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What is Melanoma ……………………………………...4
What Does Melanoma Look Like?...................6
Four Types of Melanoma……………………………..7
Hidden Melanoma……………………………………..12
Who is at Risk for Melanoma?......................14
Signs & Symptoms of Melanoma……………….18
Characteristics of Unusual Moles……………….21
Other Changes to Watch For……………………...24
TABLE OF CONTENTS
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Screening for Skin Cancer……………………………25
When an Unusual Mole is Found………………..26
Stages of Melanoma…………………………………..28
How is Melanoma Treated?...........................31
Tips for Preventing Melanoma…………………….34
Body Map……………………………………………………36
Self-Exam Schedule…………………………………….37
TABLE OF CONTENTS
WHAT IS MELANOMA?
Each year, there are more than one million cases of skin
cancer diagnosed in the United States. There are different
types of skin cancer. Basal cell and squamous cell carcinomas
are the two most common forms of skin cancer. They’re both easily treated if they’re detected early.
Melanoma is another type of skin cancer. It isn’t as easily treated and it’s growing in numbers each year. According to the American Cancer Society, there were about 120,000 new
cases of melanoma diagnosed in the United States last year.
It’s not the most common type of skin cancer, but it is the most deadly. It kills almost 9,000 people in the United States
annually.
Skin cancer forms when UV light from the sunshine or from
tanning beds injures DNA in the skin cells. Occasionally, the
damage is enough that the body cannot repair itself and the
cells do not naturally die off.
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When this happens, the new DNA can cause the skin
cells to rapidly multiply. This is cancer and the growth
of new skin cells is referred to as a tumor. In the case
of malignant tumors, the cancerous cells begin to
invade other tissues and the tumor spreads.
Cancers are named after the area where the DNA is
damaged and the cancer originates. In the case of
melanoma, the cancer begins in the pigment-
producing melanocytes in the basal layer of the skin.
The basal layer is the very innermost layer of tissue in
your skin.
DID YOU KNOW…
A person’s risk of melanoma DOUBLES if he/she has had
five or more sunburns.
PLEASE USE CAUTION!
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WHAT DOES MELANOMA LOOK LIKE?
Melanomas look like moles. In fact, many develop from
moles that are already existing on your skin. They’re most often brown or black but they can be many colors, including
purple and white. While they normally appear on the parts
of the body that are exposed to sunlight, like the face, back,
arms and hands, they can show up in unusual places - like
under your fingernails.
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WHAT DOES MELANOMA LOOK LIKE?They’re usually caused by sunburn, although some people are more susceptible to melanomas and skin cancer in general.
The good news is that when melanoma is caught early, it’s almost always treatable. If it’s not caught, or treatment is ineffective, it can spread (metastasize) to other areas of the
body.
By reading this, you will not only better understand
melanoma, but also be able to recognize it, prevent it, and
understand the treatments, and risks. Let’s begin by learning about the four different types of melanoma.
Four Types of Melanoma
There are essentially four different types of melanoma. The
difference is defined by how they spread, where they spread,
and how invasive they are. Three of the four basic types of
melanoma are sometimes invasive and generally start in the
top layers of the skin. The fourth type always become invasive
and penetrates deeper into the skin and eventually into other
layers of the body. This is what makes them so dangerous.
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WHAT DOES MELANOMA LOOK LIKE?Superficial spreading melanoma
Superficial spreading melanoma is the most common type
of melanoma, accounting for approximately 70% of all
cases. It generally begins on the legs or back, and is
common in both men and women aged 30 to 50.
It tends to evolve slowly, taking one to five years. It is
generally not raised or elevated significantly above the skin
and comes in a variety of colors. It grows on the top layer
of skin for quite a while before becoming invasive. You
might notice a discolored area that is slightly raised with
irregular borders and an asymmetrical form. It can begin in
a benign mole, which is why it’s so important to check your skin annually for changes.
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WHAT DOES MELANOMA LOOK LIKE?Nodular melanoma
Nodular melanoma is invasive and by the time it’s noticed, it has usually spread to other areas. It’s not as common as superficial spreading melanoma, and is quite aggressive.
