Important New Information on Spotting Nodular Melanoma

A few decades ago, New York-based dermatologists created a simple, effective mnemonic device to help people remember what to look for when performing their monthly skin cancer self-examinations. How simple? It’s (now) just the first 5 letters of the alphabet: ABCDE. The letters stand for Asymmetry, Border, Color, Diameter and Evolving. Advances throughout medical science are perpetual however, and new findings will at times reveal that updates to previously-promoted public education need to be made. Skin Cancer is no exception, and this post will address one important educational update.

Nodular Melanoma

Nodular melanoma is the more dangerous of the two types of potentially lethal melanoma, radial and nodular. Even worse, it disproportionally affects children. 40%-60% of newly diagnosed melanomas in teens and preteens are nodular, compared to 20% in adults. (For more information on nodular melanoma, please click HERE to read our previous post on the subject).

Many people who look for nodular melanoma concentrate their focus on finding new or changing dark-hued, irregularly-shaped moles and skin growths, which is consistent with ABCDE. That is, it was– prior to a recent, vital change.

A Crucial Discovery from the Land Down Under

Australia and New Zealand have the world’s highest incidence of melanoma; their citizens are 5 times more likely to develop melanoma than U.S. citizens. This gives their medical scientists significant motivation to continually try and find new breakthroughs in the fight against skin cancer.

In 2003, the head of the Victorian Melanoma Service published a summary of the research done by noted dermatologist Dr. John W. Kelly. It focused on the inadequacy of the ABCD warning signs, and advocated for the addition of EFG (Elevated, Firm, Growing) signs of nodular melanoma.

This quote from the cited source article illustrates just how vital the results of Dr. Kelly’s research is in helping both doctors and patients identify nodular melanoma:

“Nodular melanomas were mostly symmet-rical (80%), with a regular border and of single colour (78%), the majority (55%) being amelanotic. They were also more likely to be elevated (90%), weeping, crusted or tender in comparison to SSM.* Nodular melanoma are mostly red or pink in colour and if present, pigmenta-tion is usually evenly distributed throughout the lesion. They are raised from the outset and grow progressively as a round nodule.”

Additionally, some nodular melanoma can actually be pale in color. Together, all of this means that people who apply only the ABCDE principles to skin lesions may very well mistake a deadly cancer for a common, benign skin blemish. That type of error can have fatal consequences.

Upon learning the details of Dr. Kelly’s research, the Melanoma Education Foundation (MEF) recognized their importance and immediately incorporated the EFG signs into its educational materials and website (skincheck.org).

The Cancer Council of Australia was slow to follow-up. But last month (October 2017) it finally changed its melanoma diagnosis guidelines for doctors. The new guidelines have been updated to include EFG warning signs in addition to the previous ABCD signs. It’s time for the U.S. to follow suit!

Please help us spread the word.

*“SSM” refers to the more common superficial spreading melanoma.

Additional source articles: Researchgate.net, Australian Broadcasting Corporation

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

More Tanning Salons Ignoring State Laws

Washington D.C. joins more than 40 states that have put laws in place to protect minors from the highly dangerous act of indoor tanning. While that is a good thing in theory, laws are useless when they’re not obeyed.

A study cited within the linked source article revealed that almost 40% of tanning salons flout state laws, and many do so with little-to-no consequences.

A Burning Issue

Salons allowing teens to tan is not only an illegal act in most states, it’s also a morally reprehensible one. Most teenagers don’t have a complete understanding of the numerous hazards that tanning has on their health. And many who do are willing to take their chances in order to placate their vanity. It’s no great revelation that minors don’t always utilize the best judgement, which is exactly why these laws must be enforced regardless of the cost to a salon’s bottom line.

Tanning significantly increases the risk of developing skin cancer or, even worse, melanoma. The fact is that more people get skin cancer from tanning than get lung cancer from smoking. That statistic is staggering, and tanning salon owners know it. They also know that most of their young clientele don’t.

