What is Melanoma

Melanoma is a serious skin cancer, which is curable if detected early. Melanoma represents approximately 4-5% of all skin cancers in the USA, but accounts for about 75 % of all skin cancer deaths. Melanoma grows from pigment cells (melanocytes) in the outer layer of the skin and mucous membranes (epidermis). Although melanoma usually starts as a skin lesion, occasionally it occurs on other parts of the body such as the eye, mouth or vagina. Frequent self-examination for the ABCDE (Asymmetry, Border Irregularity, Color, Diameter asnd Evolving) characteristics of abnormal moles is suggested. Melanoma tends to spread out within the epidermis before moving into the deeper layer of the skin (the dermis). In an advanced stage it can spread to other organs of the body.

FOUR BASIC TYPES OF MELANOMA
Melanomas fall into four basic categories. Three of them begin in situ - meaning they occupy only the top layers of the skin - and sometimes become invasive; the fourth is invasive from the start. Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body.

Superficial spreading melanoma
is by far the most common type, accounting for about 70 percent of all cases. This is the one most often seen in young people. As the name suggests, this melanoma travels along the top layer of the skin for a fairly long time before penetrating more deeply.

The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat geometrical in form. The color varies, and you may see areas of tan, brown, black, red, blue or white. This type of melanoma can occur in a previously benign mole. The melanoma can be found almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both.

Lentigo maligna
is similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration. This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii. When this cancer becomes invasive, it is referred to as lentigo maligna melanoma.

Acral lentiginous melanoma
also spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians.

Nodular melanoma
is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. It is usually black, but occasionally is blue, gray, white, brown, tan, red or skin tone.

The most frequent locations of melanoma on the body are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men. This is the most aggressive of the melanomas, and is found in 10 to 15 percent of cases.

THE STAGES OF MELANOMA
Once the type of melanoma has been established, the next step is to classify the disease as to its degree of severity.

Classifications for melanomas are called stages. The stage refers to the thickness, depth of penetration, and the degree to which the melanoma has spread. The staging is used to determine treatment.

Early melanomas (Stages I and II) are localized, and advanced melanomas (Stages III and IV) have spread (metasticized) to other parts of the body. There are also subdivisions within stages.

WARNING SIGNS: The ABCDEs of Melanoma
Moles, brown spots and growths on the skin are usually harmless - but not always. Anyone who has more than 100 moles is at greater risk for melanoma. The first signs can appear in one or more atypical moles. That's why it's so important to get to know your skin very well and to recognize any changes in the moles on your body. Look for the ABCDEs of melanoma, and if you see one or more, make an appointment with a physician immediately.

	Asymmetry If you draw a line through this mole, the two halves will not match.
	Border The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
	Color Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, blue or some other color.
	Diameter Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 inch or 6 mm), but they may sometimes be smaller when first detected.
	Evolving Any change - in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting - points to danger.

Benign	Malignant
Symmetrical	Asymmetrical
Borders are even	Borders are uneven
One shade	Two or more shades
Smaller than 1/4 inch	Larger than 1/4