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Skin Deep: Preventing and Detecting Melanoma

August 19, 2021
A dose of clinical from firefly health.

Melanoma is an increasingly common skin cancer, most typically developed through ultraviolet (UV) exposure. The best prevention includes reducing exposures to UV radiation and early detection through self-screening or visiting a dermatologist is highly encouraged.

Common But Preventable

We asked our resident dermatologist, Michael Krathen, MD, to give us an in-depth analysis of the third most common type of skin cancer in the United States (an estimated 106,110 new cases in 2021). Although less common than basal and squamous cell carcinomas, melanoma has an increased likelihood to spread from the skin to distant areas of the body (also known as metastasizing). The good news is most patients diagnosed with melanoma do not develop metastatic spread and recover well after a minor surgical removal of the growth.

How does it start?

Like other cancers, melanoma develops through mutations (or changes) in the body’s genetic coding (DNA). Specifically, melanoma is cancer of a pigment-producing cell called a melanocyte. Melanocytes usually live in the bottom layer of the skin and produce melanin (the pigment in the skin). The melanin acts like sunscreen to protect other skin cells from ultraviolet (UV) radiation. When melanocytes develop their own genetic mutations, then a melanoma can form.

What are the main risk factors?

Ultraviolet (UV) light exposure, through either intense brief exposures or long-term chronic sun exposure, is the only preventative risk factor for developing melanoma. Intense brief UV exposures may include tanning bed use, blistering sunburns, or other short but intense UV exposures. Long-term sun exposure can include outdoor work, sun-exposed activities such as golf and tennis, and/or tanning (both artificial and outdoor). 

Other risk factors include:

  • age (risk increases with time)
  • light skin complexion
  • high mole (nevus) count (greater than 25 or 50 moles on the entire body)
  • atypical moles (large, multi-colored and unevenly shaped)
  • medium to large birthmarks (congenital nevi)
  • personal or family history of melanoma
Are there different types of melanoma?

Melanoma of the skin (cutaneous melanoma) is the most common type of melanoma. Cutaneous melanoma develops in various subtypes including nodular, lentigo maligna, superficial spreading and acral lentiginous. 

  • Melanoma in-situ: not yet invasive; 100% cured by excision alone.
  • Nodular: more aggressive, can develop as a small round darkly pigmented flat lesion and evolve into a raised bump
  • Superficial spreading: most common type of cutaneous melanoma
  • Lentigo maligna: develops usually on the head/neck with heavy prior sun exposure
  • Acral lentiginous: affects all skin types; most common subtype in patients of African and Asian descent; found on hands and feet, including toes and nails.
How can melanoma be prevented?

Prevention of cutaneous melanoma is accomplished by reducing exposure to ultraviolet light. Sunscreen, while helpful and encouraged, is the last line of defense. Reducing UV exposure can be also accomplished through: 

  • Reducing outdoor activities between 10AM-4PM, when the UV intensity is highest
  • Wearing protective clothing, including broad-rimmed hats and long sleeves
  • Using umbrellas and other shade structures
How is melanoma detected and treated?

Annual skin screening by a dermatologist is recommended for patients with a family history of melanoma (first degree relative), greater than 25 moles or presence of atypical moles, known genetic risk factors (such as CDKN2A mutation), history of radiation exposure (such as prior cancer treatment) or solid-organ transplant. Self- or partner-screening is also highly encouraged.

Treatment for melanoma depends on the stage. Briefly, melanoma can be divided into two categories, non-invasive and invasive, then 5 stages (0, which is least invasive, to 4, which is most invasive). Most melanomas detected are in stages 0 and 1. These low-risk melanomas are treated with a surgical excision. Stage 2, 3, and 4 melanomas are treated typically by a surgical oncologist; often these patients will also be introduced to a medical oncologist, who may discuss chemotherapy, immunotherapy, and/or radiation therapy options with the patient. New treatments for advanced melanoma have resulted in swift and long-lasting remissions for many patients and offer hope for those diagnosed with later stage disease.

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