Salons promote tanning beds as peaceful, innocent diversions that make you look and feel great. These shysters are the present-day Marlboro Men. They’re projecting a harmful product as safe, while counting on the ignorance of youth to swell their coffers.

If a bar or store were to be caught selling alcohol or cigarettes to a minor, it could very well lose its license while the person who sold it loses his or her job. Law enforcement takes this issue seriously, as it should. Police routinely set up stings to discourage the practice and to keep businesses on their toes. Such stings should also be expanded to include indoor tanning salons. Unfortunately, tanning doesn’t yet have the same stigma attached to it that smoking does. It should though, because it can be just as dangerous.

Perhaps in time and with increased education tanning salons will go the way of cigarette machines and smoking sections. We can only hope. But what about the countless lives that will be disrupted or lost between that time and this?

This isn’t like the 1960’s prior to the Surgeon General’s smoking proclamation. We already know far too much about the dangers of tanning to be this passive. Skin cancer is the most common cancer in the world, yet it continually flies under the radar while taking a back seat in both funding and prestige to other diseases.

It’s time to get serious about enforcing existing tanning laws and holding salon owners accountable. By doing so, we can help prevent the destruction of countless young lives.

*Additional source articles: Health.usnews.com

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

Melanoma Mimics

Few health-related issues cause greater instantaneous anxiety and fear than suddenly discovering something new and unsightly on our skin. After the initial shock, it’s human nature for most people to immediately start thinking about worst-case scenarios.

However, there‘s no need to panic or jump to conclusions. The reason is that there are many scary-looking, yet benign, skin growths and blemishes that only mimic the appearance of melanoma. But that determination is not something anyone should ever try to make on his or her own, or through research on popular self-help, diagnostic-focused healthcare websites.

Either through visual inspection or biopsy, only a dermatologist is sufficiently trained to distinguish which skin issues may be cancerous and which are not. As time is of the essence with regard to diagnosing melanoma, any suspicious looking changes to the skin should be brought to the attention of a dermatologist as quickly as possible.

A Look at Some Look-Alikes

To better illustrate the appearance of mimics, we’ll present six photographs of common skin conditions that have been mistaken for melanoma.

 

 

 

Solar Lentigo

These are more commonly known as age or liver spots. They’re benign, caused by sun exposure and primarily seen in older individuals.

 

 

 

 

Seborrheic Keratosis

Often found on middle-aged or older adults, they’re benign, develop as black, tan or brown in color and look like they’ve been pasted on. Black seborrheic keratoses may occasionally be a sub-type of melanoma, and have the potential to degenerate into squamous cell carcinoma.

 

 

 

 

 

Blue Nevus

Benign and, aside from their blue/black appearance they’re no different from any other ordinary mole, and have no greater potential to turn cancerous.

 

 

 

 

Dermatofibroma

These benign brown-to-red/purple growths are often caused by minor injuries, splinters or insect bites. They’re usually found on the arms and legs.

 

 

 

 

Keratoacanthoma

This common skin tumor originates within hair follicles, and is considered to be a low-grade squamous carcinoma.

 

 

 

 

Pyrogenic Granuloma

This benign blood-containing overgrowth may appear on skin or mucous membranes.

It’s important to remember that even if what’s been discovered is diagnosed as melanoma, if it’s caught and treated early enough this potentially lethal disease has nearly a 100% cure rate. So, if something on your skin doesn’t look right, get it checked out right away.

*Additional source articles: Melanoma Education Foundation (MEF) Fall 2015 newsletter

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

Age Spots and Melanoma

If you’re a nonmedical layperson, you know them as age spots, sun spots or liver spots. If you’re a doctor, they’re solar lentigines or actinic lentigines. Whatever you call them though, while visually unappealing most age spots are benign (safe/noncancerous). They can start to appear as early as a person’s 40’s, usually on the face, neck and backs of hands.

