Skin Cancer - Melanoma: The Facts

What is it?

Skin Cancer is a disease that begins in the layers of the skin. There are three types of Skin Cancer: basal call carcinoma, squamous cell carcinoma, and melanoma. This Fact Sheet will deal exclusively with melanoma. The skin protects the rest of the body from the outside elements, stores water and fat, and produces Vitamin D. The skin has three layers: the outer layer - the epidermis, the middle layer - the dermis, and an underlying layer of fatty connective tissue. Melanoma is the term used for Skin Cancer that begins in the melanocytes. Melanocytes are skin cells that contain pigment or coloring. They give the skin its color and are responsible for the change in color when the skin is exposed to sunlight. The melanocytes are part of the epidermis, which is the top skin layer. A melanoma is the term used to describe a group of abnormal (cancerous) melanocytes that grow uncontrollably.

Melanomas are the most serious and dangerous type of skin cancer. When left untreated, melanomas can spread and invade nearby tissue. Sometimes the cancer can even spread to distant areas of the body such as the lungs or bones.

Moles:

Moles are groups of closely packed melanocytes found on the skin. They may be pink, tan, or brown, round or oval shaped, and either flat or raised. Most people have between 10 and 40 moles on their body, usually above the waist area. Moles may be present at birth or may appear on the body during life, usually before the age of 40. Most moles are normal and are not cancer. However, occasionally the melanocytes that make up moles can become cancerous and form melanomas.

Who gets it?

Skin Cancers in general are currently the most common cancer in the United States. The number of Skin Cancer cases in the U.S. has doubled in the past 20 years. This year, one million new cases of Skin Cancer are predicted, and approximately 44,200 of those will be Melanoma. Although Melanoma usually affects people over 40, it is fast becoming one of the most common cancers among young adults. Melanoma is most common among Caucasians and least common among young adults. In the last 10 years the incidence of melanoma has risen approximately 50% in both men and women in Rhode Island.

There are several risk factors that have been associated with an increased chance of developing melanomas. These include:

• Atypical Moles also called dysplastic nevi; These are large moles with abnormal shapes, colors, or texture. They are not cancerous, but can become cancerous over time. Every atypical mole will not necessarily develop into skin cancer.
  
  
• Sun Exposure - 90% of Melanoma cases are caused by damage to the melanocytes from the sun. People who live in areas where sunlight is intense, such as the tropics, who have fair skins that burns easily, or who have had severe, blistering sunburn in their lives, have a much higher risk for Melanoma and other Skin Cancers. As residents of the "Ocean State," RI residents often put themselves at risk to the damaging effects of intense sunlight.
  
  
• Tanning booths and UV lamps - Tanning booths and UV lamps- These devices make use of ultraviolet (UV) light to tan the skin which places people at very high risk for Melanoma. The FDA now classifies these devices as carcinogens, or cancer causing agents.
  
  
• Medical History About 10% of Melanoma patients have a family history of Melanoma. People with a personal history of Melanoma or other Skin Cancer are also at an increased risk of getting another Melanoma.
  
  
• The Number of Moles - People with more than 50 moles on their bodies are more likely to get Melanoma.
  
  
• Complexion - People with fair skin and hair are at the highest risk. People with dark complexions have a decreased risk of skin cancer, but are not completely safe.
  

How is it Detected?

The only specific symptom of Melanoma is a change in the appearance of one or more moles on the body. However, mole changes do not necessarily indicate cancer. Abnormal moles are found through a skin exam, which can be performed by a doctor or by the patient. Doctors use an ABCD System to look for changes in moles, and patients can use the same system. You should know the locations and normal appearances of your moles, and examine your skin regularly for new moles or changes in older moles. Examine ALL areas of skin, including those never exposed to sunlight.

Men typically first develop melanomas on their head, neck, and the trunk of their bodies. Women usually first develop melanomas on their arms and legs. However, it is possible to develop a melanoma ANYWHERE on the body, even areas that do not get exposed to sunlight.

The ABCD System to detect abnormal moles:

Asymmetry - The two halves of the mole do not look the same:
Border - The edges of the mole appear blurred or ragged:
Color - There are uneven splotches of black, brown tan or pink. There may be areas of white, gray or blue:
Diameter - The size of the mole changes or grows. Melanomas are usually larger than the size of a pencil eraser:

You should report any of these moles to a doctor immediately. The entire lesion or mole is usually removed from the skin and sent to a laboratory. A doctor (pathologist) at the lab will examine the tissue under a microscope to see if cancer cells are present. This entire procedure is called a biopsy. The physician may also perform a physical exam and possibly blood tests, a chest X-ray, or other tests to determine if the cancer has spread (metastasized) to other organs, and will usually ask about any personal or family histories of Melanoma or other Skin Cancers.

If cancer cells are found in the biopsy, the physician will then determine the stage of the disease. The stage of the cancer will greatly influence the type of treatment used. The stages of Melanoma are as follows:

• Stage 0: - The cancer is only in the top layer of the skin.
  
• Stage I: - The tumor is in the lower layer of skin and is less than 1.5 mm (less than 1/8 inch) thick.
  
• Stage II: - The tumor is in the lower layer of skin and is 1.5-4.0mm (about 1/4 inch) thick.
  
• Stage III: - There may be multiple tumors, and cancer may have spread to the lymph nodes.
  
• Stage IV: - The cancer has spread to distant skin, lymph nodes, or other organs.
  
• Recurrent: - The cancer has returned after treatment.
  

Is it Curable?

The survival rate for all Skin Cancers is over 90%. However, Melanoma is the most fatal of the three types of Skin Cancer. While only 2% of all cancer deaths this year in the U.S. will be from Skin Cancer, the majority of those deaths (7,300) will be from Melanoma. Stage I Melanoma has a high cure rate, but Stages II, III, and IV are more likely to be fatal.

Certain lifestyle habits can greatly reduce your risk of developing Melanoma and other types of Skin Cancer. Some of these include:

• Avoid excess sun exposure at all times. Particularly avoid the sun during its strongest times, 10 a.m.-3 p.m. Be especially careful if you are fair skinned or burn easily.
  
  
• Wear a hat, long sleeves if possible, and sunglasses when you are in the sun.
  
  
• Take special care of children. Most Skin Cancers are the results of severe sunburns during childhood.
  
  
• Use sunscreen or sunblock with at least SPF 15 anytime you are in the sun. Preferably, sunscreen should be waterproof and applied 15-30 minutes before sun exposure. It should be reapplied every 90 minutes, or more often if you are in the water.
  
  
• Have a complete skin exam. Local hospitals and health departments usually offer annual free clinics.
  
  
• Don't smoke.
  

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