Melanomais the leading cause of skin disease related death. Melanoma presents as anirregular mole or lesion that changes or appears over time. Given the differenttypes of melanoma, they can appear on any skin surface, including areas like inthe eye or on mucus membrane in the mouth. The ABCDE rule is often used toevaluate lesions for melanoma with observing any asymmetry, borderirregularity, color variation, diameter greater than 6mm, and evolution of themole over time, which is the most important factor to consider. It is importantto remember given the different subtypes of melanoma, they can be any colorfrom flesh colored to black. Patients will often present to theoffice with a complaint of a new or changing mole on their body, or a newlesion will be found incidentally on a routine exam.
The cause of melanomamainly stems from UV radiation. Skin damage from UV rays throughout one’s life,blistering sunburns, and tanning bed use are important risk factors fordeveloping melanoma. Family and personal history of melanoma and other types ofskin cancer should be taken into account. Familial melanoma is a rare cause ofmelanoma that has a strong link to familial pancreatic cancer. Beingimmunocompromised is also another risk factor. Caucasians with light hair andeyes are at the greatest risk for developing melanoma, but individuals withdarker complexions are still at risk, particularly acral lentiginous melanoma. Ifleft untreated, the cancer will most likely metastasize and ultimately lead todeath. Key to diagnosis is having aclinical suspicion of melanoma by taking into account risk factors, familyhistory, and conducting a proficient physical skin exam.
If melanoma issuspected, a full-thickness wide excisional biopsy should be done and specimensent to pathology. If melanoma is diagnosed, one should be sent to a melanomaspecialist for treatment and even a second opinion by a dermatopathologist foraccurate margins and staging. From that point, a complete wide excisionalbiopsy should be done to make sure all remnants are removed and sentinel lymphnode biopsy should be done or offered to see if there is any metastasis.
Aone-time chest x-ray or CT scan at the time of diagnosis is also recommended tolook for metastasis, then an LDH and CRP level may be taken as well. Treatment after surgery revolvesaround proper skin protection. This includes wearing sunscreen properly. SPF 30is what is recommended and reapplication ever hour or more often if one isswimming or sweating. Men particularly, wearing a wide brimmed hat to protectface, head, and ears from the sun. Seek shade between the times of 10AM and4PM, since that is when the sun’s rays are the most intense. Avoid tanningbeds.
Recently, a form of vitamin B3 has been studied and shown to help withsun damage skin and reduce skin cancer incidence in about 20% of those whotaken it. The vitamin is called nicotinamide, and studies have shown it toefficacious in those who take it with essentially no side effects orinteractions with other meds. The most important prognostic factor isthickness. The thicker the cancer, the greater the mortality rate. Although, ofthe cancer is detected and treated early, the better the outcomes.