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Melanoma Skin Cancer: Knowing the Risks is Key

December 08, 2019

"Melanoma is definitely the most serious skin cancer that exists, and affects millions of people every year."

On today’s show with Dr. Keller Wortham, MD, we’re talking about a serious topic that affects many people in the U.S. alone — skin cancer. Skin cancer is the number one cause of cancer in the United States, but luckily it can often be treated and successfully eradicated if it’s caught early enough. Today’s show is focusing on the most serious type of skin cancer, melanoma. Keep watching to learn the risk factors for melanoma, what to look out for, and how to know when to go see the doctor.

Video Highlights

  • 01:20: Introduction to Melanoma
  • 03:06: What is Melanoma?
  • 04:55: Risk Factors for Melanoma
  • 08:04: Warning Signs of Melanoma
  • 10:49: Preventing Melanoma
  • 13:00: A Couple Notes About Melanoma
  • 13:38: Wrap-Up

Introduction to Melanoma

There are different kinds of skin cancers and some are more serious than others. Melanoma is definitely the most serious skin cancer that exists, and affects millions of people every year. If not caught early, melanoma can spread deep into the underlying tissues under the skin, and then spread throughout the body to different areas (or metastasize). Fortunately, if you catch melanoma early, you can eradicate it, and prevent it from spreading. But if you don't know what you're looking for, and for some reason the melanoma gets deeper into the tissues and spreads, the survival rates can be less than 25%

The number of people affected by melanoma is climbing every year. In fact, more and more people are getting melanoma at a younger age — especially women. It’s not entirely clear why this is happening, but it could be simply that people are getting more time outside in the sun. It could also have to do with certain chemicals in our environment. Additionally, while wearing sunscreen can protect us from UV light, it doesn't protect us from all the UV light, which can penetrate deep into the skin and cause melanoma.

What is Melanoma? 

Melanoma is a cancer of the melanocytes — skin cells deep in your skin layer, which produce pigment, or melanin. So, they're basically the cells that give your skin its color, and which activate and release more melanin to give you a tan. Obviously, fair-skinned people typically have less melanin activated in their skin cells, while people with darker skin have higher concentrations of melanin and melanocytes. However, anyone can get melanoma regardless of skin tone. 

When everything is as it should be, the melanocytes produce pigment, creating a tan, which is your body's natural defense to block UV light from penetrating deeper into the cells. But over time, the melanocyte may get irritated by UV light, or something may happen that causes the cell to misbehave. It starts to divide in a way that isn't controlled, and it gets more abnormal to the point where it loses its own ability to control its division. That out of control multiplication is cancer. 

Now these melanoma cancer cells can then get deep into the tissue and start traveling either through the bloodstream or lymph channels to other parts of the body, where they start new cancers — that's what metastasis is. 

Risk Factors for Melanoma

The risk factors for melanoma include:

  • Having fair skin. That’s because fair skin has a higher level of UV light penetrating it. Melanin protects our skin, so, the darker your skin is, the more protection you're going to have against UV light. This is especially true in people who are very fair-skinned people living near the equator in the tropics — people in places like Australia, New Zealand, South Africa, for example.
  • Your total exposure to UV light over your lifetime is a risk factor. So, if you've ever been sunburned on vacation, if you did tanning beds when you were growing up, or if you were involved in a lot of outdoor sports like lifeguarding or volleyball, then your cumulative UV exposure goes up and your risk for melanoma goes up as well. Also, if you live at high elevation, your risk goes up because there's more UV light penetrating through the atmosphere. 
  • If you have a large number of moles, that can be a risk factor. Each mole has the potential to start developing into a melanoma, to kind of start misbehaving and going through those cellular changes that make it lose control of itself. 
  • Family history is also a big link in melanoma. If you have a family history of melanoma, you may want to keep a sharp eye out for the changes that could indicate melanoma. Then, if you have any questions, go to your doctor to talk to them about them. 

With melanoma, early detection is key. It makes a huge difference in your chances of surviving this potentially devastating cancer. 

The first thing you need to be aware of is what a normal mole looks like. You could have normal moles all over your body and they don't necessarily present a problem, and they may never become cancerous. Most normal moles are uniform in color — the shades may vary from mole to mole, but should be consistent within a single mole. The border should be nice and smooth and they shouldn't be too big; generally it’s good if they’re smaller than the eraser on a normal pencil. If you have moles that are bigger than that, it's a good idea to keep an extra close eye on them or have a dermatologist examine them. 

Warning Signs of Melanoma

The good news about melanoma is that these melanocytes that cause melanoma can change rather slowly. So you might be able to see changes in a mole before it becomes cancerous. There's a bit of a middle ground where they're abnormal, but not quite cancerous. When this occurs, it’s called dysplasia, or you might have heard the term "dysplastic mole" or "dysplastic nevus." 

Fortunately, there's a nice mnemonic for knowing what to look for when it comes to moles, called A-B-C-D-E.

  • A is for Asymmetrical Normal moles are generally round. If you have a mole that's irregular in shape, that can be a sign of a more dangerous skin mole. 
  • B is Border Irregularity — A regular, normal mole has a nice, smooth border and it doesn't blur into the lighter skin around it. If you see an irregular border that starts looking like it's fanning out or becoming jagged, that can certainly be an indication of an abnormal mole and you should get it checked out. 
  • C is for Change in Color — If you have a mole that's been a nice light brown for a while, and then one day you notice it's getting darker or lighter, those changes in color can be an indication that something is happening within those melanocytes. Those pigmenting cells might be abnormal and you may need to have that looked at. 
  • D is for Diameter — If a mole is larger than the eraser on a pencil, it has a higher risk of becoming a melanoma, so keep an extra close eye on it. 
  • E is for Evolving — If you notice that a mole you've had forever starts changing in any of these ways (its shape is changing, its color is changing, the border is changing or, any combination of these things) then you it’s probably a good idea to have a doctor look at that mole. 

Preventing Melanoma

In terms of prevention, there are some things that you can do to really reduce your risk. As we've been talking about, the main risk factor for melanoma is UV light or sun exposure. You should be doing whatever you can to reduce your sun exposure. That includes not going out in the middle of the day when the sun is the brightest, especially if you live near the equator or at high elevations, and wearing sunscreen year-round. 

  • Wear sunscreen, but remember that sunscreen protects you against some UV light, but not all UV light. So don't get a false sense of security from wearing 50 SPF sunscreen. You are still getting some ultraviolet penetration into your deeper tissues, and that can still put you at risk for melanoma. 
  • Wear protective clothing. Wearing long sleeves and long pants can reduce your risk when you’re out in the sun. They have great clothing you can buy now that has a higher amount of UV protection. 
  • Know your moles (what’s normal and what’s not) so that you are ready to alert your doctor if you see any changes to your moles. 
  • See a dermatologist once a year, regardless of your family history, your health history, and your sun exposure. Keep in mind that skin cancer is the most common cancer in our country. If you catch it early, your survival rates are great. You can actually have it removed, and protect yourself from those dangerous, dangerous sequelae, like when the cancer metastasizes and starts growing in other areas of the body. 

A Couple Notes About Melanoma

Not all melanomas are related to sun or UV light exposure. You can get melanomas in areas that rarely if ever see the sun, including the soles of the feet, or the area around the genitals. You can even get melanoma inside your body (though it's very rare), in the intestine, or in the eye. 

Wrap-Up

Now you know the signs, and how serious this condition can be. Don't wait — go see a dermatologist, and familiarize yourself with these things that can indicate that melanin cells in your body are starting to misbehave. Alert your doctor to the changes, and hopefully you’ll spare yourself some very dangerous scenarios.

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