Melanoma

What is it?

Melanoma is a less common but most dangerous form of skin cancer. It starts in the melanocytes or pigment producing cells found in the outer layer of the skin. These cells grow out of control and form a tumour. Melanomas are often brown and black in colour but can show other shades.

Who gets it?

Melanoma is now the 8th most common cancer in Canada. Approximately 5,000 Canadians will be diagnosed with melanoma in 2009 and 940 will die of it. Melanoma is one of a handful of cancers where the incidence in Canadians continues to grow (1.6% per year in men, 1.0% per year in women).

The death rate for men with melanoma continues to rise (0.5% per year). Studies show older, fair-skinned men are more likely to die of melanoma than any other group. A lack of awareness of this disease and its common location in a hard-to-see area-the back-are likely the main reasons.

In Canada, the lifetime risk of melanoma for men is now 1 in 74. For women, it is 1 in 90. In comparison, the lifetime risk of melanoma for North Americans in the 1930s was 1 in 1,500.

What causes it?

Excessive exposure to ultraviolet (UV) from the sun and sunbeds plays a leading role in the development of melanoma and is the most preventable cause of this disease. Experts estimate about 90% of melanomas are associated with severe UV exposure and sunburns over a lifetime.

How can I protect myself?

The best ways to protect yourself are to:

  • Find out your risk-the risk factors are well known.
  • Learn the early signs of melanoma (see A Guide to skin cancer self-examination), find out why and how to check your skin.
  • Protect yourself from the sun from spring to fall and avoid sunbeds.
  • Check your skin once each month.
  • Consult a doctor if you see any suspicious spots.

A Guide to skin cancer self-examination

Step 1

Step 1 Ensure the area where you will 5 be checking your skin is well lit. You will need a full length mirror, a hand-held mirror, a hair dryer, and either two chairs or two stools.

Step 2

Step 2 Remove all your clothing. To begin, raise your arms to waist 2 height with your palms facing 6 upwards. Examine your palms, fingers and forearms. Open your fingers and check the skin in between them. Turn your hands over and look at the backs of your hands, fingers, fingernails and forearms. Again, open your fingers and look at the skin in between them.

Step 3

Step 3 Now stand in front of the full length mirror. Raise your arms toward your chest. Your palms should be toward you. Look in the mirror to check the backs of your forearms and elbows.

Step 4

Step 4 Now lower your arms to your sides, with palms facing away 8 from the mirror. You should be able to see the whole front of your body. Check your face, neck and arms. Turn your palms toward the mirror and check your upper arms and shoulders. Examine your chest, stomach, pubic area, thighs and lower legs.

Step 5

Step 5 Now turn your body sideways 9 to the left. Raise your arms over your head. Your palms should be facing each other. Check the whole side of your body, starting at the top with your hands, moving to your arms, underarms, torso area, thighs and calves. Finally, turn to the right and check the other side of your body in the same way.

Step 6

Step 6 Next, stand with your back toward the full length mirror. Check your buttocks and the backs of your thighs and calves.

Step 7

Step 7 For this step, you will need the hand-held mirror. Holding up the mirror in front of you and standing again with your back to the full length mirror, look at the back of your neck, your back and buttocks. Check the backs of your arms also.

Step 8

Step 8 Staying in the same position, examine your scalp. It is recommended that you use a hair dryer (on a cold air setting) to part your hair to reveal the skin. You may find this step difficult and are encouraged to have your partner or a friend conduct your scalp examination with the aid of the hair dryer.

Step 9

Step 9 Sitting down on the chair and with your right leg resting on the other chair or stool, look at the inside of your leg from the top of your thigh right down to your ankle, using the hand-held mirror if necessary. Now do the same with your left leg.

Step 10

Step 10 Remaining seated, bring your right leg over the left leg, resting your foot on your left knee. Using the hand-held mirror, if necessary, look at the top of your foot, your toes, toenails and the skin in between your toes. Check the bottom of your foot also. Now do the same so you can examine your left foot.


Early detection is directly linked to a high survival rate

Unlike many cancers, melanoma is clearly visible on the outer surface of the skin. In the early stages, the tumour is thin, has not spread to lymph nodes, and is highly curable by surgical removal.

* Melanoma has one of the highest survival rates compared to all cancers at 90% because most melanomas are found at an early stage.

What are the risk factors?

Some people are more likely to develop melanoma. Those who have:

  • Fair, sun-sensitive skin that burns rather than tans; freckles; red or blond hair.
  • Many moles-more than 50.
  • Moles which are large or unusual in colour or shape.
  • A close family history of melanoma or a personal history of melanoma.
  • Had excessive exposure to UV from the sun or sunbeds.
  • A history of severe sunburns.

The risk can be multiplied if you have several of these risk factors, for example, if you have unusual moles and a family history of melanoma.

People with no risk factors, and those with darker skin, can also get melanoma.

Why should I check my skin?

  • People are very successful at detecting melanoma on their own skin or that of a family member. Research shows that 53% of melanomas are discovered by the patients themselves and a further 17% by their family members.
  • Checking your skin can lead to a 90% cure rate. Lives can be saved.
  • A skin self-exam is simple and takes only 10 or 15 minutes once per month.
  • Recent research shows those at risk for melanoma who had a friend or family member help with checking the skin found the disease at a much earlier stage and had a 63% lower death rate compared to those who did not check their skin.
  • The risk of recurrence of melanoma during the first year after treatment is high.
  • Patients who have had melanoma present an increased risk of recurrence (increase of about 5%).

What does melanoma look like?

Melanoma can develop in weeks or months, or take years. It can appear as a new mole or freckle-like spot on the skin, or develop in an existing mole. Melanomas are usually dark in colour - browns and blacks, although some show a mixture of colours, including blue, grey and red.

The most common location for melanoma in men is on the back and, in women, the leg. It can also appear on the arm, scalp or face. While less common in darker-skinned people, melanoma can appear on the soles of the feet, toenails and palms of the hands.

The ABCDE of melanoma will help you to detect this disease. Look for these features:

download: ABCDE's of Melanoma [pdf]

Asymmetry - the shape on one side is different from that on the other side
Border - the border or visible edge is irregular, ragged and imprecise
Colour - there is a colour variation, with brown, black, red, grey or white within the lesion
Diameter- growth is typical of melanoma. It can measure more than 6 mm, although it can be less.
Evolution- Look for change in colour, size, shape or symptom, such as itching, tenderness or bleeding.

The ugly duckling sign

This is a tip to help you detect melanoma. Most moles on a person's body look similar. However, melanomas look different from all other moles-the ugly duckling sign. Generally only one melanoma appears at a time, so a spot that looks or even feels different, or changes differently compared to other moles on the body, should be checked by your dermatologist or family doctor as soon as possible.

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