However, some develop into a form of in situ (in place) melanoma called lentigo maligna. From there between 5 to 20% of lentigo malignas can further develop into the invasive lentigo maligna melanoma, over the course of a 5 to 20-year span. On its own, lentigo maligna doesn’t pose much risk. But it becomes far more hazardous if a melanoma forms inside of it.

Most age spots and melanomas are created by the same source, natural and artificial UV (ultraviolet) rays. And while both may also have similar visual characteristics, there is an enormous difference between them.

People with age spots can try to diminish them through a wide variety of cosmetic procedures if they wish. Or, if they can tolerate their appearance on their skin, they can just leave them be and suffer no adverse medical consequences.

Melanoma, conversely, must be diagnosed and treated as quickly as possible after it has been discovered. The timing of treatment can easily mean the difference between life and death.

These points are important to remember because it can be difficult for even a trained professional to determine what is or is not melanoma just by looking at it. That’s why what you may assume to be an age spot should be checked out by a dermatologist if it is changing, or showing any of the ABCD warning signs. If it turns out to be nothing, fine. But for the sake of your health it’s always a step worth taking.

These 3 photos, from left to right, depict examples of age spots, lentigo maligna and lentigo maligna melanoma:

 

 

 

 

*Additional source articles: DermNet New Zealand, Livestrong.com, DermNet New Zealand (Same source, separate article)

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

Melanoma Does Not Discriminate: The Story of Jacqueline Smith

One of the more difficult tasks when educating the public about melanoma, is helping to dispel the notion that it’s a “whites only” disease. While it’s true that whites are statistically much more susceptible to melanoma, it can develop in any person from any race.

What’s also not widely known is, for various reasons, while whites are more likely to get melanoma, once contracted blacks are more likely to die from it. Black people also have a greater tendency to develop melanomas in areas that don’t often see the sun. These places include beneath toenails and fingernails and on the soles of feet. A famous example of this is popular Reggae singer Bob Marley, who died at age 36 from a melanoma that began on his big toe.

To help illuminate these points, we’re going to share the story of Jacqueline Smith, a young black woman from New Jersey whose story was chronicled by writer Kellee Terrell (cited below).

 

 

 

 

 

Jacqueline Smith

Her tale begins the same unfortunate way that the tales of too many melanoma patients do. She found a skin growth that was misdiagnosed -in her case twice- by two different doctors. This highlights the importance of seeing a dermatologist rather than a general practitioner after a suspicious skin growth is discovered. With melanoma, the speed of diagnosis and treatment means everything. And a dermatologist has much greater training and experience with skin cancer than a regular doctor does.

Fortunately, Jaqueline didn’t let it go. Upon returning home from college she got a third opinion. This time, the doctor sent her to an oncologist (a doctor whose specialty is cancer) where tests determined she had Stage 3 melanoma.

Jacqueline relates that her initial reaction to learning of her diagnosis was nearly identical to what we’ve described in our opening paragraph. She thought melanoma (skin cancer’s most lethal form) was exclusive to whites. She recalls that in grade school she was told not to bother with sunscreen, because her skin tone made sunscreen unnecessary.

A surgeon excised Jacqueline’s cancerous lymph node, but within three years her cancer returned to give her the fight of her life. She underwent more surgery and was subjected to exhaustive treatment. Her odds weren’t good. But now, a decade later, she’s beaten those odds on her long-term prognosis by 5 years.

Jacqueline still has concerns that her cancer may return one day, but they’re not slowing her down.

Like many people who experience melanoma either first-hand, or through a cherished relative or friend, she was inspired to help others learn the truth about the disease. She’s focusing on the black community, and is working hard to dispel the myth that melanoma only impacts whites.

We wish this brave young woman continued success with all of her educational efforts.

*Information source article: “Black Woman Shares Skin Cancer Survival Story: ‘Please Don’t Think It Can’t Happen To You’”, an article written by Kellee Terrell, contributing writer to Hellobeautiful.com

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

Sun Safety-Based Lessons are Ineffective for Educating Teens About Skin Cancer

Over the 18 years since the Melanoma Education Foundation (MEF) was founded, we’ve learned that the success of sun safety instruction varies, depending on the age of the students.

