Melanoma

The diagnosis of melanoma can be challenging and requires dermatology expertise. Approximately thirty percent of melanoma arise within previously stable pre-existing moles. The remaining seventy percent of melanoma cases arise on previously normal skin. In men, melanoma is most common on the trunk, especially on the back. In women, the lower legs are the most common site.

The ABCDE’s of melanoma detection can provide helpful clues:

• Asymmetrical Moles: Melanoma lesions are often irregularly shaped, with one half not matching the other half in size, shape, or color.
• Irregular Borders: The borders of melanoma lesions may be uneven, scalloped, or poorly defined.
• Changes in Color: Melanomas may have different colors or shades within the same lesion, including black, brown, tan, red, white, or blue.
• Large Diameter: Melanoma lesions are typically larger in diameter than a pencil eraser (greater than 5 millimeters), although they can be smaller.
• Evolving or Changing Moles: Any changes in the size, shape, color, or elevation of existing moles or the development of new moles should be monitored closely. The ugly duckling sign refers to the one mole that looks different from all the others on patient’s body and should be seen by a dermatologist.

Keep in mind, some lesions don’t follow the ABCDE’s of detection. A suspicious lesion should always be evaluated!

Melanoma, like many cancers, develops due to a combination of genetic and environmental factors. The primary cause of melanoma is thought to be prolonged exposure to UV radiation from the sun or artificial sources such as tanning beds. Overexposure to UV radiation damages the DNA in skin cells, including melanocytes, leading to mutations that can trigger the development of melanoma. A single episode of indoor tanning increases melanoma risk by up to 79%! Several other factors can contribute to the development of melanoma:

• Fair Skin: Individuals with fair skin, light-colored eyes, and blond or red hair are at a higher risk of developing melanoma because they have less melanin, which provides natural protection against UV radiation.
• History of Sunburns: Having a history of sunburns, particularly blistering burns during childhood or adolescence, increases the risk of melanoma later in life.
• Dysplastic Nevi: Having many moles (nevi) or atypical moles (dysplastic nevi) increases the risk of melanoma.
• Family History: A family history of melanoma or other types of skin cancer increases the risk of developing melanoma.
• Genetic Factors: Certain genetic mutations can predispose individuals to melanoma. Mutations in genes such as BRAF, CDKN2A, and MC1R have been associated with an increased risk of melanoma.
• Parkinson’s patients have a higher risk of developing melanoma, and people with melanoma have a higher risk of developing Parkinson’s.
• Previous Skin Cancer: Individuals with a history of melanoma or other types of skin cancer have an increased risk of developing future melanomas.

The diagnosis of melanoma is typically made through a combination of medical history, physical examination, and often a skin biopsy. Unlike other types of cancer, you can see skin cancers. This makes it easier to detect them early. Skin cancer screening exams and self-exams at home help detect skin cancer earlier. If you notice a new or suspicious spot on your skin, or develop a changing mole or dark spot, it is best to check in with a board-certified dermatologist and skin cancer expert like Dr. Thomas Knackstedt.

Here’s how the process generally unfolds (ideally the following paragraphs are separated by arrows):

Medical History

The team at Apex Skin Center will inquire about your medical history, including any previous skin conditions, sun exposure habits, family history of skin cancer, and any symptoms or changes in the skin.

↓

Physical Examination

Board-certified dermatologist Dr. Knackstedt will conduct a thorough examination of the skin, focusing on any suspicious lesions or growths. Dermoscopy, a tool that allows for the magnification of structures within a skin growth is used to aid in the diagnosis of melanoma and can help differentiate melanoma from benign, noncancerous moles and freckles.

↓

Skin Biopsy

If Dr. Knackstedt suspects melanoma based on the physical examination and dermoscopy findings, a skin biopsy may be performed. During a skin biopsy, a small sample of tissue is removed from the suspicious lesion under local anesthesia (numbing) and sent to a laboratory for analysis. The tissue is examined under a microscope to confirm the presence of melanoma and to assess the cancer’s characteristics.

↓

Once the diagnosis of melanoma is confirmed, further evaluation may be necessary to determine the extent of the cancer and plan appropriate treatment. As a fellowship trained, board-certified Mohs surgeon and dermatology oncologist (cancer specialist), Dr. Thomas Knackstedt and the team at Apex Skin Center have significant expertise in the management of all types of skin cancer. Dr. Knackstedt has authored over twenty papers on melanoma.