Melanoma Skin Cancer: Symptoms, Signs, and Treatment
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Example Case
A male patient presents for evaluation of a mole on his back. He states it has been there “for as long as he can remember”, but his spouse has noticed recent changes to its shape and form.
He reports a family history of melanoma and has worked as a construction worker for 25 years. On examination, you appreciate an irregularly shaped lesion with color variation.
Melanoma Skin Cancer
Melanoma is a type of skin cancer caused by melanocytes, which are the pigment-producing cells.
Although melanoma is more rare than other skin cancers (such as basal cell or squamous cell carcinomas), melanoma comprises the largest percentage of all skin cancer mortalities.
This lecture will easily walk you through the important features to know regarding melanoma.
Every EZmed lecture provides you with a simple memory tricks to remember the content.
This lecture will be no different.
Today you will learn the ABCDE mnemonic to remember the cardinal features of melanoma.
So let’s get right into it!
What is Melanoma?
As previously mentioned, melanoma is a type of skin cancer caused by melanocytes.
Melanocytes are specialized skin cells responsible for producing melanin, a pigmented protein that determines our skin and hair color.
Through the production of melanin, melanocytes work to protect us from the dangerous effects of ultraviolet (UV) radiation.
However, excessive UV exposure over time can increase the risk of developing skin cancer - more on that later!
So, what is a mole? And are they dangerous?
A mole is a cluster of melanocytes.
While the majority of moles are benign, they can change over time and become malignant.
There are several changes you should look out for in a mole, as it could indicate cancer.
These concerning features can be remembered using the ABCDE acronym below!
ABCDE - The Cardinal Features of Melanoma
There are several signs and features to a mole that can raise suspicion for malignancy.
These cardinal features can be remembered using the ABCDE mnemonic.
A = Asymmetry
B = Border
C = Color
D = Diameter
E = Elevation/Evolution
A = Asymmetry
The “A” stands for asymmetry.
Most benign moles are symmetrical.
Moles become concerning if they take on an irregular, asymmetric shape.
If you were to draw a straight line through the center of a mole and fold one end of the mole over the other on that line, then they should align fairly well.
However, this may not be the case if the mole is asymmetrical which could indicate a cancerous lesion.
The image on the left shows a less concerning symmetrical lesion. The image on the right shows asymmetry which should raise suspicion for malignancy.
B = Border
The “B” in the ABCDE mnemonic stands for border.
Benign moles tend to have smooth and circular borders.
If sharp edges or corners are present, then this could be concerning for malignancy.
The image on the left shows a less concerning lesion with a smooth, round border. The image on the right shows a more concerning border with sharp edges and corners.
C = Color
The “C” stands for color.
In addition to the shape of the lesion, color is also important.
A benign mole tends to be uniform in color.
If there is color variation, then this could be concerning for melanoma.
The image on the left shows a less concerning lesion with uniform color. The image on the right shows color variation which is more suspicious.
D = Diameter
The “D” in the ABCDE mnemonic stands for diameter.
In addition to the shape and color of the mole, size is also crucial.
The important number to remember is 6mm, or about the size of a pencil eraser.
Most benign lesions tend to be smaller than 6mm in diameter.
A larger mole, or one that is changing/growing in size, could be a sign of malignancy.
A mole with a diameter less than 6mm, or about the size of a pencil eraser, tends to be benign. Larger moles, or moles that are growing/changing, are more concerning.
E = Elevation/Evolution
Lastly, “E” stands for elevation, evolution, and enlargement.
First, benign moles tend to be fairly flush with the skin.
If a degree of elevation is present, then this could be suspicious for malignancy.
Second, the patient in the example scenario at the beginning of this lecture was being evaluated because his spouse noticed “changes to the mole”.
This is where evolution comes into play.
Most benign moles do not drastically change over time.
If a lesion evolves, then this could also be a sign of malignancy.
A mole that is elevated or changing/evolving raises suspicion for malignancy.
Risk Factors
The two major risk factors for developing melanoma include genetics and UV radiation.
Genetics
One of the most significant risk factors is a primary relative with a history of melanoma.
Genetic mutations that may cause melanoma can run in the family.
This is important because most people associate melanoma with UV radiation exposure only.
UV Radiation
Significant exposure to UV radiation from the sun can damage the DNA of skin cells.
Areas of intermittent sun exposure on the body, including the backs of men and the legs of women, are common locations for melanoma.
Tanning beds are also a source of UV radiation, and therefore can have the same DNA damaging effects on skin cells as the sun does.
For this reason, tanning beds are considered a risk factor for developing skin cancer as well.
Diagnosis
Melanoma is diagnosed starting with a thorough examination of the lesion at question, as well as comparison to other moles on the body.
A biopsy will be performed under local anesthesia and sent for pathological review.
If melanoma is confirmed on biopsy, then the melanoma can be staged using tumor thickness/ulceration and lymph node involvement as criteria.
Treatment
Treatment varies depending on the presence or absence of metastatic disease.
If melanoma is discovered early and/or the disease is localized, then surgical excision may be sufficient.
It is important to remove enough of a margin around the cancer to help reduce recurrence rates.
Mohs procedure is commonly performed to help ensure adequate margin removal.
Each time a new piece of tissue is excised it is examined for cancer cells, and this determines the necessity for further tissue removal.
For more advanced disease or metastasis, adjunctive therapy may be necessary.
Adjunctive therapy may include combinations of chemotherapy, immunotherapy, and radiation.
While treatment can lead to remission, there is unfortunately a risk of recurrence.
One major prognostic indicator is the thickness of the cancerous lesion.
If the lesion is superficial and detected early, then there is less of a chance for metastasis.
However, a lesion that is deeper/thicker may increase the likelihood of cancerous cells invading blood vessels, which could lead to hematological spread and possible metastasis.
Other prognostic indicators include the type of melanoma, presence of ulceration, location, presence of satellite lesions, and lymphatic invasion.
Here are 5 points to know for melanoma.
Summary
Hopefully this provided you with a concise summary of melanoma.
The ABCDE mnemonic is a useful tool to help you remember the cardinal features of melanoma.
A = Asymmetry
B = Border
C = Color
D = Diameter
E = Elevation/Evolution
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