Skin Checkup. ABCDEs of Melanoma
A self performed skin checkup is a significant step as part of our health routine. Throughout the year, every person should examine his own skin head-to-toe once a month, looking for any unusual sign or for changes in pre-existing conditions. Self-exams can help us identify potential skin cancers early when they can be successfully cured in most cases.
For a successful exam, the person needs to know the ABCDE of melanoma, a specific strategy for early recognition of the disease developed by dermatologists around the world.
Moles, brown spots and growths on the skin are usually inoffensive, but sometimes it is not like that. A person with more than a hundred moles on the body is at higher risk for melanoma. The first signs can appear in one or more atypical moles.
How can we examine the Moles?
First, we need to check our skin with a mirror and good lighting paying close attention to areas of the skin that are often exposed to the sun, such as the hands, arms, chest, and head, but not limiting our check only to those areas as melanoma can potentially develop in any region of the body where melanosomes, the organelles producing the skin pigment melanin, are present.
The following ABCDEs are concerning signs of moles that could be evolving into skin cancer. If we discover that a mole exhibits any of the symptoms listed below, have it checked immediately by a dermatologist or by your GP:
- A – Asymmetry. A benign mole, when you draw a line through the middle of it, will have two symmetrical halves. A malignant one will have two halves that don’t match, meaning it’s asymmetrical and possibly malignant.
- B – Border. The border of a benign mole is smooth and even. A malignant one is notched and uneven.
- C – Color. A benign mole is all one single color, usually a shade of brown. Malignant moles can be of different strange looking colors and often display several different colors or shades of color in the same mole.
- D – Diameter. A benign mole is usually <5mm in diameter. A malignant one is >5mm in diameter.
- E – Evolving. Common, benign moles stays the same over time. Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger and is a warning sign.
What is Melanoma?
Melanoma is the most dangerous form of skin cancer. It is the fifth most common cancer after the breast, lung, prostate, and colorectal cancer.
Melanoma is most often caused by exposure to ultraviolet (UV) rays. Overexposure to UV rays, from the sun, sun lamps, or tanning beds damages the DNA of genes that control skin-cell growth. These damaged genes generate mutations with a consequent fast multiplication of cells and formation of malignant tumors.
A melanoma often looks like a mole. It is usually black or brown, but it can also be skin-colored, purple, blue, red, pink, or white.
Causes of Skin Cancer and Melanoma
The causes may be related to:
- Family history – Several studies have probed that positive family history in 5% to 10% of patients; increase the risk of skin cancer.
- Personal characteristics. Persons with bright eyes, fair and red hair, pale complexion; skin reaction to sunlight, freckling; benign and dysplastic melanocytic nevi immunosuppressive states (transplantation patients, hematologic malignancies) can develop skin cancer with a high tendency
- Sun exposure over a lifetime – UV radiation exposure, both from the sun and from artificial sources such as tanning beds, is a proven and main cause of skin cancer. UV protection should be applied 365 days a year, no matter the time of the day or weather conditions.
- Atypical mole syndrome (formerly termed B-K mole syndrome, dysplastic nevus syndrome, familial atypical multiple mole melanoma)
When melanoma is caught early, as 4 out of 5 cases are, it is almost always curable. The five-year survival rate for melanoma that has not metastasized is over 98 percent. But when melanoma goes undiagnosed, it can spread to other parts of the body, becoming more challenging to treat, with a higher risk of becoming deadly.
Melanomas can develop in any part of the body with melanocytes. As a result, it can also develop in the eye. Mucosal melanoma, which is also rare, can occur in any mucous membrane, including nasal passages, the throat, vagina, anus, or mouth. It accounts for about 1 percent of all melanoma cases.
Keeping skin healthy requires taking some common-sense measures every day to avoid overexposure to UV radiation. Finding shade, especially during the peak UV hours of 10 a.m. to 4 p.m., is critical. Other ways to minimize UV exposure include covering up with clothing and a hat, using sunscreen (and reapplying it every two hours, or right away after swimming or heavy sweating), and avoiding tanning beds.
If we fail to prevent melanoma, we need to catch cancer early. An annual skin examination by a doctor with mapping of the existing moles as well as monthly self-exams can be a lifesaver.
Regular self-exams will help familiarize the person with all the moles, spots, and other growths on the body. Having this baseline knowledge will make it easier to detect any changes in color, size, shape, or other traits that may indicate cancer.
Treatment of Melanoma
Melanoma detected early can generally be treated with surgery. With the patient under local anesthesia, the doctor can cut (excise) the tumor out, along with an area of healthy tissue surrounding it.
If melanoma cells have spread to the lymph nodes or distant parts of the body, surgery alone is not enough. In addition to removing the tumor and lymph nodes with surgery, further treatments will be necessary, such as chemotherapy.
Immunotherapy, which stimulates the body’s immune system to destroy cancer cells, has emerged in recent years as a powerful, front-line treatment for metastatic melanoma.
Targeted cancer drugs are another treatment options. About half of all melanomas, for instance, have mutations in the BRAF gene. A medication called a BRAF inhibitor, like vemurafenib and dabrafenib, can prevent those cancer cells from growing, helping patients live longer.
- Jonathan B. Heistein; Utkarsh Acharya. Cancer, Melanoma, Malignant Mol Cell Pharmacol. Author manuscript; available in PMC 2015 Mar 2.
- Yuxin Liu and M. Saeed Sheikh Melanoma: Molecular Pathogenesis and Therapeutic Management. Mol Cell Pharmacol. 2014; 6(3): 228.Published online 2014.
- Kozovska Z, Gabrisova V, Kucerova L.Malignant melanoma: diagnosis, treatment and cancer stem cells. Neoplasma. 2016;63(4):510-7. doi: 10.4149/neo_2016_403.
- NIH study reveals how melanoma spreads https://www.genome.gov/27567794/2017-news-feature-nih-study-reveals-how-melanoma-spreads/