Sun safety education has a much greater effect on elementary school students than it does on teens who attend junior high and high school.

Sloan Kettering Cancer Center recently conducted a study on this topic. They researched the difference between elementary and middle school students in Framingham, Massachusetts. They discovered a 50% reduction in the use of sunscreen use by the middle schoolers in comparison with that of the elementary school students.

Despite significantly increasing the amount of sun safety instruction taught in classrooms, we’re frequently informed by secondary school health teachers that their students aren’t taking heed of the information presented to them. They ignore the dangers of skin exposure to UV rays, and continue to tan either naturally or through tanning beds.

The sun’s harmful UV rays are directly responsible for 70% of melanomas and 95% of other skin cancers. In light of these alarming statistics, the question remains why would teens continually disregard sun safety lessons designed to keep them safe and healthy?

We think that the way the information is being presented is improperly balanced. Sun safety is overemphasized at the expense of sufficiently educating students about the consequences of overexposure to UV rays.

MEF lessons do include sun safety information of course, but they start by focusing the students’ attention on melanoma itself; what it really is, what it does and how it does it. This is tremendously important, because melanoma is the skin cancer most likely to affect them all the way from infancy into adulthood.

Our lessons start with providing key information about melanoma.

Specifically:

  • That teens are susceptible to melanoma right now
  • How melanoma develops and spreads to other parts of the body
  • Its risk factors and warning signs
  • How (and how often) to self-examine their skin for early signs of the disease
  • How easy melanoma is to cure if it’s found early- and how lethal it is if found too late

The second part of the lessons focus on the role that UV radiation plays in causing melanoma, and how to reduce the risks from it.

It’s important that the lesson topics are presented in the correct order: melanoma first, sun safety second. To a teen sitting in a classroom, a sun safety talk may sound very much like a parental lecture on brushing their teeth or washing their hands. In other words, just the sort of white noise they’d be likely to tune out.

However, when melanoma is explained to teens; when right off the bat they’re informed (and, also importantly, shown) just how much damage this disease can inflict, they are much more likely to take sun safety seriously and give it the respect it commands.

A teacher survey that we recently conducted regarding the impact of MEF’s lessons yielded some very positive results. Among them:

  • 73% of teachers reported that students made appointments to get moles checked after receiving the lessons
  • 14.8% of teachers were told by students that early melanomas were found because of the lessons
  • 34% of teachers said students found precancerous moles because of the lessons
  • After the lessons, 95% of teachers reported students said they would use more sunscreen, and 81% reported students said they would stop using tanning beds

That is very encouraging data. Our previous blog post on this specific survey provides additional positive results regarding the impact of the lessons on teachers and their families. If you’d like to read it, please click HERE.

*Information source articles: MEF Fall 2017 Newsletter Article, Prospective Study of Sunburn and Sun Behavior Patterns During Adolescence, Pediatrics. Feb 2012; 129(2): 309–317, Sun-protective behaviors in populations at high risk for skin cancer, Psychology Research and Behavior Management, December 20, 2013, Indoor Tanning Is Not Safe, Centers for Disease Control and Prevention, Updated January 24, 2017, Melanoma Knowledge and Sun Protection Attitudes and Behaviors Among College Students by Gender and Skin Type, American Journal of Health Education, Sept/Oct 2005, Vol 36, No. 5

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

Melanomas with No Identified Primary Site

Most melanomas are initially discovered on the skin. However, in a small percentage (5%-10%) of people who’ve had a recent melanoma diagnosis, the disease has spread beyond their skin and into other organs or lymph nodes; with little-to-none of the initial blemish left visible.

Regression

Though the amount varies widely, to some extent we all have moles and skin growths. Occasionally, our immune system takes a disliking to one- and sets out to kill it. Once the body has set this ‘seek-and-destroy’ mission in motion the pigment, and thus the appearance and visibility of the targeted growth, slowly starts to dissipate. Sometimes, to the extent that a person can’t even tell that it was ever there at all.

