Melanoma: Know The Signs, Reduce Your Risk

Melanoma is not the most prevalent type of skin cancer, but it is the most dangerous type.

Affecting more than 1 million Americans, the rate of melanoma has risen significantly in the past 30 years, according to the American Academy of Dermatology. Melanoma accounts for just two percent of skin cancer cases but claims up to 13,000 American lives each year, according to the American Cancer Society.

A Franciscan Health skin cancer expert explores what melanoma is, along with its causes, risk factors and key symptoms.

What Is Melanoma?

Melanoma is a type of cancer that starts in the cells that make pigments, known as "melanocytes." While not as common as other types of skin cancer, melanoma is more serious.

"Melanomas can occur on almost any area of the body, including areas that don't get much sun exposure, such as the soles of your feet, palms of your hands and fingernail beds," said Juliana Meyer, MD, melanoma surgeon with Franciscan Physician Network and director of the Melanoma Clinic at Franciscan Health Cancer Center in Indianapolis. "Melanomas are usually black or brown in color but can be pink, red or purple."

Melanoma types

The Skin Cancer Foundation lists four main types of melanoma:

• Superficial spreading melanoma is the most common type and tends to occur on the upper back, the legs for women and the torso for men
• Lentigo maligna melanoma tends to occur in older adults and often shows up on the arms, upper torso, face and ears
• Acral lentiginous melanoma is the most common type for people of color and mostly occurs on the soles of the feet, palms and under the nails
• Nodular melanoma is considered the most aggressive type and typically occurs on the arms, legs, torso and scalp in older men

Stages of melanoma

According to the ACS, the stages of melanoma are:

• Stage 0: The cancer is only on the skin’s outer layer (called melanoma in situ)
• Stage I: The tumor is less than 2 mm thick and hasn’t spread beyond the skin
• Stage II: The tumor is at least 1 mm thick and may be more than 4 mm thick and hasn’t spread beyond the skin
• Stage III: This stage has four different substages. The primary tumor can vary in size or not be visible depending on the substage, and the cancer has spread to nearby lymph nodes or areas of the skin
• Stage IV: The tumor has spread to distant lymph nodes or organs

What Are Signs Of Melanoma?

The first sign of melanoma is often a change in a mole, or the appearance of a new mole. Be on the lookout for irregular-looking spots on your skin, new spots or ones that change size, shape or color.

ABCDE rule for moles

This ABCDE rule can help you tell a normal mole from one that might be melanoma. The ABCDE rule for skin cancer is:

• Asymmetry. One half of the mole does not match the other half.
• Border irregularity. The edges of the mole are ragged or irregular.
• Color. The mole has different colors in it. It may be tan, brown, black, red or other colors. Or it may have areas that appear to have lost color.
• Diameter. The mole is bigger than 6 millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.
• Evolving. A mole changes in size, shape or color.

Other symptoms of melanoma

Other melanoma symptoms may include:

• Fluid (like blood or puss) on a spot’s surface
• Itching, redness or pain
• New inflammation outside the spot’s original borders
• Color (pigmentation) that spreads to surrounding areas
• A spot that won’t heal

Early detection of melanoma or skin cancer is important for survival. If you notice that any of these apply to your skin, please contact your primary care physician or dermatologist to get professionally screened. Your doctor can diagnose melanoma with an exam and test to examine suspicious moles or growths.

Am I At Higher Risk For Melanoma?

Many skin cancers – including basal cell cancer and melanoma – are linked to damaged DNA mutations caused by UV-ray exposure from the sun or tanning beds. 

People at risk of getting melanoma are those with fair skin, a history of sunburn, frequent exposure to ultraviolet light from the sun or tanning beds, and people who live at high elevations or close to the equator. Also, people with a family history of melanoma and those who have many moles are at higher risk.

The most common risk factors for melanoma include:

Risk factors you can control

• Sun exposure. Sunlight, the main source of UV rays, is a major risk factor for melanomas (and other skin cancers). Some research suggests that having many sunburns, especially in childhood, might increase the risk of getting melanoma.
• Artificial tanning. The use of tanning beds and sunlamps has been linked to an increased risk of melanoma.

Risk factors you cannot control

• Age. Melanoma is more common in older people, but it is still one of the more common cancers in younger people.
• Gender. Men have a higher risk for melanoma overall, but women have a higher risk before age 50.
• Moles. While most moles are harmless, people who have many moles or abnormal moles (dysplastic nevi) are at increased risk for melanoma.
• Fair skin, light hair. People with light-colored skin are many times more likely to develop melanoma than those with darker skin. People with very pale skin, those who freckle easily, and those with red or blond hair are at higher risk.
• Family history. People whose parents or siblings have had melanoma are at higher risk of melanoma. In some families, people share specific gene changes that increase their risk. For example, some families share changes in a gene known as CDKN2A, which increases their risk. Still, known gene changes account for only a small portion of melanomas.
• Certain inherited conditions. People with certain rare, inherited conditions, such as xeroderma pigmentosum (XP), are at increased risk for melanoma.
• Personal history of skin cancer. People who have had melanoma or another type if skin cancer before are more likely to develop melanoma again.
• Weak immune system. People who have a weak immune system, such as people who have had an organ transplant, are at higher risk for melanoma.

Can I Prevent Melanoma And Other Skin Cancers?

Reducing the risk of skin cancer is paramount - and simple. There is no sure way to prevent melanoma, but there are some steps you can take to lower your risk for skin cancer.

Using sunscreen and other sun exposure protection strategies – such as wearing hats, protective sunglasses and long-sleeved clothing – is key to preventing melanoma and other skin cancers. Applying daily sunscreen with SPF 30 reduces your risk of developing melanoma by 50%.

In addition to wearing broad-spectrum sunscreen year-round, you can help prevent skin cancers by:

• Not using tanning booths and sunlamps
• Practicing sun safety. Limit time in the sun when UV light is strongest (between 10 a.m. and 4 p.m.)
• Wearing sunglasses that have 100% UVA/UVB protection
• Wearing sun-protective clothing to shade your face and cover your body
• Doing skin checkups.

“It’s important to protect yourself and your children from the sun,” Dr. Meyer said. “We’re currently seeing an upswing of melanoma among folks in their forties. That’s because so many got burned as kids at a time when we didn’t know as much about sun protection.”

Finally, while skin cancer self-exams are important, you should also schedule routine check-ups with a dermatologist, especially if you are at high risk for developing skin cancer.

“Your best defense is identifying melanoma early, when it’s easier to treat,” Dr. Meyer said.

How Is Melanoma Treated?

Melanoma treatments include:

• Surgery to remove the cancer
• Chemotherapy and radiation
• Immunotherapy drugs
• Targeted gene and protein therapy

Early detection is key to better melanoma outcomes. Self-monitoring of moles and other markings on the skin helps with detecting melanoma and other skin cancers early.

HealthDay News contributed information to this article.