It’s found in 10% to 15% of melanoma cases.
It begins as a black and blue or purplish lump or bump. It
can also be gray, white, brown, tan, or even red. Its most
frequently found in the elder population, and most
commonly found on the trunk, legs, and arms.
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WHAT DOES MELANOMA LOOK LIKE?Lentigo maligna
Lentigo maligna develops slowly, often beginning on the
face - which can make it easier to identify and catch before
it develops into a dangerous tumor. It can also be found on
the ears, arms, and the shoulders.
It looks like a large and odd-shaped freckle. Like the
superficial spreading type of melanoma, it stays close to
the surface of the skin. It can be flat or slightly elevated
and it’s usually tan or brown. It occurs most often in older people who have had a lot of sun exposure. This cancer is
malignant and invasive.
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WHAT DOES MELANOMA LOOK LIKE?Acral lentiginous melanoma
This type of skin cancer spreads superficially first. It
spreads quickly and can be difficult to identify. It looks
quite different from the other types of melanoma and can
be dangerous. It can appear as a dark discoloration on the
soles of the feet or under fingernails. It can be found on
dark skinned people and is the most common type of
melanoma in African-Americans and Asians, and the least
common among Caucasians.
Next, we’ll take a look at hidden melanomas and then we’ll transition into what to look for – signs and symptoms
of melanoma.
HIDDEN MELANOMA
Melanomas can be tricky. They can develop in hidden areas of
your body that see little to no sunshine. When melanomas
occur in people with darker skin, it’s more likely to be found in one of these hidden areas. This can be dangerous because if a
melanoma goes unnoticed, it can metastasize and invade
other tissues.
Subungual melanoma
This is rare and usually happens under the nails on the hands
or feet. It’s more common in people with dark skin and is often mistaken for a bruise. It’s usually brown or black in color.
Mucosal melanoma
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This occurs in locations where there are mucous membranes.
They’re difficult to detect because they happen in hidden areas and because they’re often mistaken for other conditions. Mucosal melanoma can develop in the mucous membranes
that line the nose, mouth, anus, urinary tract and vagina.
Mucosal melanoma
Ocular melanoma
This is also called eye melanoma. It occurs in the uvea, which is
the layer that sits beneath the white of the eye, also called the
sclera. It’s usually diagnosed during an eye exam and can cause changes in vision.
These hidden melanomas can be frightening because they can
become invasive and metastasize before they’re even noticed. The good news is that these types of skin cancer are extremely
rare.
Now, let’s take a look at risk factors. Knowing your risk is the first step to prevention and protection.
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Some people have a higher risk of developing skin cancer,
specifically melanoma. Simply because you may have the
following risk factors, doesn’t mean you’re going to get skin cancer. What it does mean, is that vigilance is necessary. If you
have a higher risk of developing skin cancer, then you want to
pay careful attention to your skin.
Fair skin
If you are extremely fair skinned, you have a higher risk for
developing skin cancer. Those with fair skin have less melanin
and pigment in their skin. Melanin helps protect the skin from
the sun’s UV (ultra violet) rays.
Fair skinned individuals often have blonde or red hair, with
blue or light gray eyes. They may freckle in the sun, and
sunburn easily. If you have fair skin, you should take every
precaution when exposed to the sun.
WHO IS AT RISK?
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History of sunburns
If you have a history of sunburns, you’re at a higher risk for skin cancer and melanoma. Each time your skin is burned, it’s a sign of severe damage to your skin cells and the DNA in
those cells.
When the DNA is damaged, it can change in such a way that
skin cells begin to multiply uncontrollably. This is a tumor. If
the skin cells begin to invade surrounding tissues it is called
metastasis, and becomes very dangerous. If cancer is
contained, it’s easy to remove. When it starts moving into surrounding tissues, it can be difficult to know how far it has
spread.
Family history
If you have a family history of skin cancer or melanoma, you’re at a higher risk for developing it, also. The closer the relative,
the higher the risk. For example, if a parent, child or sibling
has had melanoma, your risks are increased.
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Time outdoors
Do you spend a lot of time outside? For example, do you work
outdoors or spend a great deal of time enjoying nature?
