Melanoma

Melanoma is a rare yet more aggressive form of skin cancer. It originates in melanocytes, the cells responsible for giving your skin its color, and it can appear on any part of the body. Interestingly, melanomas can also develop in the eyes (ocular melanoma) and in areas of the body that have never been exposed to sunlight. Australia holds the unfortunate record for the highest incidence of melanoma in the world. Each year, approximately 16,800 Australians are diagnosed with melanoma, and about 1,300 individuals succumb to this disease. However, there are preventive measures you can take to lower your risk of melanoma.

Melanoma Topics Overview

• Identifying Melanoma
• Melanoma Stages
• Causes & Diagnosis
• Treatment
• When to Seek Medical Advice
• Prevention

How Does Melanoma Appear?

While most melanomas are brown or black, they can also be tan, pink, or even white. They may appear flat or raised, varying in size and shape. The four types of melanoma exhibit distinct characteristics:

• Superficial Spreading Melanoma: These can be either flat or slightly elevated. They may have colors ranging from tan, brown, black, red/pink, blue, to white. These melanomas are typically asymmetrical, with uneven borders.
• Lentigo Maligna: These tend to form as uneven patches, either flat or slightly raised. While they are commonly blue-black, they can range from tan to dark brown. They also have irregular borders.
• Acral Lentiginous Melanoma: This type occurs at the extremities, including the palms of the hands or soles of the feet, and can even affect fingernails or toenails.
• Nodular Melanoma: These melanomas are often blue-black but may also appear in pink or red shades. They usually present as a raised bump and may exhibit more aggressive growth.

Graeme's Experience

Graeme grew up in rural Australia during the 1960s and 70s, spending much of his time outdoors engaged in activities such as cycling, swimming, fishing, and playing sports. Despite having fair skin and blue eyes, sunscreen was not commonly used during that time. He recalls how melanoma had already impacted his social circle before his own diagnosis, two close family friends passed away from it. Aware of its severity, Graeme adopted sun-safe habits in the 1980s. However, in 2010, he noticed a lump behind his ear. A specialist confirmed it was melanoma after removal, and the tests showed it was aggressive and advanced. and healthcare expenses.

Recognizing Melanoma

It’s important to follow the ABCDE guidelines when examining your skin for potential melanoma:

• Asymmetry: Do the two halves of the mole differ in shape or size?
• Borders: Are the edges uneven, scalloped, or notched?
• Color: Is the mole unevenly colored?
• Diameter: Is the mole larger than 6mm, or is it growing even if smaller?
• Evolving: Has the mole changed in any way, such as in shape, size, or color?

If you answered “yes” to any of these, it’s crucial to consult a healthcare provider for further evaluation.

Causes of Melanoma

The primary risk factor for melanoma is exposure to ultraviolet (UV) radiation, which can come from the sun or tanning beds. Limiting UV exposure can significantly lower your risk. Other risk factors include:

• A history of tanning and sunburn, particularly during childhood or adolescence.
• A family history of melanoma, especially if it was diagnosed before the age of 40.
• Having a previous skin cancer diagnosis, such as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).
• Possessing numerous moles.
• Having fair skin or skin that burns easily, with freckles.
• Having red or fair hair and light-colored eyes.
• Inheriting genetic mutations that increase susceptibility to melanoma.

How is Melanoma Diagnosed?

Melanoma is primarily diagnosed through a physical examination. If a doctor suspects melanoma, they will typically perform a biopsy, removing a sample of tissue from the suspicious spot to examine it under a microscope for confirmation.

Stages of Melanoma

Melanoma is classified into stages, which help determine how much cancer is in the body and if it has spread. Staging ranges from 0 to IV (Roman numerals):

• Stage 0: The melanoma is confined to the outermost layer of skin, the epidermis.
• Stage I: The melanoma is localized and has not spread beyond the original site. It is less than 2mm thick.
• Stage II: The melanoma remains localized but has grown beyond 2mm in thickness, indicating a higher risk.
• Stage III: The melanoma has spread to nearby lymph nodes or other surrounding tissues.
• Stage IV: This is metastatic melanoma, meaning it has spread to distant parts of the body, such as the lungs, liver, brain, bones, or distant lymph nodes.

Treatment of Melanoma

• Nasal: Rhinorrhea (runny nose), nasal congestion, post-nasal drip
• Ocular: Conjunctival redness, tearing, eyelid swelling
• Throat/Lung: Scratchy throat, cough, occasional wheezing
• Systemic: Fatigue, headache, difficulty concentrating, sleep disturbance

When detected early, melanoma is typically treated by surgical removal. Lymph node removal is usually unnecessary for early-stage melanoma. However, if the melanoma is advanced, treatment options may include surgery, radiation therapy, targeted therapy, or immunotherapy. In some cases, palliative care may be recommended to reduce symptoms and improve quality of life.

When to Consult a Doctor

If you notice changes in your skin, you should consult a dermatologist. Look out for:

• Spots that appear or feel different from others.
• Changes in the color, texture, size, or shape of existing moles.
• Sores that do not heal after a few weeks.
• Sores that are itchy or bleed.

If you’re concerned about your melanoma risk, a healthcare professional can advise whether regular skin checks are necessary.

Preventing Melanoma

The good news is that you can significantly lower your risk of melanoma by protecting your skin from UV radiation. When the UV index is 3 or higher, follow these tips:

• Slip on protective clothing.
• Slop on a broad-spectrum, water-resistant sunscreen with SPF 30+.
• Slap on a hat.
• Seek shade whenever possible.
• Slide on sunglasses that meet Australian standards.

Avoid using tanning beds or lamps, which are banned in Australia due to their increased cancer risk.

Graeme’s Tips for Skin Protection

• Today counts: Whether you’re starting sun-safe habits now or continuing them, every step helps.
• Know your skin: Melanoma can appear anywhere on your body. Get any changes checked.
• Regular skin checks: Keep track of any changes, and stay consistent with your checkups.
• Wear wide-brimmed hats: Protect your face and neck with a broad-brimmed hat.
• Sunscreen is routine: Make sunscreen a part of your daily outdoor routine.
• Wear long clothing: In hot weather, choose light fabrics to stay cool while staying protected.

You can easily access the UV index via the weather pages of Australian newspapers, the Bureau of Meteorology website, or the free SunSmart app.