Melanoma is the deadliest form of skin cancer because of how fast it spreads to other parts of the body. It accounts for only 2% of skin cancer cases but is responsible for the majority of skin cancer deaths.

Each year, more than 87,000 cases of melanoma are diagnosed in the United States, and over 9,000 people die from it. The incidence of this condition is increasing faster than any other potentially preventable cancer in the United States.

Risk factors include:

• High mole count (more than 25 moles, and those with more than 100 moles are at higher risk for developing this condition.)
• Presence of atypical moles (3- to 20-fold elevated risk of developing malignant melanoma compared to the general population.)
• Extensive or repeated intense exposure to sunlight and sunburn in adolescence or childhood; research indicates that if you had 5 or more blistering sunburns between ages 15 and 20, your risk of getting melanoma increases by 80%.
• Ultraviolet exposure from tanning beds, especially before the age of 35, can increase your risk of melanoma by 59%.
• Light skin pigmentation, red or blond hair color, high-density freckling, and light eye color (green, hazel, blue.)
• History of childhood cancer with radiation treatment and immunosuppression.
• Family history (about 10% of melanoma are familial.)

Melanoma usually presents as a brown to black spot that changes in size, shape, or color. The ABCDEs of melanoma include:

• A - Asymmetry: One half of the abnormal area does not match the other half.
• B - Border: The growth or mole has ill-defined or irregular borders.
• C - Color: The abnormal area or mole contains different colors instead of one solid color. There may be different shades of tan, brown, black, red, blue, or white.
• D - Diameter: The mole or abnormal growth is larger than a pencil eraser. However, some melanomas may be smaller.
• E - Evolving: The mole or abnormal area is growing or changing in appearance.

The "ugly duckling" sign can also be helpful for recognizing this condition. Most moles tend to resemble one another; the “ugly duckling” looks different than surrounding moles. Rarely, melanomas can be skin color and not pigmented.

Any new growth or change in a previous mole should be evaluated. While rare, melanoma can also occur in unusual sites such as under the nail, in the eye, and on mucosal surfaces (nasal passages, mouth, throat, vagina, anus).

The most common types are:

• Superficial spreading melanoma: 70% of all melanomas, with a tendency to occur on the trunk and back in men and lower extremities and back in women.
• Nodular melanoma: 15 to 30% of all melanomas; the most aggressive type of melanoma.
• Lentigo maligna melanoma: 10 to 15% of all melanomas; most commonly arises in chronically sun-damaged areas of the skin, such as the face, in older individuals.
• Acral lentiginous melanoma: Less than 5% of all melanomas. It is the most common type of melanoma among Asian and dark-skinned individuals, who are at lower risk for more sun-related melanoma subtypes. Acral lentiginous melanomas arise most commonly on the hands, feet, and nail bed.

Other less common variants include amelanotic melanoma, spitzoid, and desmoplastic melanoma.

Tumor thickness is the single most important determinant of prognosis. Survival rates decline as tumor thickness increases. Early detection of melanoma is therefore crucial to improve outcomes and save lives.

Melanoma is classified according to its stage, which describes how far it has grown or spread. Stages I-IV are also divided into subgroups according to different variables such as how thick the melanoma is, whether there is ulceration (the skin covering the melanoma has broken open),  the size and number of lymph nodes involved, or where the cancer has spread.

• Stage 0: This refers to melanoma in situ, which is confined to the epidermis (top layer of skin) and is very unlikely to spread to other parts of the body.
• Stage I: In this stage, melanoma is confined to the skin, but has grown thicker, up to 1.0 millimeter.
• Stage II: In this stage, melanoma has grown thicker, up to 4.0 millimeters, extending into the dermis (the layer of skin below the surface layer). The skin covering the melanoma may have broken open (ulcerated), but the cancer has not yet spread.
• Stage III: In this stage, melanoma has spread to one or more lymph nodes near the original site of the cancer or to nearby skin.
• Stage IV: In this stage, melanoma has spread to other parts of the body far away from the original melanoma, such as distant locations on the skin or soft tissue, distant lymph nodes, or internal organs like the lungs, liver, intestines, brain, or bones.

Once melanoma has been diagnosed, the dermatologist will surgically remove it with an adequate margin of normal tissue. Margins vary from 0.5 cm to 2 cm around the tumor, depending on the tumor depth. In specific cases, a sentinel lymph node biopsy may be considered.

When melanoma grows deeper into the skin or spreads, treatment becomes more complex. Affected lymph nodes may need to be removed. Other treatments may include:

• Immunotherapy
• Chemotherapy
• Radiation therapy
• Targeted therapy using FDA-approved drugs that can extend lives by months or years, with a rising number of patients going into long-term remission

Call us at one of our offices to schedule an appointment with a dermatology provider or request an appointment online.

• North and South Colorado Springs & Woodland Park: (719) 355-1585
• Pueblo & Cañon City: (719) 543-1111