Common Questions about Melanoma

At this time, metastatic melanoma is extremely difficult to cure. On the other hand, melanomas that are caught early have an excellent prognosis. Naturally, our best weapon in fighting melanoma focuses on public education and awareness, prevention, and identification.

What is melanoma?

  • Melanoma is the most dangerous type of skin cancer, accounting for the majority of all skin cancer related deaths despite being the rarest form of skin cancer.
  • Melanoma is a cancer of the melanocytes, cells that produce pigment. They will often present as mole-like growths. A mnemonic called the ABCDEs of melanoma can help identify it: Asymmetry, Borders, Color, Diameter, and Evolution.
  • Being a cancer, melanoma will multiply, spread, and become worse until treated.
  • Melanoma is a very aggressive cancer that can quickly become incurable and fatal if left untreated. Once this cancer spreads to internal organs, the prognosis becomes very bleak.
  • Fortunately, unlike other cancers that affect internal organs, melanoma is visible on the skin and will not be life-threatening until it can spread to other areas of the body. Early diagnosis and treatment will cure most cases of skin cancer.
  • Like other cancers, genetic factors play a large role in determining susceptibility to skin cancer. However, environmental factors also play a large role in influencing skin cancer.
  • Exposure to UV radiation from the sun is the primary cause of skin cancer. Tanning beds pose similar or even higher risks due to concentrated exposure of UV light. There is no such thing as a safe tan.
  • Lesser factors include smoking, HPV infections, and rare genetic syndromes

How dangerous is melanoma and why is it so deadly?

  • Melanoma is one of the most feared conditions among diseases that affect the skin. Few skin conditions have potentially life threatening consequences like melanoma. According to the World Health Organization, up to 48,000 people die due to melanoma.
  • Melanoma is a very aggressive cancer that has the ability to spread to distant organs very quickly. Where most skin cancers spread locally first and become noticeably larger, melanomas can spread horizontally deeper into the skin and into the bloodstream at an earlier stage when the visible symptoms may not be clear.
  • Melanoma can resemble other common and benign growths like moles or seborrheic keratosis which can delay the patient in seeking treatment.
  • If melanoma is identified and treated at an early stage, it has a cure rate of 95% or better. On the other hand, if melanoma advances and spreads to internal organs, prognosis is notoriously poor. Thus, early identification and treatment is absolutely critical.
  • Deaths by skin cancer can be significantly reduced by furthering public education about the disease so that people are more likely to identify and cure them before it becomes dangerous.

Isn´t melanoma genetic? Can we really prevent it?

  • Many elements of skin cancer risk are genetically determined. Patients with a family history of melanoma for example, are at higher risk of developing skin cancer themselves. Those with a family history of skin cancer are urged to be extra cautious of sun exposure.
  • Those with lighter skin tones are more vulnerable to skin cancers. Melanin which is plentiful in people with darker skin tones, help to protect the skin from UV light to a certain extent.
  • Although there are many genetic aspects that determine a person's statistical vulnerability to skin cancer, the direct cause of the cancer is often environmental like excessive exposure to UV light.
  • Sunscreen use on a regular basis can significantly reduce the chance of developing skin cancer. Other precautions like sun avoidance (within reason), wearing long sleeves, and wide-brimmed hats can reduce the risk further.
  • While we cannot control our genetic susceptibility, we have a lot of control over environmental factors that make skin cancer more or less likely to develop.
  • Regular use of sunscreen can significantly reduce the risk of developing all types of skin cancer later in life. It can also minimize the effects of skin aging such as wrinkles, brown spots, and leathery skin.
  • Melanoma has a cure rate of over 95% if caught early. Early identification and treatment is critical in improving prognosis.
  • Regular check at the dermatologist office or self-monitoring of skin can help identify possible signs of early skin cancer development.
  • Public education about the signs and symptoms of skin cancer can significantly help lower the risks of skin cancer.

Why is melanoma awareness such an important issue?

  • Each year, many patients die because of skin cancer. Many of these deaths are preventable with proper knowledge about skin cancer prevention and identification.
  • As most people do not visit their dermatologist on a regular basis, the patient or their partner is the most likely person to identify any skin irregularities that might indicate that they potentially have melanoma.
  • Few people have the expertise of a dermatologist in identifying skin cancer which is a problem as early identification and treatment is the most important factor in determining skin cancer prognosis.
  • The goal of skin cancer awareness is not to provide advanced and detailed knowledge about skin cancer. Even dermatologists will require a biopsy to be certain of a skin cancer diagnosis. The goal, rather, is to help patients identify with key features of skin cancer so that they are able to identify suspicious lesions that may be skin cancer so that they can visit a dermatologist if they find these.
  • Public awareness about skin cancer risks and sun exposure can help reduce the overall incidence of skin cancer.
  • ABCDE of melanoma is a useful mnemonic that can be used to help people identify possible signs of this dangerous skin cancer.

What are the ABCDEs of melanoma?

  • Asymmetry is a common feature in melanoma, and one which distinguishes it from moles. Moles (and many other benign growths) have symmetry-if an imaginary line were to be drawn through the middle of the mole, the left and the right side of the mole should mirror the other. Moles are very common but benign growth which can resemble melanoma in appearance. As most people have some moles, it is important to be able to differentiate between the two conditions.
  • Border is the second criteria in identifying melanoma. While moles have clear even borders that separate normal skin from the growth, melanoma often presents with irregular and uneven borders.
  • Color is also another distinguishing feature. Most moles have a single color, usually brown. Melanoma often first appears in shades of brown or black that blend in to each other without clear borders. Other colors such as red, white, and blue will often appear which signifies that the melanoma is advancing.
  • Diameter is a common measure of identifying melanoma. While common moles do in fact grow, they grow extremely slowly taking years or decades to grow. They also rarely grow larger than 6mm in diameter, or the size of a pencil eraser. It is important to note that melanoma can be diagnosed before it reaches this stage. The faster this disease is diagnosed, the better the prognosis.
  • Evolution refers to the quickly changing nature of melanoma. While benign growths like moles can and often do change over time, these changes are typically very slow taking years to decades, and for that reason often unnoticeable. Melanoma is a fast moving cancer, and will often make noticeable changes in width, height, color and other characteristics in a short amount of time.
  • The goal of the mnemonic is not to make the public become melanoma experts, but to help them get to a dermatologist as soon as possible if they find a suspicious growth.

I´ve heard of people who never sunbathe dying of melanoma. Isn´t sun prevention futile?

  • Melanoma, like many other diseases has some genetic components. There is variability in how susceptible we may be to certain diseases. Individuals with a family history of melanoma, for example, are at a higher risk of developing this cancer compared to the average person.
  • Sun exposure is the most significant environmental factor known to us in causing melanoma. This does not mean that all sun bathers will get melanoma or that people who don't sun bathe as often will never get melanoma. It is, however, a meaningful statistic.
  • Choosing not to exercise sun protection in the face of mounting evidence about the dangers of sun exposure is tantamount to arguing that smoking may not be bad because some smokers live until old age.
  • We also need to admit that we can't ever truly purport to understand every detail when it comes to disease causes; there will always be an element of chance.
  • Sun protection is definitely not futile. It is the most important environmental factor relating to all skin cancers including melanoma. Overexposure to the sun will also promote symptoms of premature aging such as wrinkling, mottled skin, and pigmentation problems.