Charles Padgett, MD, chief of medical oncology, Paul Fowler, MD, radiation oncologist, and Lois Kamugisha, MD, medical oncologist. Chemotherapy may be part of your skin cancer treatment plan, depending on your unique condition.
Melanoma—a cancer that starts in the deep layers of skin with the cells produce pigment—is the leading cause of death related to skin cancers. Fortunately, if treated early, melanoma can be cured.
Melanoma can be found anywhere on the body, including the trunk, arms and legs, head and neck areas and under the nails. While fair-skinned people are more likely to get melanoma (as they have less pigmentation to protect their skin from sun damage), it does occur in people with different skin tones. And, while approximately 5 to 10 percent of diagnosed cases are genetically-linked, 20 percent occur in people with a history of sunburns.
The following have been identified as possible risk factors for melanoma:
- Family history of cancer, especially melanoma
- Excessive sun exposure and exposure to UV radiation
- Multiple blistering sunburns
- Actinic keratoses; rash of scaly or crusty bumps that could be pre-cancerous
- Diagnosis of non-melanoma skin cancer such as basal cell and squamous cell
- Use of sun lamps and tanning beds, which have been proven to be cancer-causing in people
- Fair complexion
Have discussions with your doctor about skin cancer during your regularly scheduled appointments or if you notice any specific changes to your skin or to moles in particular. The most important changes to look for, and immediately discuss with your doctor, include changes in any mole including:
- Growth, bleeding, or itching
- Asymmetrical appearance (left and right sides of mole do not look identical)
- Irregular, blurry, or jagged edges
- Color change including loss, spreading, darkening, loss of color, or the appearance of multiple colors
- Large size: a diameter greater than 6 mm (the size of a pencil eraser)
- Raised above the skin with an uneven surface
You should also consult your doctor if you notice any lesions or areas of damaged skin. This includes lesions that:
- Appear smooth or waxy
- Grow in a cluster that is pink or red with a shiny or scaly appearance
- Heal and reopen repeatedly
- Form as a brown or black streak underneath a nail
Early detection can be your greatest tool in fighting skin cancer—treatment is much more effective when skin cancer is caught in its early stages.
To protect your skin from cancer and the ever increasing radiation from the sun’s rays, just remember these four steps:
- SLIP—Slip on a comfortable shirt that is tightly woven.
- SLOP—Slop on the sunscreen with an SPF of at least 15 and apply it every 15-20 minutes (even if it says waterproof).
- SLAP—Slap on a wide brimmed hat to protect your face, neck, and ears.
- WRAP— Wrap sunglasses around your eyes, some of the most sun sensitive organs in your body.
If you have a mole that changes in size, color or shape or one that bleeds, see your doctor. The sooner skin cancer is diagnosed, the less chance it has to spread to other parts of the body.
One of the best ways to detect possible melanoma is to know your body and skin so you can spot any changes in your skin or moles. You can do this by doing a monthly skin self exam.
- Look at the front and back of your body in a full length mirror, if possible.
- Look at your sides with your arms raised.
- Bend your elbows and look at your forearms and upper arms. Don't forget to look at your hands.
- Sit down to look at the front and back of your legs and feet. Remember to look between your toes and on the bottom of your feet.
- Check the back of your neck and your scalp. Try using a hand held mirror for a better look.
Do the skin exam regularly and you'll know what is normal and when to call your doctor if you see any changes in your moles or skin. Pay attention to
- Asymmetry—One half of the mole does not match the other
- Border—The edge of the mole is uneven, notched or blurred.
- Color—The color of the mole is not all the same. Red, white, and even blue colors can appear.
- Diameter—Any sudden or on-going change in size.
Screening and Diagnosis
Patients at high risk for developing melanoma and forms of skin cancer can benefit from periodic screenings. This includes any patient with:
- A personal history of melanoma
- A family history of melanoma
- A suspicious lesion, mole, or spot
- Moderately to severely sun-damaged skin
- Multiple pigmented lesions
Have a dermatologist check you once a year for any skin growths that could potentially be skin cancer. You may also want to take note of any moles or large freckles you have, paying careful attention to their shape and size, and point them out to your dermatologist at your appointment.
At a screening for skin cancer, you can expect MedStar Health dermatologists or dermatologic oncologists to review your medical history, perform a physical exam, and even take photographs to monitor any suspicious lesions. Our specialists may need to perform one or both of the following procedures:
The dermatoscope is a hand-held medical device that is composed of a series of lights or bulbs and a magnifying lens. Your physician can evaluate features of a mole using this device. Certain characteristics make a mole more likely or less likely to be melanoma—the dermatoscope allows doctors to examine the mole to determine if a biopsy is necessary.
If your physician has determined that the structure of the mole is not stable, meaning it needs to be examined more carefully under a microscope, you may need a biopsy. Biopsy techniques include
- Shave biopsy—Performed with either a handheld blade or a DermaBlade. Neither of these requires stitches.
- Punch biopsy—Removal of a core of tissue and requires a few stitches.
- Excisional removal—If the mole is large, your physician will perform a narrow cut to remove the entire mole.
Any biopsies taken will be reviewed by a dermatopathologist for signs of cancer. If necessary, you may be evaluated by other specialists.
Staging and Treatment
Staging is a complicated process that determines treatment for melanoma and other skin cancers, It takes into account original information from the surgical consults, and if necessary, imaging studies. The stages are as follows:
Tumors are <1.0mm thick, without ulceration. Stage 1A melanomas have not penetrated deeper than the epidermis.
Tumors are <1.0 mm thick and are either ulcerated or have penetrated into the deep dermis layer of the skin. Tumors 1.01-2.0mm thick that are not ulcerated are also classified as Stage 1B.
Tumors 1.01-2.0 mm thick with ulceration or tumors 2.01-4.0mm without ulceration.
Tumors 2.01-4.0mm thick with ulceration or tumors >4.0mm thick without ulceration.
Tumors >4.0mm thick with ulceration. They are aggressive tumors that are very likely to spread.
Stage IIIA, Stage IIIB, Stage IIIC
Tumor can be any size. Disease has spread (metastasized) to nearby lymph nodes. Metastasis may be detectable only on microscopic examination (micrometastasis) or on clinical examination and biopsy (macrometastasis).
Tumor can be any size. Disease has spread to distant lymph nodes or other organs such as the brain, liver and lung.
To plan the best treatment for each patient, your MedStar Health doctor considers the location and size of the cancer; the risk of scarring; and the person's age, general health, and medical history.
Fortunately, when treated at an early stage of development, skin cancer has a very high rate of cure. Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes a combination of these methods is used.
At MedStar Health, we do not just treat skin cancer. We treat the whole patient, which is why we place so much value on continued care.
Even though most skin cancers can be cured, the disease can recur in the same place. And, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer elsewhere on the skin. That's why it's important for them to continue to examine themselves regularly, to visit their doctor for regular checkups, and to follow the doctor's instructions on how to reduce the risk of developing skin cancer again.