scarring, no anxiety.
How else can I prevent melanoma and other skin cancers?
Although environmental factors and heredity can cause melanoma, “the greatest contributor (approximately 65 percent) is exposure to ultraviolet (UV) rays from natural or artificial sources, such as sunlight and indoor tanning beds.” Many people have been under the erroneous assumption that tanning beds do not cause skin cancer, but that could not be further from the truth. Multiple recent studies from all around the world have found conclusive evidence that the use of indoor tanning beds leads to melanoma. It is imperative that people who use tanning beds stop, and that people who don’t use them never start.
Although very limited sun exposure is necessary for getting Vitamin D, it is recommended that protective measures be taken for the majority of the time when exposed to the sun. Protective clothing should be worn when weather permits, and a sunblock should be used, and reapplied as necessary at all other times. Many people forget to protect the scalp from the sun’s harmful rays, which often results in sunburns that are both painful and also increase skin cancer risk. It is a good idea to wear a hat or other type of head protection. Many people also forget to apply sunblock to the sensitive skin on the tops of the feet, which also results in burns and sun poisoning, leading to an increased skin cancer risk.
There are many sunscreens and sunblocks on the market that boast ridiculously high SPFs. These are not the best options. High SPFs do not equal more protection; they just equal more potentially harmful chemical ingredients. The best thing to do is to choose a mineral, or physical sunblock with an SPF no lower than 15 and no higher than 30. Zinc oxide is best active sunblock ingredient because it offers broad spectrum protection. It should be reapplied every two hours during sun exposure, and immediately after swimming or excessive perspiration.
So this May, take the time to learn all you can about melanoma, schedule your annual full body skin check, do your self exams, and encourage others to do the same. Prevention and early detection come from education, which of course stems from spreading awareness. Instead of sitting back and waiting for science to find a cure for melanoma and other skin cancers, let’s be proactive and focus on getting educated and being conscientious about screening for melanoma, and taking the appropriate measures to prevent it.