Get answers to your Melanoma questions.
Skin cancer; Squamous cell cancer; Basal cell cancer; Actinic keratosis; Nonmelanoma skin cancer
Education and prevention programs have led to improved screening for skin cancer, which in turn has improved diagnosis and survival rates for melanoma. For example, a study published in the journal CANCER has shown that older men are more likely to undergo a whole body skin exam if they are aware of personal risk factors and know where to go for the exam.
Skin cancers may have many different appearances. They can be small, shiny, or waxy, scaly and rough, firm and red, crusty or bleeding, or have other features. Itching, tenderness, scaling, bleeding, crusting, or sores can signal potentially cancerous changes in any mole.
There are a number of factors to look for, which can serve as a general guide. They fall under the skin cancer ABCDE rule:
Keep in mind that the most important warning sign of melanoma is a new or changing skin lesion, regardless of its size or color. Changes that occur over a short period of time (particularly over a few weeks) are most concerning.
Anyone with risk factors for skin cancer should check their entire body about once a month. People who regularly check moles on their skin may have a lower risk of developing advanced melanoma.
Experts suggest drawing a map of the body, indicating locations of moles, areas of discoloration, lumps, or other blemishes. Whenever you do a self-examination, compare your body to the map to check for new lesions, lumps, or moles and for changes in shape, color, and size.
Some experts have defined three specific body areas to look for skin cancers, including melanomas:
Ask a partner to help you check these areas. Turn on a hair dryer to separate your hair and examine the scalp.
Some experts recommend that everyone, especially those with a high risk of developing melanoma, have a dermatologist perform a whole body skin exam. High-risk people include those with a personal or family history of melanoma and individuals with atypical nevi (irregular moles that are larger than normal).
Such people should protect themselves from overexposure to sunlight and have a medical examination of the entire skin surface every 3 - 12 months (the frequency depends on your risk factors). The doctor may take photographs of specific moles, or your entire body, at each visit and compare them with previous photos to look for any changes.
Examinations for Patients Previously Treated for Melanoma. People who have had melanoma and have been treated successfully are at risk for the cancer returning (recurrence) or for developing another primary melanoma. Based on recurrence rates by cancer stage, a team of researchers suggested the following guidelines for being reexamined by the doctor after treatment:
All patients should be checked annually after year 5. These are guidelines only and may depend on the individual patient.
Abbasi NR, Yancovitz M, Gutkowicz-Krusin D, Panageas K, Googe P, King R, et al. Utility of lesion diameter in the clinical diagnosis of cutaneous melanoma. Arch Dermatol. 2008;144:469-474.
American Cancer Society. Cancer Facts and Figures 2008. Atlanta, GA: American Cancer Society; 2008.
Anderson L, Schmieder GJ, Werschler WP, et al. Randomized, double-blind, double-dummy, vehicle-controlled study of ingenol mebutate gel 0.025% and 0.05% for actinic keratosis. J Am Acad Dermatol. 2009;60(6):934-43.
Basal cell and squamous cell cancers: NCCN Medical Practice Guidelines and Oncology;V.1.2009. Accessed July 15, 2009.
Braathen LR, Szeimies RM, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, et al. Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. International Society for Photodynamic Therapy In Dermatology, 2005. J Am Acad Dermatol. 2005;56:125-143.
Brantsch KD, Meisner C, Schonfisch B, Trilling B, Wehner-Caroli J, Rocken M, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. The Lancet Oncology. 2008;9:713-720.
Clinical practice guideline for melanoma: NCCN Medical Practice Guidelines and Oncology;V.2.2009. Accessed July 15, 2009.
Cyr PR. Atypical Moles. Am Fam Physician. 2008;78(6):735-40. Review.
deBerker D, McGregor JM, Hughes BR. Guidelines for the management of actinic keratoses. Br J Dermatol. 2007;156:222-230.
Eggermont AM, Suciu S, Santinami M, et al: EORTC Melanoma Group. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final result of EORTC 18991, a randomised phase III trial. Lancet. 2008;372(9633):117-26.
Garcia C, Polette E, Crowson AN. Basosquamous carcinoma. J Am Dermatol. 2009;60(1):137-43.
Goodson AG, Grossman D. Strategies for early melanoma detection: Approaches to the patient with nevi. J Am Acad Dermatol. 2009;60(5):719-35: quiz 736-8. Review.
Guadagnolo BA, Zagars GK. Adjuvant radiation therapy for high-risk notal metastases from cutaneous melanoma. Lancet Oncol. 2009;10(4):409-16.
Hexsel, CL, Bangert SD, Hebert AA, et al. Current sunscreen issues: 2007 Food and Drug Administration sunscreen labelling recommendations and combination sunscreen/insect repellent products. J Am Dermatol. 2008;59(2):316-23. Review.
Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the surveillance, epidemiology, and end results (SEER) program. Arch Dermatol. 2008;144:515-521.
Lange JR, Fecher LA, Sharfman WH, et al. Melanoma. In: Abeloff MD, Armitage JO, Nierderhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone; 2008:chap 73.
Lautenschlager S, Wulf HC, Pittelkow MR. Photoprotection. The Lancet [early online publication]. May 3, 2007.
Markovick SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, et al. Malignant melanoma in the 21st century, part 1:epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc. 2007;82:364-380.
Markovick SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, et al. Malignant melanoma in the 21st century, part 2: staging, prognosis, and treatment. Mayo Clin Proc. 2007;82:490-513.
Morton CA, mckenna KE, Rhodes LE:British Association of Dermatologists Therapy Guidelines and Audit Subcomittee and the British Photodermatology group. Guidelines for topical photodynamic therapy: update. Br J Dermatol. 2008;159(6):1245-66. Review.
Morton DL, Thompson JF, Cochran AJ Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307-1317.
Olsen CM, Zens MS, Stukel TA, et al. Nevus density and melanoma risk in women: to test the divergent pathway hypothesis. Int J Cancer. 2009;124(4):937-44.
Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007;57:484-501.
Savel MS, Wong SI. Review of evidence-based support for pretreatment imaging in melanoma. J Natl compr Canc netw. 2009;7(3):281-9. Review.
Suh KY, Bolognia JL. Signature nevi. J Am Acad Dermatol. 2009;60(3):508-14. Review.
Telfer NR, Colver GB, Morton CA. Guidelines for the Management of Basal Cell Carcinoma. BJD. 2008;159:35-48.
Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion-when and how. J Am Acad Dermatol. 2008;59(5):852-71. Review.
Treatment for Metastatic Ocular Melanoma. NCI Cancer Bulletin. March 7, 2006;3(10):8.
Vestergaard ME, Macaskill P, Holt PE, et al. Dermoscopy compared with naket eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669-76.
Warycha MA, Zakrzewski J, Ni Q, et al. Meta-analysis of sentinal lymph node positivity in thin melanoma. Cancer. 2009;115(4):869-79.
Wood GS, Gunkel J, Stewart D, et al. Nonmelanoma skin cancers: basal and squamous cell carcinomas. In: Abeloff MD, Armitage JO, Nierderhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone; 2008:chap 74.
Zeichner JA, Stern DW, Uliasz A, et al. Placebo-controlled double-blind randomized pilot study of imiquimod 5% cream applied once per week for 6 months for the treatment of actinic keratoses. J Am Acad Dermatol. 2009;60(1):59-62.
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