If such a growth is benign (noncancerous) it’ll dissolve harmlessly. If it’s a malignant melanoma it is a real problem, and may be even more dangerous than the more traditional form of melanoma.

How can Regressive Melanoma be “More Dangerous” than Traditional Melanoma?

On the surface (so to speak) in and of itself regressive is not a deadlier version of melanoma. What makes it more dangerous though is that it’s much harder to see, and easier to misdiagnose, than a typical case. Melanoma is more often spotted by the patient than it is by his or her doctor. And the cure rate for melanoma is nearly 100% if it’s caught early enough. But regressive melanoma can metastasize (spread) without a patient even knowing it existed. Its remnants can be easily mistaken as nothing. And it’s totally natural for a medical layperson to assume that something “clearing up” is a good thing.

Our immune systems are a biological marvel; the lengths to which they go every day to protect us are truly extraordinary. Unfortunately, with regressive melanoma, their efforts to terminate cells that they believe to be harmful may be incomplete, allowing the disease to progress. In other words, they’re inadvertently helping melanoma conceal itself until it’s too late.

What can I do?

When performing your monthly skin self-exam, be sure to pay as much attention checking for moles and blemishes that appear to be fading unevenly, as you do to for those that are more visibly growing and changing. If either is found, schedule a dermatologist appointment quickly.

Here are two melanoma photos of both early and late-stage surface regression, presented respectively:

 

 

 

 

As can clearly be seen here, especially with the late-stage photo on the right, these blemishes appear to be healing. Healing marks of any kind tend to be disregarded.

That’s fine when it’s a simple, garden-variety bruise sustained from lightly bumping an arm against a countertop. But a fading skin growth, mole, or blemish should never be disregarded or ignored. They should be leant the same weight as any other suspicious change to the skin.

*Additional information sources: Melanoma Education Foundation (MEF) newsletter; Autumn 2015, Lloyd-derm.com

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

Expediting a Dermatologist Appointment

When educating people about melanoma, the fact that is stressed the most (equally alongside the importance of monthly skin self-examinations) is how crucial it is to have skin cancer quickly diagnosed and treated.

But what happens when you discover a suspicious skin growth and wisely go to have it checked out- only to learn that you can’t get a dermatologist appointment for an unacceptable length of time?

Above all else, the one thing that you’d never do is shrug your shoulders, take an “oh well, I tried” attitude, and then drop the matter. That could be a fatal mistake.

What can I do?

Dermatologist appointments are often scheduled 3 or more months in advance. That’s too long to wait if you’ve found something suspicious on your skin. However, before trying to expedite an appointment, be sure to check the photos and information on skincheck.org. Don’t “cry wolf”.

Once done, contact a (or your own) dermatologist, explain your concern, and state that you’ll accept any time slot opening they may have available to you. Also, ask if you can be called first in the event that another patient cancels a previously scheduled appointment. If you are successful at securing a quick appointment, don’t expect a complete skin exam. Generally, in these instances a dermatologist will focus solely on the source of your concern.

What can I do if I Still Can’t Get a Fast Appointment?

If you’ve done everything discussed above but still can’t get a fast appointment, (no longer than within 1 week) there are other avenues to pursue. You can:

  • Contact the office of a board-certified general surgeon or plastic surgeon. They are fully trained in excising moles and early melanomas. They’re also typically available sooner for appointments than dermatologists are.
  • Contact the dermatology department of a large hospital and make an appointment. You can often meet with a dermatologist without a referral; though your insurance company may require one before they’ll cover the cost of your visit. You will not be turned away regardless of your financial situation.
  • Contact the American Academy of Dermatology (888-462-3376). or conduct an online search at < https://www.aad.org/find-a-derm > for information about dermatologists in your area.

