As May is skin cancer prevention month, it is appropriate to talk about the most lethal of the three main types of cutaneous malignancies, melanoma. The occurrence of melanoma over the past several decades has continued to increase. It seems more and more people are being diagnosed and treated for this type of skin cancer. One of the reasons for this greater incidence is that the disease is being detected much earlier today. More aggressive detection through self-screening practices, health fairs, and public awareness has led to earlier diagnoses and treatments.
Because advanced melanoma and metastatic spread has no real satisfactory treatments, diagnosing early melanomas which can be successfully treated by surgery is extremely important. Evaluations can be done on a very regular basis by self-examination or periodically by physician examinations. A recent study out of Stanford published in the March issue of Skin & Aging magazine has shown that physician examinations are associated with thinner melanoma diagnoses than patient self-examinations. Of 223 melanoma patients studied, those who had a physician exam in the last year had a mean tumor depth of 1.58 mms at diagnosis compared to 2.51 mms in those who did not. The importance of a thinner diagnosis is that the chance of disease spread and 5 year survival rates are primarily related to how thick (deep) the tumor has penetrated into the skin at the time of diagnosis. (Breslow level)While self-examinations may be done more frequently, the ‘eyes’ are not as skilled at detecting suspicious lesions as that of a physician. Plus, physician examination is more likely to lead to an immediate biopsy of any suspicious lesion, hence catching melanomas earlier in their spread.
These results in no way suggest that self-detection is not important. The study also reports that 80% of melanomas in men and 90% in women are detected by the patient or someone in the patient’s life as opposed to a physician. So self-examination is still key, it should just be combined with intermittent physician evaluation, particularly in those patients with a personal history of melanoma or a family history of melanoma. Seeing a screening physician at least every year would be an important complement to one’s self- evaluation. Plus I remember reading that about 50% of melanomas in men occur on their backs, a difficult area for good self-evaluation.
Self-examination historically uses the ABCD method, A = asymmetry B = border irregularity C = color variation D = diameter greater than a pencil eraser. While this method is still valid, revised methods of detection are being developed. High-risk factors for melanoma are white skin color, those with moles or with a personal or family history of melanoma, those who burn easily or are older than age 40, and those with dysplastic nevi. Important visual cues include the presence of multiple characteristics in one lesion such as white scar-like areas or milky red areas and red spots.
In my Indianapolis plastic surgery practice, I get asked frequently to look at skin lesions to see if they are ‘ok’. Many times they are normal. But if there is any question, a simple punch biopsy is the most accurate method to find out and one should have a very low threshold for having that simple procedure done.
Dr. Barry Eppley
Indianapolis, Indiana