Perhaps you simply take your children to the park every day to
play. The more time you spend outside, the more UV radiation
you’re exposed to.
If you have a job that keeps you outdoors or you spend a lot of
time outside, it’s important to protect yourself. This becomes even more important if you live in an area that is close to the
equator or at a higher elevation because the sun’s rays are more direct, exposing you to more UV rays.
Many moles
People who have many moles, are at an increased risk for
melanoma. Melanoma often begins in benign moles.
Additionally, if you have unusual moles then you’re at an increased risk.
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Weakened immune system
Having a chronic condition or an immune disorder increases
the risk for skin cancer and melanoma. This is because the
immune system is responsible for getting rid of abnormal cells.
Skin cancer cells have damaged DNA, and are generally
targeted and destroyed by your immune system.
However, with a compromised immune system, the body can
miss the cancerous cells. If they are allowed to multiply, then a
tumor can develop.
Did you see yourself in any of the risk factor groups? If so,
then it’s quite important to take steps to protect yourself from future sun damage and to prevent skin cancer. However, even
if you didn’t see yourself on the list of risks, you can still get melanoma. Protection and prevention are important.
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You’ve learned about where skin cancer and melanoma can often be found. You’ve also learned what different types of melanomas can look like. Now, it’s time to take a detailed look at what to look for when you’re identifying melanoma and the various signs and symptoms of skin cancer.
Check your moles
Most of us have moles on our body. These are larger, darker
freckles. Some of them are raised a bit and they may have hair
coming out of them. The hair isn’t a sign of illness or irregularity. It’s normal. What isn’t normal, is when your mole changes.
What’s a normal mole?
SIGNS & SYMPTOMS OF MELANOMA
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A normal mole is generally symmetrical. This means that if you
drew a line down the middle, both sides of it would look
relatively similar. They’re usually brown or black in color and the have a clearly identifiable border. Normal moles are
generally round and they are smaller than the eraser on a
standard pencil.
Changes in your moles
If you notice a change in any of your moles, it should be not
be ignored. Make an appointment with your doctor or
dermatologist. Typical changes might include changes in the
size or border, changes in color, and changes in the height of
your mole.
A new mole or growth
Melanoma doesn’t always begin in a benign mole. Sometimes, it can develop on clear skin. If you notice that you have a new
growth or a new and unusual looking mole or pigmented area,
then you may have the beginnings of skin cancer.
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Most people have a dozen or so moles, and they tend to stop
appearing by age 40. They can disappear. However, if you get a
new mole and it looks different than your other moles, it’s worth getting checked out. Unusual moles may indicate
melanoma.
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DID YOU KNOW…
Sunscreen should only be used
on babies OVER six months
of age.
KEEP NEWBORNS
OUT OF THE SUN
When looking at your moles, or helping to examine someone
else, it’s good to know what to look for. There is an easy five-
step process to help assess any skin patches or moles you are
unsure about. It’s as easy as your ABCs.
A - Asymmetry
Asymmetry means that the two halves of a mole or pigmented
area are different. If you can draw an imaginary line down the
middle of a mole, would both sides look the same or
different? If both sides would look different then the mole
should be checked out by a doctor or dermatologist.
B –Border
How does the border look around your mole? Is it even and
distinct or is it irregular, wavy, or notched? Irregular borders
are common with melanomas.
Characteristics of Unusual Moles
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C – Color
What color is your mole? Is it one color or many? Normal
moles are generally brown or black and they’re one solid color. If your mole has many colors or it is an unusual color
like white, gray, pink, red, blue or purple, it may be a
melanoma.
D - Diameter
How large is your mole or the pigmented area of your skin?
If it’s larger than a ¼ inch in diameter, it may need to be checked out. It could be a sign that the mole is cancerous
and growing.
E – Evolving
Is the mole getting taller? Is it changing shape, color, or size?
Any change or increase in height is something to be
suspicious of.
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Sometimes, your skin can change in strange and unusual ways.
Often when these skin changes happen, we think it’s from a rash, a bruise, or an irritation. It can be difficult sometimes to
diagnose a melanoma yourself. If you notice any of the
following signs, be suspicious and have it checked out.
