While melanoma account for only 4% of all skin cancers, it is the leading (77%) cause of death among all cancers in the western world; approximately 7700 patients per year die of melanoma.

Dr Shehnaz Arsiwala, Consultant Dermatologist, Cosmetic Dermatosurgeon

Saifee Hospital and Prince Aly khan Hospital, “The skin type 1 and 2, that is, the white skins are the prototypes who are predisposed to this threatening cancer, a cumulative sun exposure with history of intermittent sunburns or an inability to tan and a personal or family history of melanoma or dysplastic nevus increases the risk of getting melanoma many fold. Also certain individuals on Ultraviolet A therapy (UVA) are at an increased risk.”

She continues, “However even though incidence of melanoma is less in pigmented skin the melanoma can still occur and for all those afflicted can die due to delay in early detection over a false sense of security, for the survival rate in melanoma is directly related to early detection!”

Facts

• 95% of melanomas are totally curable if detected and treated early.
• A previously benign mole may change into a melanoma if strong predisposition exists however not all melanoma develops from a changing mole.
• Melanoma can also appear on a totally normal skin where there was no a previous mole or appear as a nail streak or non-healing bruise.
• Patient education and awareness to be able to recognize a melanoma in its earliest stages is important.

Dr Shehnaz, “The ABCD sign of melanoma is the most widely followed guide to detect an early melanoma on an examination.

• A -- Asymmetry of the lesion on skin
• B -- Border irregularity in a skin lesion
• C -- Colour variability in a skin lesion
• D -- Diameter > 6mm”

Diagnosis and treatment

Once detected the staging of melanoma is crucial in deciding the prognosis and line of treatment

• Specific tests include
• Family history of dysplastic nevi
• Complete cutaneous and mucous membrane examination
• Dermoscopy
• Skin biopsy
• Lymph node biopsy
• Body scans to detect spread

Treatment required may include

Surgical excision

Lymph nodes removal

Immunotherapy

Chemotherapy

Radiation therapy

And regular follow up

Prevention

Prevention or risk reduction strategy is extremely important. Childhood is an especially important time for sun protection; protecting the skin during the first 18 years of life can reduce the risk of some types of skin cancer by up to 78%.

Prevention is advised at two levels

• Primary prevention includes public education and awareness, self-examination, frequent dermatological evaluation and biopsy of suspected skin moles.
• Secondary prevention includes education of high-risk patients about ABCD signs and total body self-examination.

Screening programmers and regular examination by health professionals play an important role.

Dr Shehnaz suggests following a comprehensive sun protection regimen goes a long way in stopping the development of skin cancer and delay skin aging.

People of all ethnicities are encouraged to

• Seek the shade, especially between 10 am and 4 pm
• Do not burn
• Avoid tanning and UV tanning booths
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses
• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
• Examine your skin from head-to-toe every month.
• See your physician every year for a professional skin exam

Guidelines for use of sunscreens

• Wear, broad spectrum Sunscreen, SPF >15, water resistant
• Use sunscreens daily. Even on cloudy, rainy days and while driving
• Apply liberally - Most people fail to achieve the SPF as listed on the bottle, because they apply too little sunscreen, thus purpose of the sunscreen fails to serve individuals at high risk, who may need a sunscreen with a higher SPF.
• Apply 30 mines before sun exposure
• Remember to apply over ears, baldhead, back, neck, hands, back of feet
• Reapply every 2-3 hrs or immediately after swimming / strenuous activity/ or if sweating excessively
• Sunscreen should be applied indoors and at home too
• It should be applied as a good thick film and (0.5mm thick) and in enough quantity.
• A simple rule is 6 teaspoons for the whole body
• ½ tsf for face and neck
• ½ tsf for each arm
• 1tsf for each leg and
• 1 tsf each for chest and back.

The oft repeated and underlined mantra remains, “Prevention is better than cure. Be aware, be suspicious and get examined when in doubt.”

Pic: Yarik Mission

To know about the types of Melanoma that exist, click here