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Malignant Melanoma: Learn to Recognize a Killer

By Stephen M. Schleicher, MD, Lawrence A. Schiffman, DO and Brian J. Stairs, DO

Skin cancer is the single most commonly diagnosed type of cancer in the world. It will affect about 50 percent of us if we live long enough. Although not all types of skin cancer are metastatic, malignant melanoma-the type of skin cancer that is rising faster than all others-is aggressive and potentially deadly.

Massage therapists work intimately with clients' skin. We are in a unique position in that we might see and track changes that our clients may not recognize. While we can't diagnose what we observe, we can give excellent advice about visiting a dermatologist as soon as possible when we encounter a lesion that looks suspicious. Some therapists (myself included) go a step further and stipulate that they will not proceed with another session until a client consults a dermatologist about an undiagnosed skin change. This article provides excellent guidelines for recognizing malignant melanoma. Consider keeping this piece close by to share with clients who have questionable marks or changes on their skin.

- Ruth Werner

Skin cancer has become an epidemic in the United States, with approximately 1 million new cases diagnosed each year. The most common form of skin cancer, basal cell carcinoma, rarely spreads to other organs; left untreated, however, this tumor will erode deep into the skin and cause local destruction of tissue. Another common type of skin cancer, squamous cell carcinoma, is related to two well-known risk factors: chronic sun exposure and smoking. If left untreated, squamous cell carcinoma has the potential to spread inward and result in death.

The most serious form of skin cancer is malignant melanoma, which accounts for the greatest number of skin cancer-related deaths worldwide. It is alarming to note that the incidence of this malignancy is rising at a faster rate than any other cancer.

Indeed, today it is estimated that 1 in 70 Americans will develop melanoma during his or her lifetime, with the risk increasing to 1 in 50 by the year 2010. Over 100,000 new cases of melanoma will be diagnosed this year worldwide. Unlike other types of skin cancer, melanoma can strike younger individuals, with one in four new cases occurring in persons below the age of 40.

Certain risk factors are associated with an increased chance of developing malignant melanoma, including having fair skin; blond or red hair; a history of blistering sunburns during childhood or adolescence; and a family history of this cancer. Certainly, anyone with a large number of moles is at risk, even more so if the moles appear to be changing.

Malignant melanoma is curable if diagnosed and treated in a timely manner. The key to survival is prompt recognition. The majority of melanomas remain symptom-free but are visible on the skin surface to the naked eye. Thus, every individual should examine his or her skin on a regular basis. Good light and a mirror are the only tools necessary for this self-screening; however, enlisting the help of a friend or relative for hard-to-view areas is recommended. Thoroughly examine the back; backside; posterior legs; scalp; and digits, including the toenails and fingernails. If a new skin lesion is noted, or if an existing lesion appears to have changed, consultation with a dermatologist is highly recommended.

Both the American Cancer Society and the American Academy of Dermatology recommend regular skin examinations by a trained professional, and individuals who fall into high-risk categories should be examined more frequently. Luckily, newer technologies using digital cameras and Internet-based image transmission will allow for more widespread screening, which will save more lives.

The ABCDs of Malignant Melanoma Recognition

What does malignant melanoma look like? When examining a skin growth, certain warning signs may signal the presence of this serious malignancy. These are easily remembered as the ABCDs of melanoma recognition.

A=Asymmetry "A" stands for Asymmetry: In other words, one part of the growth is different from other parts of the same lesion. Ordinary moles are round and symmetrical.

B=Border Irregularity "B" stands for Border Irregularity: As is the case with many cancers, melanomas are characterized by uneven growth rates, which result in both asymmetry and irregular borders. Ordinary moles have smooth, even borders.

C=Color Change "C"stands for Color Changes: Common moles usually have a fairly uniform color (most are brown or black). In addition to manifesting various shades of black and brown, melanomas may also demonstrate shades of red, white and blue.

D=Diameter "D" stands for Diameter: Any lesion that demonstrates the above ABCs, and whose size is equal to or greater than the size of a pencil eraser, should be examined by an experienced health care professional.

To the above, we like to add the letters "E" and "I".

E=Elevation "E" stands for Elevation: Over time, most melanomas will become raised. It's better to recognize this cancer before elevation has taken place.

"I" stands for Itch: On occasion, a very early signal that a mole is becoming cancerous is the sensation of itching at the site of the lesion. Thus, any itchy mole merits a trip to the dermatologist immediately.

Malignant melanoma is the most deadly form of skin cancer, but early recognition saves lives. Any mole that enlarges, changes in color or begins to itch should be viewed with suspicion and evaluated by a physician experienced in skin cancer recognition.

Caught early, malignant melanoma is a curable disease.