Diagnosis isn’t the End,
it’s the Beginning
Melanoma is the most serious type of skin cancer. It can metastasize or spread quickly to other parts of the body. This can be deadly, but, when found early, melanoma is highly treatable.
You can find melanoma early by following this 3-step process:
- Learn the warning signs of melanoma.
- Look for the warning signs while examining your skin.
- See a dermatologist if you find any of the warning signs.
Melanoma can appear on your body in different ways. Visit a dermatologist if you see any of the following features in a preexisting mole or in a new spot or patch on your skin. These warning signs are known as the ABCDEs of melanoma:
- Asymmetrical shape
- Uneven and irregular borders
- The presence of more than one color (blue, black, brown, tan, etc.)
- Lesions greater than 6 millimeters in diameter
- Fast evolution of changes in the mole
When checking your skin, it is important to check everywhere including your scalp, lips, toes, nails, and genitalia. Making an appointment with a dermatologist is critical, however, because research has proven that dermatologists correctly diagnose melanoma more than any other type of physician. Early diagnosis and treatment are key to having a melanoma cured.
Who gets melanoma?
Anyone can get melanoma. Most people who get melanoma have light skin, but people who have dark skin also get melanoma. Your risk of getting melanoma increases if you seek the sun, tanning beds, or sun lamps.
Other characteristics that play a role include:
- Having light-colored skin, hair, or eyes or certain moles
- Taking certain medications or having some medical conditions, such as AIDS, which weaken your immune system
- Having a history of melanoma in your family
What causes melanoma?
Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. UV light from the sun and tanning beds can cause melanoma on normal skin and increase the risk of a mole on your skin turning into a melanoma. Some people inherit genes that increase their risk of getting melanoma.
How do dermatologists diagnose melanoma?
To diagnose melanoma, a dermatologist will carefully examine the skin for moles and other suspicious spots. A device called a dermatoscope which shines a light on and magnifies the skin to better see its pigment and structures, may be used. The dermatologist may also feel the patient’s lymph nodes (also known as lymph glands).
If the dermatologist finds a mole or other spot that looks like melanoma, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab. Your dermatologist may call this a biopsy. Melanoma cannot be diagnosed without a biopsy. If the biopsy report says that the patient has melanoma, the report may also tell the stage of the melanoma.
The melanoma stages are:
- Stage 0 (in situ): Melanoma is confined to the epidermis (top layer of skin).
- Stage I: Melanoma is confined to the skin, but has grown thicker, up to 1.0 millimeter.
- Stage II: Melanoma has grown from 1.01 millimeters to greater than 4.0 millimeters, but cancer has not spread.
- Stage III: Melanoma has spread to either nearby lymph nodes or nearby skin.
- Stage IV: Melanoma has spread to an internal organ, lymph nodes further from the original melanoma, or is found on the skin far from the original melanoma.
A type of surgery called a sentinel lymph node biopsy (SLNB) may be advised to stage the melanoma. This procedure checks whether the melanoma has spread to the closest lymph nodes. Other tests that may be performed include X-rays, blood work, and CT scan.
How do dermatologists treat melanoma?
The type of treatment a patient receives depends on the following:
- How deeply the melanoma has penetrated the skin
- Whether the melanoma has spread to other parts of the body
- The patient’s health
When treating melanoma, doctors want to remove all cancer. When cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. The patient often remains awake during the surgical procedures described below. These procedures are used to remove skin cancer:
The dermatologist numbs the skin with local anesthesia and then surgically cuts out, or excises, the melanoma and some of the normal-looking skin around the melanoma. This normal-appearing skin is called a surgical margin. There are different types of excision. Most of the time, this can be performed in a dermatologist’s office.
A Mohs surgeon first removes the visible part of the melanoma. Next, the surgeon begins removing skin that may contain cancer cells one layer at a time. After removing a layer, it is prepped so that the surgeon can examine it under a microscope and look for cancer cells. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less, and it has a very high cure rate.
When melanoma grows deeper into the skin or spreads, treatment becomes more complex. It may begin with one of the surgeries described above, but a patient may need more treatment. Other treatments for melanoma include:
- Lymphadenectomy: Surgery to remove lymph nodes.
- Immunotherapy: Treatment that helps the patient’s immune system fight the cancer.
- Targeted therapy: Drugs that can temporarily shrink the cancer; however, some patients appear to be fully cured.
- Chemotherapy: Medicine that kills the cancer cells (and some normal cells).
- Radiation therapy: X-rays that kill the cancer cells (and some normal cells).
Other treatment that may be recommended includes:
- Clinical trial of medicine or other treatment
- Adoptive T-cell therapy (using the patient’s immune system to fight the cancer)
- Palliative care to relieve symptoms and improve a patient’s quality of life during cancer
Because UV exposure is the leading cause of melanoma, you can greatly reduce your risk of getting melanoma by taking steps to prevent skin cancer.
The following tips can help you get the information you need if you have or believe that you have melanoma. These tips can also help make sure you give your dermatologist essential information.
What to tell your dermatologist
You can improve communication by telling your dermatologist the following about yourself.
- How much information you are comfortable in receiving
- Honest answers to questions that may seem embarrassing or irrelevant
Tips to help you understand — and remember — what your dermatologist tell you
When we’re stressed, it can be difficult to remember what we hear. The following tips can help you get the information you need.
- Bring a laptop or pad of paper to your appointments and jot down plenty of notes and questions.
- Take a family member or close friend with you.
- Ask for an explanation if anything your dermatologist says seems unclear.
What to do at the end of each appointment
- Quickly summarize the important points that you heard.
- If you need to make an important decision, request time to decide.
- Ask whom you can contact if you have questions later.
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