Skin Cancer: Everything You Need to Know About Melanoma

Media Contact: Karina Rusk
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As the spring season teases us with warmer temperatures and longer days, it’s easy to forget the dark, dreary days of winter and give into the sunshine. However, it’s imperative to be mindful of the damaging effects UV rays can have on the skin—especially when it comes to skin cancer.

Melanoma is one of the deadliest skin cancers. While it is less common than basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), melanoma is more dangerous because of its ability to spread to other organs more rapidly if not caught in its earliest stages.

To listen to an in-depth conversation on this topic with Dr. Amy Paik, Dermatologist at the Salinas Valley Health Clinics Multi Specialty Clinic, click here.

“Melanoma can be very aggressive, because it easily metastasizes, meaning that some cells can break off and spread to lymph nodes or organs. In the beginning stages when melanoma is growing and when it's very thin, the risk of it metastasizing is very low,” states Dr. Amy Paik, MD, dermatologist at Salinas Valley Health Clinics Multi Specialty Clinic in Salinas.

Dr. Paik and her colleagues use an analysis called “Breslow Depth” to predict potential patient risk. Thicker melanomas, especially those greater than four millimeters, carry much more risk because they have invaded deeper into the skin.

Stages Zero to Four

As with other cancers, melanoma is categorized into stages. Stage zero represents a melanoma that has not entered the skin at all; or a “melanoma in situ” (meaning “in place”). From there, the stages progress depending on thickness or if any ulceration has occurred.

Stage three is when the cancer has spread to the lymph nodes, and the cancer is considered stage four if it has spread to other sites on the skin or other organs (e.g. brain, lungs).

Who Is at Highest Risk?

People who have fair skin that easily burns are at higher risk for melanoma. Overall, Caucasians represent the highest-risk category. However, all skin types can develop melanoma—and it’s not always related to outdoor sun exposure.

For example, tanning beds use UVA rays—which penetrate deeper into the skin than UVB rays. “That's one reason why tanning beds are specifically linked to an increased risk of melanoma; because of the UVA rays they use,” explains Dr. Paik.

Check Yourself: The A-B-C-D-E Method

One way individuals can be active participants in their own skin cancer detection is to regularly perform self-checks. Dr. Paik describes what to look for.

“A typical mole will be one even color. If it's soft and fleshy, that's actually a really good sign. I always say, if you have a little hair coming out from it, that's also a very good sign because hair is a complicated skin structure. Cancer doesn't know how to make complex things. All it knows is how to grow. A melanoma would look different; multiple colors and unusual shape, rapidly growing. So, anything that looks different, is acting different than anything else that you have. I like to call it the ‘ugly duckling’ lesion. That's the one we want to be concerned about.”

It’s especially important to pay attention to changing appearance of moles, as many melanomas are asymptomatic in the early stages. Per Dr. Paik, they typically don’t hurt or itch. She advises using the A-B-C-D-E assessment:

• A=Asymmetry. If you cut a mole down the middle, the two halves should mostly “match.”
• B=Border. Anything rough, jagged, or scalloped is concerning. No mole is going to be perfectly round or perfectly oval, but generally it should have a smooth shape.
• C=Color. While some melanomas are all one color, multiple colors within one mole is a pretty good indicator something is amiss.
• D=Diameter. Any mole bigger than six millimeters (the size of a pencil eraser) is concerning. This does not apply to congenital moles.
• E=Evolution. Anytime a mole is rapidly changing, you should definitely have it checked out.

Treatment Options

Once a melanoma has been diagnosed, the first step is to remove the skin cancer and a rim of normal skin around it to address any microscopic spread. This is called a wide local excision.

“There may be a few errant melanocytes or individual cells that travel out from that location and spread to other sites. That's the first treatment,” notes Dr. Paik. “Then it depends on how thick the melanoma was when it was first diagnosed. If it tends to be thicker, we're more aggressive with scans and imaging.”

Sometimes, a melanoma is in an intermediate zone where additional tests can be employed to try to determine if the melanoma has spread or not. While the treatment options for advanced stage melanoma used to be quite limited, Dr. Paik assures many more currently exist.

“We've had this remarkable wave of new medications that are quite effective for metastatic melanoma. They are generally either immunotherapy medications—medications that stimulate your own immune system to attack and fight off the skin cancer—or targeted therapy. So, it's targeting the genes or the proteins of the cancer to prevent it from growing so easily.”

Follow-ups are crucial for anyone who has had an early-stage melanoma removal. “We want to make sure you don't have a recurrence of the melanoma at that site. Also, your risk of developing a second melanoma is higher,” cautions Dr. Paik. “That means skin checks every three to four months for the first two years, then every six months for the next three years, and then yearly for the rest of your life.”

Prevention Tips

The positive aspect of skin cancer—if one was to be identified—is that individuals can actually do a lot in the way of preventative measures. As mentioned, regular self-checks and professional dermatology appointments are largely influential in catching melanomas early on.

Dr. Paik urges individuals use sunscreen anytime they are outdoors (even when it’s seemingly “overcast”), stay out of the sun during the hours the UV rays are most dangerous, and wear protective clothing such as rash guards and wide-brim hats. She also warns people to avoid sunburns at all costs.

“The statistic I've heard is that for every five sunburns, your risk of melanoma doubles.”

All of these steps combined can be very effective in staving off deadly skin cancer. That said, there are also benefits to being outdoors—both mental and physical perks. Dr. Paik encourages individuals be mindful of the sun’s detriments and act accordingly, but not be fearful of the sun.

“I think it’s best to strike a balance. It is really important to protect your skin. Use sunscreen. Keep an eye on your moles. But, try not to have such immense fear about developing melanoma. There are so many benefits to being outside and being active in the sun. There are a lot of mental benefits, physical benefits. I just tell my patients to protect your skin, and try to be smart.”