Skin cancer is the most common cancer in the United States, and it is the sixth most common cause of cancer death in the United States. Melanoma is the least common of the skin cancers (the other types are squamous cell carcinoma and basal cell carcinoma), but it is the most serious. It can be life threatening if it spreads (metastasizes) to other parts of the body. The frequency of diagnosis of melanoma has been increasing in recent years, faster than any other cancer.Melanoma starts in the color-producing cells of the skin and may develop in an existing mole or may occur as a new mole. Early diagnosis and treatment can lead to a complete cure, while advanced forms are likely to have a poor outcome. Advanced melanoma can spread to lymph nodes as well as other areas in the body, typically the lungs, liver, and brain.
A skin biopsy, where a physician removes a small sample of skin for testing, is a rapid and convenient office procedure that aids in the diagnosis of a patient's skin condition or lesion. Although usually done by a dermatologist, any physician who is skilled and knowledgeable with the technique and its indications can safely perform a skin biopsy. There are several techniques that involve sampling tissue from a skin lesion or eruption. Once removed, the tissue sample is processed and examined under a microscope by a pathologist. It usually takes several days before a final diagnosis is rendered.Skin biopsy procedure selection very much depends on the suspected diagnosis, size, and location of the lesion.
Atypical moles (atypical nevi) or dysplastic moles (dysplastic nevi), are caused by collections of the color-producing (pigment-producing) cells of the skin (melanocytes) in which the cells grow in an abnormal way. Atypical moles may occur as new lesions or as a change in an existing mole. Lesions may be single or multiple. In atypical-nevus syndrome, hundreds of atypical moles may be seen. People with atypical moles may be at increased risk for developing skin cancer (melanoma), with the risk increasing with the number of atypical moles present.
A mole (nevus) is a non-cancerous (benign) skin lesion that is made up of the color-producing (pigment-producing) cells of the skin (melanocytes). A mole that is present at birth is referred to as a congenital nevus. A dysplastic nevus (discussed elsewhere) is a mole in which unusual (atypical) growth is noted. Moles (nevi, the plural of nevus) slowly enlarge evenly in all directions. After moles stop growing (stabilize), they may persist or they may become smaller (regress) later in life. Sun exposure and family tendency (heredity) play a role in the development of moles. Moles may sometimes become warm or red in color (inflamed) or irritated by friction from rubbing or contact with rough clothing or by other types of injury.
A birthmark (congenital melanocytic nevus, CMN) is a mole that is present at birth or shortly thereafter. A congenital melanocytic nevus is one common type of birthmark, caused by a cluster of color (pigment) cells in the skin and sometimes in deeper tissues.All birthmarks have a 2–5% lifetime risk of turning into a cancerous (malignant) mole, which is called melanoma. This risk is higher in children who have a giant (larger than 20 cm, or about 8 inches) congenital melanocytic nevus.Large moles on the head or spine may rarely have associated nervous system problems.
Oral melanotic macule is a non-cancerous (benign), dark spot found on the lips or inside the mouth. An oral melanotic macule found on the lip is sometimes called a labial melanotic macule.
Psoriasis is a noncontagious, lifelong skin condition that affects about 2–3% of the population of the United States. People with psoriasis have thickened, red, and often scaly patches on their skin. Psoriasis is very likely to run in families, but it can also be triggered by certain situations, such as emotional stress, injury to the skin, infection, as well as taking certain medications. The exact cause of psoriasis is unknown, but it seems to be caused by errors in how the immune system functions.
Many dermatology patients will undergo a skin biopsy at some point during their lives, especially if they have a new lesion that could potentially be a skin cancer. During a biopsy, a sample of body tissue is taken so that a type of doctor, known as a pathologist, can examine the individual cells in the tissue under a microscope in order to make a more definitive diagnosis.
Melanoma cancers are classified most frequently by their depth into the skin and the deeper layers of the skin. The pathologist reads the biopsy and measures the depth of the melanoma cancer cells under the microscope. There are several melanoma stages, an early melanoma is typically quite superficial. The hope is that people will recognize the early signs of melanoma, see their doctor, and have the lesion removed – and that the pathology report will reveal a melanoma that has not deeply invaded the skin. A melanoma that has not invaded into the deeper skin is called a “melanoma in situ.”
Personal account by Kierna Terrisse The first time I noticed the mole on my fiancé Eric’s upper arm, we were living in New York City. It was only a mole, so we ignored it. Three years later we were celebrating our honeymoon when I noticed the mole appeared more distinct. It looked strange, but still, neither of us gave it much attention. At the time I didn’t realize something so simple and harmless looking could kill you. If I knew then what I know now, things might have turned out much differently.
Since both moles and melanoma come from melanocytes, how can you tell the difference between a normal mole and a melanoma?
Did you know approximately 20 out of every 100,000 light-skinned people will develop malignant melanoma? With odds like that you might not think it’s worth it to give much thought to this cancer. But malignant melanoma is real. I was one of those 20 in 100,000. My story isn’t unusual. In fact, you may find that my sun exposure sounds a lot like yours. I’m in my 30s and spend most of my days inside at work. It’s been years since I spent my summers life guarding at the pool. Plus, as an adult I always wore sunscreen whenever I knew I was going to be outside for any length of time. So what happened? Why did I get malignant melanoma? And more important, how did I manage to detect it early when it really wasn’t a prominent concern on my health radar?
Question: I’ve heard so much about the high cure rates for Mohs surgery in treating nonmelanoma skin cancers. Why isn’t Mohs surgery popular for malignant melanoma?
An experimental drug called PLX4032 shrunk advanced melanoma tumors in 81% of patients, according to an early phase study reported in the New England Journal of Medicine. For two patients, the tumors disappeared completely, while in 24 others the tumor shrank by more than 30%. In most cases the shrinkage was temporary, so the goal is for the drug to be combined with other treatments to produce a long-lasting effect. PLX4032 is designed to target tumor cells with a mutation in a gene called BRAF.
A recent study published in the April issue of Mayo Clinic Proceedings reports that between the years 1979 and 2009, the incidence of melanoma increased eightfold among young women and fourfold among young men ages 18 to 39. “There is currently a melanoma epidemic in the U.S., particularly in young women and middle-aged men. This has been documented by various large population-based studies, with our study confirming that trend in young women,” said Mayo Clinic dermatologist Dr. Jerry Brewer.