With some exceptions, referrals are not usually difficult to obtain. If your physician does deny you one, either find another doctor or go get checked out anyway. General practitioners don’t have the extensive training and experience with skin cancer that dermatologists do. Unfortunately, this inexperience has led to numerous unnecessary melanoma deaths.

The bottom line is that these are merely petty obstacles that pale in comparison to the ultimately horrible end-result of an undiagnosed, untreated melanoma. Money and medical red tape should be no deterrents to protecting your health, and potentially saving your own life.

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

CHANGE: The Most Important Melanoma Warning Sign

The appearance of melanomas can vary widely from one to another. They develop in many difference colors, sizes and other unique visual characteristics. For this reason, trying to discern whether a mole is cancerous just by looking at it isn’t a reliable method. Even dermatologists can’t always tell the difference based solely on appearance.

However, there is one distinctive warning sign that (nearly) always identifies a melanoma: change. it’s the most important reason why performing a regular monthly skin self-examination is so vital. It’s just as significant to check any pre-existing skin growths for change as it is to look for new ones.

What to Look for

This is a list of skin growth changes to help learn what it is you should be looking for:

– An increase in its diameter or elevation

– A change in its shape; especially if that shape has become irregular

– A change in its color or shade

-Persistent itching

– Any change in its surface, including:

  • Texture
  • How it feels to your touch
  • How it reacts to light (reflects)
  • Development of one or more bumps- even if they’re small
  • An ulceration (liquid-like appearance, such as found in an open sore)
  • Bleeding spontaneously or upon minor trauma

Any of these changes that continue for 3 weeks or longer need to be checked out. Though any bleeding or ulcerations should be brought to the immediate attention of a dermatologist.

Please note that this list is a helpful guide, but it’s not all-inclusive. Any changes to skin growths that are not found here should not be ignored.

We recently published a blog post that highlighted the differences between the two primary forms of melanoma, Radial and Nodular. As it’s relevant to this one, we’ll re-post it. To read it, please click HERE.

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma

A Melanoma Menu

There is a lot to learn about melanoma. On the surface, it’s a fairly-straightforward subject; yet it’s also one that carries with it many important subtopics. This piece consists of selections from our previously published posts on the subject.

To view the original Melanoma Education Foundation (MEF) article on any of the topics below, simply click the link and you’ll be brought directly to it.

From Bad to Worse

About Radial and Nodular Melanoma, the two primary forms of the worst skin cancer.

A Bad Match: Keeping Moles Away from the Sun

The reasons why exposing moles to sunlight is a very bad idea.

Ginger Ail

A discussion on the increased risk of melanoma to redheads.

Connecting the Dots

For those with many moles, there is a tool that dermatologists can use to help keep tabs on patients’ skin health.

Which is Which?

How to tell the difference between freckles and moles

Normal and Abnormal Moles

Differentiating between normal and atypical moles.

Your Chances of Developing Melanoma

A discussion of melanoma risk factors.

Checking Up on Yourself

How to examine yourself for early signs of melanoma.

Skin Cancer: Not Child’s Play

The differences and similarities between childhood melanoma and melanoma in adults.

Melanoma: A Color-Blind Cancer

Information on Acral Lentiginous Melanoma, which is more common in blacks, Hispanics and Asians than it is in whites.

Stage 0 Melanoma

The best form of the worst skin cancer.

The Eyes Have It

Ocular Melanoma is a rare, deadly cancer that is not caused by UV (ultraviolet) ray exposure.

Can You Identify the Bad Guys?

A quick visual quiz that tests your ability to tell benign moles from those that are cancerous.

Action, Not Fear

What to do if a suspicious growth is found during a skin self-examination.

Survey Says?!

The excellent results from teachers who were surveyed regarding the effectiveness of the Melanoma Education Foundation’s (MEF) classroom melanoma lessons.

To visit our websites, please click: Skincheck.org and/or Melanomaeducation.net

Facebook: Melanoma Education Foundation

Twitter: @FindMelanoma