Melanoma is the deadliest and most preventable skin disease. It is a skin cancer arising from melanocytes, skin cells that carry pigment also know as melanin, which gives skin its color. Melanocytes are the cells that also form benign (non-cancerous) moles known as nevi. The distinction between harmless moles and potentially deadly melanoma can be challenging even for the most experienced dermatologists.
Patients can identify suspicious moles through self examination of brown (pigmented) and even pink (non-pigmented) spots on the body that are large, changing in shape, color, and/or size. This has been referred to as the ABCDE’s of melanoma detection:
Asymmetry or the lack of similarity within a mole
Border irregularity referring to the non-uniform outside rim.
Color variation referring to a change both in colors or a variety of colors within a mole.
Diameter greater than 6 millimeters.
Evolution of a spot that has been changing in size, shape, color and even texture.
The risk factors for melanoma include:
Fair skin/light eyes/red hair.
Geographic location close to the equator.
Repeated, intermittent sun exposure. For example, vacationers who repeatedly burn.
Chronic sun exposure. For example, people who are out in the sun all the time
Family history or self history of melanoma.
People with many large atypical appearing moles also known as dysplastic nevi.
The incidence and mortality rates for melanoma have been rising steadily. Melanoma is among the most common forms of cancer in young adults and is the most common cause of death in individuals with skin disease and in those with skin cancers.
Up to one-fifth of patients who develop a metastatic spread of melanoma cancer throughout the body usually die. However, early detection and appropriate treatment lead to a cure rate of over 90 percent.
While the gold standard of diagnosis of melanoma remains a skin exam and biopsy (cutting out a small sample and sending it to a pathology lab) of any suspicious lesions, other diagnostic tools used by pigmented specialists help further the specificity and sensitivity of early detection and treatment.
Pigmented specialists use tools such as dermoscopy — a hand-held imaging device that helps aid in the diagnosis and early detection of melanoma. Dermatologists that specialize in pigmented lesions also use short-term digital dermoscopic mole monitoring whereby they take images of moles that appear to be suspicious. This helps to prevent biopsies of non- harmful moles that appear atypical or suspicious. It can also lead to earlier biopsies of moles that do not yet appear suspicious.
In addition, imaging of moles may be helpful because moles with the potential to turn into skin cancer — possibly early melanoma — will show very slight changes over time that may be invisible to the naked eye. Many specialists in melanoma skin cancer also use total body photography in certain types of high-risk patients to provide a constellation map of a patient’s existing moles to help capture and identify any new suspicious moles.
Since early detection of melanoma is critical in its treatment and patient survival, there is ongoing research to find additional tools to help aid in the diagnosis of early melanomas. On the horizon there are a number of machines like MelaFind — which allows the operator to place a sensor on a mole and send it to a computer for analysis.
Another tool is confocal in vivo microscopy to examine skin live to diagnose skin cancers.
A third is multi-beam optical coherence tomography using ultrasound which helps diagnose and obtain margins for skin cancers.
Finally, tape stripping involves placing a piece of tape on the body that strips genes from the skin which is then sent for laboratory analysis. All of these tools along with dermoscopy and photography will further increase the chances of catching these deadly cancers at earlier stages, significantly improving patient survival.
Since melanoma is the deadliest and most preventable skin disease, eliminating or reducing one’s exposure to the sun’s harmful rays, as well as the use of sunscreens to reduce exposure to UV radiation remain the first lines of defense in the prevention of melanoma. And, regular skin examinations can help in the early diagnosis of melanoma, increasing the individual’s chances of survival.
For additional information or to schedule an appointment call (212) 241-9728.
Dr. Orit Markowitz, FAAD, is director of the pigmented lesions and skin cancer department of dermatology and assistant professor of dermatology at Mount Sinai Medical Center in NYC.