When the spring sunshine finally warms the earth, it’s very tempting to want it to warm our skin, too. And that’s okay—as long as you remember the sunscreen. But going out unprotected can be dangerous, no matter how ‘healthy’ you think a tan looks.
Melanoma is a potentially deadly form of cancer that begins in the skin. “We’re definitely seeing more cases of melanoma in the last few years,” says Dr. George Hruza, a dermatologist and medical director of the Laser and Dermatologic Surgery Center. “The good thing is that many of these cases are due to earlier diagnosis, and that’s the most important thing you can do to treat this cancer.”
Melanoma begins in the upper layers of skin cells and migrates to deeper layers as the disease progresses. The depth is critical to the patient’s prognosis. “Once it’s thicker and more advanced, there really is no good treatment,” Hruza says.
The importance of diagnosing melanoma in its earliest stages led the medical establishment to implement memorable criteria for recognizing suspicious moles: ABCD, which stands for asymmetry, border, color and diameter. Moles should be assessed by a physician if they become asymmetrical in shape, develop irregular borders, appear black or very dark brown, or expand to a diameter of more than 6 millimeters.
Melanoma is related to DNA damage of the skin’s pigment cells, explains Dr. Lynn Cornelius, chief of the division of dermatology at Washington University. “These cell mutations are associated with exposure to ultraviolet radiation, among other things. Tanning is the skin’s way of trying to protect us from UV damage, and as the cells produce more melanin, to shield us, there is increased risk.”
If a suspicious mole or growth is found, a biopsy is needed, Hruza says. “The treatment is excision with adequate margins,” he says, which means the lesion, along with some area around it, is completely removed. The goal is to remove all the cancer cells in one procedure.
Following the excision, pathologists examine the cells to determine the thickness of the cancerous area. Evidence of cancer cells in the deeper layers of skin means there is an increased risk that the cancer has metastasized to surrounding structures. If this is the case, the next step involves a biopsy of nearby lymph nodes. “If the nodes are negative for cancer cells, that’s a good sign,” Cornelius says. “If not, the patient is counseled about his or her options to remove more nodes or try a systemic therapy.”
Although targeted and immunotherapy are available for metastatic melanoma, Cornelius notes that “they typically increase survival only by a matter of months.” That’s why prevention is the focus. “Most melanomas are related to UV exposure,” she says. “The best way to treat it is to prevent it, and it’s easy to protect your skin.” LN