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Melanoma

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WOMEN'S HEALTH

Hair/Nails/Skin

CANCER

Skin

From MayoClinic.com

Risk factors

Factors that may increase your risk of skin cancer include:

  • Fair skin. Having less pigment (melanin) in your skin means you have less protection from damaging UV radiation. If you have blond or red hair, light-colored eyes and you freckle or sunburn easily, you're more likely to develop melanoma than someone with a darker complexion. Fair-skinned people of Northern European ancestry are particularly at risk. Queensland, Australia, has the highest skin cancer rate in the world because it has unusually high levels of UV radiation and because most of its inhabitants are of English or Irish descent.

  • A history of sunburn. Every time you burn your skin, you increase your risk of developing skin cancer. People who have had one or more severe, blistering sunburns as a child or teenager are at increased risk of skin cancer as an adult. For that reason, it's particularly important to protect children from the sun, not just with sunscreen but also with a hat, protective clothing and dark glasses. Although sunburns in adulthood are also a risk factor, the greatest damage seems to occur before you're 18. Infants are at greatest risk because the melanin in their skin isn't fully developed.

  • Excessive sun exposure. Exposure to UV radiation is the leading cause of all skin cancers, including melanoma. Many experts believe that the greatest damage may occur before age 18. For that reason, it's especially important to make sure children wear sunscreen or protective clothing when they're outdoors.

  • Sunny or high-altitude climates. Living in a sunny climate exposes you to more UV radiation than does living in a cool, cloudy climate. Skin cancer is far more common in Arizona than in Minnesota. If you live at a high elevation, where the sun is stronger, you're also exposed to more UV radiation.

  • Moles. Having just one dysplastic mole doubles your risk of melanoma. Having 10 or more increases your risk 12 times. But it's not only atypical moles that make you more susceptible to melanoma — having more than 50 ordinary moles also increases your risk.

  • A family or personal history of skin cancer. If a close relative, such as a parent, child or sibling, has had melanoma, you have a greater chance of developing it too. And if you've had melanoma once, you're more likely to develop it again.

  • Weakened immune system. People with weakened immune systems are at greater risk of many diseases, including skin cancer. This includes people who have undergone an organ transplant, have certain cancers or HIV/AIDS, or are taking medications that suppress the immune system.

  • Exposure to environmental hazards. Exposure to environmental chemicals, including some herbicides, increases your risk of melanoma.

  • Rare genetic disorder. People with xeroderma pigmentosum, which causes an extreme sensitivity to sunlight, have a greatly increased risk of developing melanoma.

Screening and diagnosis

The American Cancer Society (ACS) recommends skin examinations every 3 years for adults between the ages of 20 and 40 and yearly exams for everyone older than 40. These screening exams involve a head to toe inspection of your skin by someone qualified to diagnose skin cancer such as a dermatologist or nurse specialist. If you have risk factors for skin cancer — fair skin, a history of severe sunburns, one or more dysplastic moles, or a family history of melanoma — talk to your doctor about more frequent screenings. Some doctors believe that all close family members of a person with melanoma also should be screened.

In addition, the ACS recommends monthly self-exams for everyone older than 18. This helps you learn the moles, freckles and other skin marks that are normal for you, so you can notice any unusual changes. It's best to do this standing in front of a full-length mirror while using a hand-held mirror to inspect hard to see areas. Be sure to check the fronts, backs and sides of your arms and legs; your groin, scalp and fingernails; and your soles and the spaces between your toes.

If you notice a new skin growth, a change in an existing mole or a sore that doesn't heal in 2 weeks, see your doctor. He or she may suspect cancer by simply looking at your skin, but the only way to accurately diagnose melanoma is with a biopsy. In this procedure, your doctor or dermatologist removes all or part of the suspicious mole or growth, and a pathologist analyzes the sample. Sometimes more than one pathologist may examine the tissue to determine whether cancer is present.

If your mole is small, your doctor is likely to perform an excisional biopsy such as a punch biopsy or an elliptical excision. In this procedure, the entire mole or growth is removed, along with a small border of normal-appearing skin. On the other hand, your doctor might use an incisional biopsy for large moles, or for those on your hands or face, where scars are more obvious. In that case, only the most irregular part of a mole or growth is taken for laboratory analysis.

Staging

If you receive a diagnosis of melanoma, the next step is to determine the extent, or stage, of the cancer. Melanoma is staged using these criteria:

  • Thickness and depth. A pathologist determines the thickness and depth of a melanoma by carefully examining it under a microscope. The depth of a cancerous lesion is the most important factor in deciding on a treatment plan. In general, the deeper the tumor, the more serious the disease.

  • Spread. It's also important to determine whether melanoma cells have invaded your lymph nodes. To do so, your surgeon may use a procedure known as a sentinel node biopsy. Until recently, surgeons would remove as many lymph nodes as possible to verify that the nodes didn't contain cancer cells. But this greatly increased the risk of lymphedema — severe swelling of the involved area — and other side effects. That's why a procedure was developed that focuses on finding the sentinel nodes — the first nodes to receive the drainage from malignant tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed. This spares you the risks of more extensive procedures.

Melanoma is staged using the numbers 0 through IV:

  • Stage 0. This melanoma is also called in situ (in one place) melanoma. At this stage, the cancer is confined to the epidermis and hasn't begun to spread. Finding and treating a cancerous tumor at this stage offers the best chance for a full recovery.

  • Stages I through IV. These cancers are invasive tumors that have the ability to spread to other areas. A stage I cancer is small and well localized and has a very successful treatment rate. But the higher the stage number, the lower the chances of a full recovery. By stage IV, the cancer has spread beyond your skin to other organs, such as your lungs, liver and bone. Although it may not be possible to eliminate the cancer at this stage, treatment with radiation or biological or experimental therapies may help alleviate symptoms the cancer is causing.

Melanoma > 1 > 2 > 3 > 4

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