• Scaliness, particularly around moles
• Itchy moles or pigmented skin areas
• Spreading of pigment from the mole into the
surrounding skin
• Oozing or bleeding of a mole or an area around a
mole
And remember that sometimes melanoma can occur in nail
beds and on the bottoms of your hands or feet. These areas
often look like dark bruises.
If you notice any of these signs or symptoms, it’s time to head to the doctor.
OTHER CHANGES TO WATCH FOR
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The discovery of melanoma can happen one of two ways. You
might head to your doctor because you discovered an unusual
looking mole or skin patch. Or, you might head to your
dermatologist or doctor for a routine check-up and an unusual
mole may be discovered during a skin cancer screening.
A skin cancer screening is a process where a physician takes a
look at your skin from head to toe. During your first skin
cancer screening they may create what’s called a mole map. This is literally a map of all of your moles. It can take some
time if you have a lot of moles. This map is helpful because it
can help your doctor identify any new moles. Also, notes can
be taken about specific moles that look irregular or unusual.
You can also do a skin cancer screening yourself. You can
examine the moles and freckles that you currently have. Using
a mirror, you should be able to see all areas of your body.
Don’t forget to check your scalp and some of those hard to reach areas. If you’re in a high risk group, it makes good sense to have your doctor do this annual screening.
SCREENING FOR SKIN CANCER
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In some instances, a melanoma can be detected just by
looking at your skin. Whether melanoma is detected, or your
doctor finds an unusual mole and is uncertain - a biopsy is the
next step. There are different types of biopsies depending on
what the doctor believes you’re dealing with.
Punch biopsy
A punch biopsy is a biopsy where your doctor uses a sharp
circular tool to remove tissue from your suspicious mole. A
“Punch” is a tool that makes a hole, hence the name “punch biopsy.” It makes a small hole in your mole.
Excisional biopsy
During this procedure, your entire mole is removed along with
a small area around the mole. With any biopsy you’ll receive a local anesthetic.
WHEN AN UNUSUAL MOLE IS FOUND
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You’ll likely receive more help managing pain when larger areas of skin are removed.
Incisional biopsy
With this type of biopsy the doctor will remove the most
irregular part of a suspicious mole. With any type of biopsy,
including an incisional biopsy, the tissue in question will be
sent to a laboratory for analysis. Doctors will examine the cells
under a microscope and look for signs of cancer. Cancerous
cells look and behave quite differently than normal cells.
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If the biopsy indicates that the tissue is, in fact, cancerous and
you’re dealing with a melanoma, the next step is to categorize it. This classification is used to identify how severe the cancer
is.
You’ve probably heard someone describe cancer as stage one or stage two. This is what’s called staging. When a doctor stages a melanoma, they’re looking at the thickness of the melanoma, the depth of penetration and how far the cancer
has spread. Knowing this, the doctor can then identify the
treatment.
Stage I and II
These stages of melanoma are localized. They haven’t penetrated other tissues and are contained. They’re also known as thin melanomas and measure less than 1 millimeter
in depth. Stage I melanoma may also be classified as in situ
which means that it is confined to the epidermis.
The thinner the melanoma, the better the chance of a cure.
STAGES OF MELANOMA
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Stage III and IV
These stages indicate that the cancer has spread into other
tissues. The tissue depth is between 1 and 4 millimeters for
intermediate tumors and greater than 4 millimeters for thick
melanomas. If the melanoma has an ulceration, that’s also included in the classification.
For example, a melanoma may be listed as:
Stage 4a - the tumor is thicker than 4.0 mm without
ulceration
Stage 4b - the tumor is thicker than 4.0 mm with ulceration
In Stage III, the tumor has spread to the lymph nodes or to
the skin between the original site and the nearby lymph
nodes.
With Stage IV, the melanoma has metastasized to lymph
nodes further away from the original cancer site. This means
that it can also be impacting your organs, including your
brain, liver, and bone.
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Once the cancer has been classified or staged, the next step is
to determine treatment. This is all a scary part of being
diagnosed with melanoma. Take comfort in the fact that most
people catch their skin cancer before it reaches advanced
stages and treatment is usually successful.
