Blog: What I Wish Everyone Knew About Melanoma

What I Wish Everyone Knew About Melanoma

 I wish all melanomas were as obvious as the ones commonly displayed on photos from The Skin Cancer Foundation or the American Academy of Dermatology. You know, the photos that show a black, gnarly lesion or a bizarre-looking tri-colored mole that is part black, brown, and pink? I mean, how could someone not notice something that dark and irregular on their skin? 

 The truth is that a lot of melanomas are not that obvious. Most patients are completely unaware when a melanoma is on their skin, and some melanomas have even been missed by physicians, including dermatologists. How could that be?

 I try to educate my patients on what to look for so that they will come see the dermatologist right away if they notice something concerning, rather than waiting months or years, when it is often too late.

 It's important to know that the majority of melanomas show up as a brand-new skin lesion that you never had before. In contrast, only about 25% of melanomas arise from within a pre-existing mole, such as a mole you've had all your life that suddenly starts looking more irregular in shape, size, or color.

 Second, almost all melanomas start out flat. You typically won't be able to feel a melanoma because it's flat like a freckle. Only when a melanoma has been there a while and has begun to grow deep will it also raise up so that your fingers can feel it. Once a melanoma has raised up, it has become more dangerous.

 Melanomas can be subtle. Every dermatologist can tell stories of "that melanoma I almost didn't biopsy but I'm so glad I did." So, it's important to know what to look for. Uncommonly, melanoma can be missed because it can look like a nonspecific pink patch or a cyst-like lesion in the skin, but by far the most common presentation of melanoma is that it looks similar to your other moles or freckles but just a shade darker.

 So here comes my "ugly duckling" rule. If you have dozens or even hundreds of moles or freckles on your body, so many that it's hard to keep track, just remember that if there is one lesion that catches your eye because it looks a little different than the rest, such as being a shade darker, then get it checked right away. The ugly duckling is the one that is suspicious for melanoma, and with melanoma time is of the essence.

 When melanoma is caught early, while it is still flat, it is in its most curable stage. The longer a melanoma has been present, the deeper it grows which portends a worse prognosis. In fact, dermatologists categorize melanomas by depth from the skin surface (<1 mm, 1-2 mm, 2-4 mm, >4 mm), with those that have grown the deepest being the most dangerous.

 For most melanomas that measure less than 0.8 mm deep, lymph nodes do not need to be tested and treatment involves surgical excision only followed by routine surveillance. For deeper melanomas, lymph node testing and a referral to an oncologist might be in order. The good news is that oncologists now have new targeted drugs to treat metastatic melanoma that were not available even 5-10 years ago. Thankfully, the average melanoma patient is living longer now, even those who have stage 4 disease.

 Who is at risk for melanoma? About 2-3% of people will develop melanoma in their lifetime, so that's about 1 in 30 to 1 in 40 people. While it can occur in any race and ethnicity, it is much more common in those with pale skin who are prone to sunburns. Having freckles, blue or green eyes, and red hair also puts one at higher risk. A history of many sunburns and/or tanning bed use are other big risk factors. Also, melanoma incidence increases with age, not only due to cumulative sun exposure but also due to the relative weakening of our immune systems with age.

 What can you do to prevent melanoma? Far better than slapping on sunscreen is simply keeping your skin covered with clothing. Have you ever gotten a sunburn through your clothing? Unlikely. Any clothing will do, but darker, tighter weaves of fabric work better than light, loosely woven fabric such as linen. Many clothing companies now sell lightweight, breathable UPF-protective clothing that makes sun protection much easier. 

 Wear a hat, preferably one with a broad brim to shield your ears and face, and wear sunglasses. Apply sunscreen (the higher the SPF the better) to any remaining exposed skin such as the lower legs and tops of feet, face, neck, and hands. Most people underapply sunscreen by roughly 50%, so that's where the higher SPFs will protect you better. And if you are swimming or sweating, sunscreen should be reapplied hourly.

 Lastly, if you have never had your skin checked by a dermatologist, it's not a bad idea to see one for a full-body skin cancer screening. The great majority of skin cancers that I diagnose are ones that I spot on a routine skin exam, but of which patients are completely unaware. When it comes to melanoma, something as simple as a routine skin check could save your life. 


By Heather Downes, MD

Board-Certified Dermatologist

Owner/Founder of Lake Forest Dermatology