Is that mole friend or foe?

Malignant melanoma has increased 1,000 percent over the past 50 years. This dramatic increase in the number of cases of melanoma-type skin cancer is one of the main reasons it is so important to determine if that mole on your skin is a friend (benign) or foe (malignant melanoma). Currently it is estimated that one in 100 Americans will develop malignant melanoma.

Melanoma is the type of skin cancer that can have a high risk of spreading centrally to the lungs, liver, or brain with life-threatening results. Malignant melanoma is increasing at a rate faster than all other cancers in the United States. Unfortunately, melanoma often strikes in the most productive years, from the ages of 20 to 60. Melanoma can strike at any age, however. There have been babies born with malignant melanoma, and certainly melanoma can arise at any age throughout one's lifetime.

Melanoma occurs most often in light-skinned people. People with blond or red hair blue eyes, and fair, heavily-freckled, easily-burned skin are at highest risk for melanoma. A family history of melanoma does increase the risk of developing a melanoma among all blood relatives. People with dark skin are less likely to but may still develop melanoma. Often the location of the cancer is still in the lighter skin such as the palm or sole of the foot in these ethnic groups. The lowest incidence of melanoma is found among Asians.

There are three major types of skin cancer:

Basal cell carcinoma usually appears as a shiny, pink, or skin color translucent bump on the skin with small blood vessels running through the growth. Over time, as the basal cell carcinoma grows, the lesion may begin to bleed, ulcerate, and develop a central crusted scab. Basal cell carcinoma is the most common type of skin cancer, and it is a primarily locally destructive cancer. Basal cell carcinoma is very unlikely to become metastatic; less than one in 1,000 cases of basal cell carcinoma will spread centrally and become life-threatening.

Squamous cell carcinoma is the second most common type of skin cancer. Squamous cell carcinoma usually appears as a red scaly patch or as a red, firm, scaly, or crusted bump on the skin. Squamous cell carcinoma is also a primarily locally destructive cancer, but if neglected, up to one in 10 cases of squamous cell carcinoma can spread centrally and become life-threatening.

Malignant melanoma is developed primarily through excess sun exposure--in particular, sunburning. It has been said that one childhood sunburn will double the lifetime risk of developing a malignant melanoma.

This type of skin cancer can, if untreated, spread centrally and involve the lymph nodes, lungs, liver, brain, and other systemic organs with life-threatening results. The risk of melanoma becoming metastatic--that is, to spread centrally--is directly related to the depth of invasion of the cancer roots into the skin. If the melanoma i-s very superficial, the cure rate approaches 100 percent. However, if the melanoma has had time to grow and change, sending roots down into the skin around the blood vessels, the risk of melanoma spreading to the rest of the body with life-threatening results can approach 80 to 90 percent. Thus early detection is the key to surviving malignant melanoma.

About 20 to 40 percent of malignant melanomas develop in a preexisting mole that was benign for the first 15 to 40 years of its life. Thus the imperative question is Is that mole a friend (benign) or foe (suspicious for malignant melanoma)? One very important criterion that makes a mole suspicious is when it displays any change. Any change in a mole's color (lighter or darker), (larger or smaller), or surface (bleeding, crusting, or peeling off), is suspicious, and action should be taken.

Treatment Options

Biopsy of the lesion is the most common treatment approach taken. This involves cleaning the growth and giving local anesthesia prior to removal of the lesion. Recent advances minimize the discomfort of the anesthetic, and there is no pain with the procedure. After removal, the lesion is examined under the microscope for any irregularities, including signs of malignant melanoma. If the mole is benign, no further treatment will be needed. If the mole is irregular, "dysplastic" or "atypical," a conservative piece of skin to include the entire mole should be removed to prevent possible future progression to malignant melanoma. If the lesion is found to be a malignant melanoma, appropriate action should be taken. A larger piece of skin must be removed around the melanoma to include any roots of the cancer as well as a thorough evaluation for central spread of the cancer.

The Melanoma Bottom Line

Malignant melanoma can be cured if found at an early stage. In the early stages of melanoma, the lesion may not look like much more than a bump on the skin. If all melanomas could be removed at this early stage, the number of deaths from malignant melanoma would assuredly decrease. The problem arises when someone just watches a bump on the skin grow and change. Unfortunately, by the time many patients come in for evaluation, the risk that the lesion has spread is higher than it would have been had they come in just months before.

Five dangerous words when it comes to the skin are "Maybe it will go away."

Melanoma can be beat. Avoidance of too much sun exposure and early detection will make you the winner over malignant melanoma.

If you have any question regarding a growth on the skin, make an appointment to have a dermatologist examine your skin in an effort to detect melanoma at the earliest stage possible.

RELATED ARTICLE: Is It a Suspicious Mole?

A useful method to determine if a mole is suspicious is the A-B-C-D system.

A = asymmetry of the lesion. This refers to the fact that benign moles are generally round, while melanomas are generally oddly shaped.

B = border irregularity. Malignant melanomas tend to have edge color that spreads out from the main growth into the surrounding skin.

C = color variation. If a growth has two or more colors--in particular, dark brown or black--it raises the suspicion of malignant melanoma.

D = diameter of the growth. Malignant melanomas in the past have generally been thought to be of a larger size, six millimeters (1/4-inch) across or larger. This, however, is not always the case; as with any cancer, melanoma starts as a microscopic growth that at first is too small even to see with the naked eye.

RELATED ARTICLE: Protecting Your Skin

Each time you get sunburned, you increase your risk of developing malignant melanoma. But The American Institute for Cancer Research offers these simple precautionary steps you can take. Remember, this is a year-round process. Any outdoor activity exposes you to the sun's ultraviolet rays.

* Use sunscreens: Those marked "SPF 15" or greater are best, preferably waterproof. (SPF stands for sun protection factor.) Be sure to cover sensitive parts such as lips, nose, and ears. Remember to apply liberally at the beach or at higher elevations even when you're in the shade, because sand, water, snow, and white concrete can reflect the UV rays.

* Wear protective clothing: Skin cancers generally develop on the most exposed parts of the body. Wear broad-brimmed hats and long-sleeve shirts.

* Avoid exposure during the times when the sun's UV rays are strongest: During daylight time that's 11:00 a.m. to 3:00 p.m. During standard time it's 10:00 a.m. to 2:00 p.m.

* Be careful when taking medications that make skin burn more easily. These include tetracycline, sulfa drugs, thiazide diuretics, indomethacin, and Retin-A. In any case, be sure to check with your physician.

Steven E Hodgkin, M D, is a dermatologist at the High Desert Skin Center in Victorville, California.