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DID YOU KNOW…
Using tanning beds increases
your risk of melanoma by
300%
Treatment is determined by several factors. As mentioned,
treatment depends on the severity or stage of the cancer. It
also depends on the type of melanoma, your age, your health
and your preferences. You do have a choice in how your
cancer is treated.
Early –stage
Treatment for early-stage melanomas usually includes surgery
to remove the melanoma. Even if you’ve had the melanoma removed through biopsy, doctors may go in and remove a bit
of normal tissue around the affected area. In many cases, this
is the only treatment you’ll need. You’ll be asked to schedule more frequent skin cancer screenings and to take precautions
to protect your skin from the sun’s rays.
HOW IS MELANOMA TREATED?
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Advanced-stage
If melanoma has spread beyond the skin, treatment options
usually begin with surgery to remove the affected area and
the nearby lymph nodes. If your lymph nodes have been
affected, then chemotherapy is usually the next step.
Chemotherapy is a therapy that is used to kill cancer cells
throughout your body. In some cases, you can take a pill or it
may be administered intravenously.
Radiation therapy is sometimes used to treat melanoma that
has impacted organs. It uses x-ray type beams to kill cancer
cells. Biological therapy boosts your immune system so that
your body can better fight the cancer.
There’s also targeted therapy, which uses medications to target specific types of cancer cells. This is usually used when
the cancer cannot be treated with surgery and has spread
throughout your body. In many cases a doctor will
recommend a combination of therapies to help you get a
complete eradication of the cancer.
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It’s important to remember that with proper care and attention, you can overcome melanoma. In fact, it is more
common to thrive and survive than not. Just to bring this fact
home, let’s take a look at some melanoma facts and statistics before learning prevention tips and advice.
Melanoma Statistics
• Skin cancer is the most common form of cancer. Of that,
Melanoma accounts for less than 2% of the cases of skin
cancer.
• This year, the American Cancer Society estimates that
there will be about 96,480 new melanomas diagnosed. Of
that number of cases, approximately 7,230 are expected
to die from melanoma.
• The occurrence of melanoma has been increasing steadily
for the past 30 years. Melanoma is increasing faster in
females age 15-29 than males in the same age group.
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The good news about melanoma and all skin cancers, is that
there are ways you can prevent getting the most common
forms. The following tips are simple, easy, and inexpensive.
The biggest challenge you’ll have is following through and being consistent with your behavior.
Wear sunscreen
SPF 30 is a minimum sunscreen to apply to all areas of your
skin that are exposed to the sun. Choose a broad screen
sunscreen that protects you against both UVA and UVB rays. If
you’re wearing light clothing, consider applying sunscreen under your clothes as well. Clothing doesn’t provide complete protection from the sun’s rays. If you’re going to be outside, reapply sunscreen every two to four hours.
TIPS FOR PREVENTING MELANOMA
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Avoid midday sun
Stay out of the sun during the middle of the day, between 10
a.m. and 2 p.m. This is when the sun’s rays are the strongest. If you have to be outside during this time, wear protective
clothing, like hats and long sleeves, and use a broad
spectrum sunscreen.
Map your skin
Become familiar with your skin and conduct annual skin
cancer screenings. You can ask your doctor to do this for you,
as well. The American Cancer Society recommends an
annual skin cancer check-up for men and women beginning
at age 20.
Print the enclosed self-exam body map to keep track of any
spots you notice on your body. Note the location, size, color
and date. For each exam after that, find the spot on your
skin that matches each dot, record the new date next to the
old one, and note any change in size, color, or shape. Record
any spots you did not see on last examination.
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In closing
Finally, take good care of your health. The stronger your
immune system, the less likely you are to develop invasive
cancer. This includes eating well, getting enough exercise,
practicing good sleep habits and embracing a positive
outlook. Your mental health and wellbeing impacts your
physical health.
Melanoma and skin cancer can be a scary topic, and if you’ve had a cancer scare, then you know just how terrifying it can
be. The good news is that death from skin cancer is not
common and there are steps you can take today to protect
yourself.
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For more wellness and self-help resources,
please visit http://coolbeanliving.com/
