Integrative Medicine Blog

Melanoma: A Guide For Early Detection

Heidi S. Puc M.D., FACP, ABIHM Sunday, May 08, 2016
Istock skin cancer

Prevention and early detection is key for melanoma.

Did you know that skin cancer is the most common of all types of cancer? This is, in fact, true.

Skin cancer can be divided into two major groups, melanoma and nonmelanoma (primarily squamous cell and basal cell) cancers. Malignant melanoma, the deadliest form of skin cancer, is a tumor that arises from cells called melanocytes which are found in the skin in what is known as the basal layer of the epidermis. Malignant melanoma is the fifth leading cause of cancer in men (5%) and the sixth leading cause of cancer in women (4%). Lifetime chance for development of invasive melanoma increases with age, and whites have a higher (10-fold) incidence than that of non-whites.

  • Basal cell cancer is the most common type of skin cancer overall (75%) and arises from cells called basal cells which are found in the epidermis and also in hair follicles and sweat ducts
    • Basal cell skin cancers can have the following presentation: flat, firm, pale or yellow areas similar to a scar; itchy, raised, reddish patches; small pink or red translucent or shiny, pearly bumps which could have blue, brown, or black areas; pink growths with raised edges and a lower area in their center which may contain abnormal blood vessels; or open sores with oozing and crusting that either don’t heal, or heal for a while but then come back
  • Squamous cell cancer is the second most common type of skin cancer (20%) and arises from scaly cells found on the surface of skin
    • Squamous cell skin cancers can appear as rough or scaly red patches which might crust or bleed; raised growths or lumps with a lower central area; open sores that ooze or crust and don’t heal, or heal but return again; or wart-like growths

What is a major cause of skin cancer?

  • Ultraviolet (UV) light exposure and sunburns appear to be causative in all types of skin cancers, both melanoma and nonmelanoma skin cancers
    • Ultraviolet A radiation can lead to development of melanoma and squamous cell skin cancer by producing reactive oxygen species
    • Ultraviolet B radiation causes oxidative stress, DNA damage and impairment of repair, premature aging of the skin, and multiple effects on the immune system
  • Other risk factors for malignant melanoma include:
    • Personal or family history of melanoma
    • Weakened immune system or immunosuppressive therapy, and higher socioeconomic group. Immunosuppression also increases risk for squamous cell skin cancer.

Measures to minimize UV light exposure of skin can be protective for all types of skin cancer.

How can you make a difference? Early detection of both melanoma and nonmelanoma skin cancers is important to assure early treatment and prevention of debility, and, in particular with melanoma, possible death.

  • Self examination of your skin, with possible assistance of spouse or family members, should be done monthly, and can be an effective screening strategy to identify any new suspicious skin lesions, and this should be encouraged
  • The American Cancer Society screening guidelines recommend regular skin self-examination for all adults. Pamphlets for self-examination of the skin are available from the American Cancer Society, the American Academy of Dermatology, and the Skin Cancer Foundation
  • Clinical examination of the skin by a dermatologist should be done yearly for individuals at high risk for skin cancer (these could include those with a family or personal history of skin cancer and those with a high number of pigmented moles, or those with specific syndromes such as xeroderma pigmentosum or basal cell nevus syndrome)

Your self-skin exam is best done in a well-lit room in front of a full-length mirror. A hand-held mirror can be used to look at areas that are hard to see, such as the backs of the thighs. A family member can help by looking at the back and scalp. Getting familiar with location and size of existing moles is important. It is best to do these exams after a bath or shower, and, of course, to be thorough!

It is important that you recognize the difference between normal and suspicious moles.

  • A normal mole is usually an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised, and either round or oval. Moles are usually less than 6 millimeters (1/4 inch) in size, about the width of a pencil eraser. Moles can be present at birth, or arise during childhood or young adulthood; new moles that appear later in life should be checked by a health care provider
  • The most important warning sign for melanoma is a new mole on the skin or a mole that is changing in size, shape, or color
  • Another important sign is a mole that looks different from all the other moles on the skin. These too should be checked by a health care provider

The “ABCDE” screening guideline is helpful to guide detection of melanoma (you can see color images of normal and abnormal moles at www.skincancer.org; I highly recommend you take a look!) The guideline is as follows:

  • Asymmetry: one half of the mole does not match the other
  • Border: mole edges are irregular, ragged, notched, or blurred
  • Color: color is patchy and not the same all over, may include shades of brown, black, pink, white, blue
  • Diameter: mole is larger than 6 mm across (although sometimes melanomas are smaller than this)
  • Evolving: mole is changing in size, shape, or color over time

However, some melanomas do not “fit” the ABCDE guidelines and may present as: a sore that does not heal; spread of pigment from the border of a mole into the surrounding skin; redness or a new swelling beyond the border of a mole; itchiness or pain in a mole; or change in the surface of a mole (scaliness, bleeding or oozing of a mole).

Fortunately, imaging studies such as xrays and CT scans are not needed for early detection of skin cancer--just careful visual exam of the skin. So grab a mirror and start inspecting!

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