Melanoma in the skin cancer clinic
Melanoma diagnosed at a routine skin check is a very rewarding outcome because early treatment will result in cure. Every effort should be made for an early diagnosis of malignant melanoma.
Why is Melanoma so important?
- Australia has the second-highest rate of melanoma in the world.
- The overall rate of melanoma in Australia is still increasing, and has almost doubled in the last 34 years.
- Melanoma is the 4th most common cancer in Australia (other than the non melanoma skin cancers).
- Most melanoma is caught at the curable stage.
- Melanoma can easily be mistaken for benign skin lesions.
Who is at risk of melanoma?
The strongest risk factors are:
- Family history (first degree relatiaive ie. a brother, sister, mother, father or child with melanoma)
- Lots of moles (eg. More than 100)
- Large unusual-looking moles – atypical moles.
- Previous melanoma
Other risk factors are:
- Red hair, blue eyes, skin that easily burns
- History of blistering sunburn. Specifically, a history of 5 or more episodes of blistering sunburn doubles the risk of melanoma.
- Previous use of sunbeds – particularly at an early age.
- Being on immunosuppressant medication.
The gap between rates of melanoma in younger and older people is increasing. Nevertheless, younger people still get melanoma, with a rate of 9.4 cases per 100,000 reported in 2016.
Melanoma is overall more common in men than women. However, Melanoma is more common in women than men under the age of 40, reflecting hormonal factors and different patterns of UV radiation.
UV exposure, age and genetics lead to genetic aberrations such as a single substitution of V600F of the BRAF gene that accounts for 50% of melanoma.
Can I tell if I have a melanoma?
You simply can’t DIY whether a mole is harmless or not. Why? Because expert use of a dermatoscope is required to truly tell whether a mole is definitely harmless.
Around 65% of melanoma develope de novo whilst 35% develop from a pre-existing mole. In other words, you need to keep an eye out for both changing lesions as well as new lesions! This doesn’t help much, right?
Should you worry about every new lesion? Harmless moles continue to appear in Young to middle aged adults whilst adults from their 30’s will will skin lesions like seborrhoeic keratosis and age spots (solar lentigo). Yet early melanoma can look like either of these lesions.
How can you evaluate change in a lesion? The famous ABCDE is a good starting point. A changing lesion is one that has a change in any of the Assymetry, Border, Colour, Diameter or is Evolving. In truth, any change is important. Melanoma may not be pigmented. Indeed, melanoma may be entirely pink. The EFG rule was added later to help identify a dangerous type of melanoma called nodular melanoma.
Dermatoscopy examination has two benefits
- A skin lesion that looks fine with the “naked eye” may be concerning after dermatoscopy.
- A skin lesion that might otherwise look “nasty” may be entirely reassuring after dermatoscopy.