Melanoma – a primer for my mom

Yesterday, I called my parents to wish them a Happy New Year. I had to time the call for halftime of the early bowl games – and absolutely avoid any of the Ohio State-Alabama pre-game coverage or my dad would probably disown me. Anyway, I was chatting with my mom and realized that she was paranoid that everyone in my extended family would eventually produce pink melanoma. And I thought it was time to provide some knowledge I’ve picked up since my diagnosis.

On average, more than one million cases of skin cancer will be diagnosed in the coming year. Melanoma is the least common of all skin cancers. The three main types are basal cell carcinoma, accounting for 80% of all new skin cancer cases; squamous cell carcinoma (16%); and melanoma (4%). As I put it to my mom, imagine getting 100 people in a room that were diagnosed with skin cancer. Only 4 of them would have melanoma. That’s a pretty small percentage, but don’t let that get you complacent about wearing SPF. According to the Cleveland Clinic, the incidence of melanoma increased 690% from 1950 to 2001. Thank you aerosol and freon for helping destroy our protective ozone layer…

Melanoma comes in four types: superficial spreading melanoma; lentigo maligna melanoma; acral lentiginous melanoma; and nodular melanoma. The website www.skincarephysicians.com has a good primer on the different types of skin cancer.

When you think of melanoma, you probably get a picture in your head of a blackish/brown mole that is all jagged borders and looks like something that needs to get checked. What you’re thinking of is SSM or superficial spreading melanoma, which accounts for about 70% of all diagnosed melanoma. You know those ABCDE guidelines? Asymmetrical, irregular borders, different colors within the mole, growing diameter, and evolving growth of the mole… Those guidelines are best for spotting an SSM type of melanoma. Pay attention to those types of moles. SSM is the leading cause of death from cancer in young adults.

Lentigo maligna melanoma looks like those age spots on elderly people. You know, those darker, liver spots? This type of melanoma accounts for 10% of diagnoses. They mostly occur on sun-damaged skin and usually on the face. A good reason for wearing SPF every time you go out. This type of melanoma spreads slowly for years – sometime for as long as 10-15 years! It’s treatable and curable if caught fast enough but the problem is that because it looks like a typical “age spot”, it’s often ignored until it either grows very large or it gets bumpy. If you have older relatives who spent a lot of time outdoors, keep an eye on their facial skin for any changes and urge them to get checked out – even if they claim it’s just an age spot.

Acral lentiginous melanoma accounts for 5% of melanoma in the United States. It is the most common form of melanoma in Asians and people with dark skin. Yes, even darker-skinned people who tan quite easily can get skin cancer and should also be vigilant about wearing sunscreen when outdoors. This type of melanoma is often overlooked in its early stages because it appears on parts of the body not normally exposed to sun and usually not examined – like palms of the hands, soles of the feet, underneath fingernails and toenails, and even in areas like the mouth, nasal passages, and genitals. It can take the appearance of a bruise or nail streak. In areas like the nose, you won’t even see it – but maybe get nosebleeds and sinus “stuffiness”. All of those things can be attributed to other causes, which makes this type of melanoma “hidden in plain sight”. Fortunately, it’s pretty uncommon.

And finally, we get to my type of melanoma – nodular melanoma. Nodular melanoma is the most aggressive form of melanoma, making early detection and treatment critically important. It accounts for 15% of all melanoma cases. It’s different from the other types of melanoma because of three important distinctions: it grows in thickness rather than diameter, penetrating the skin deeper; it may not have an apparent visible phase of development; and it may grow in a spot where there wasn’t a mole before. This holds true in my case. My pink spot popped out in an area where there were no previous moles. For these reasons, nodular melanoma is more deadly because it takes people longer to recognize that there’s something growing that shouldn’t be there.

Remember getting those people in the room? Let’s say those 4 out of 100 got lonely. We decided to get 500 people with skin cancer diagnoses into a room. That’s a lot of people, but only 20 of them have melanoma; so we make the other 480 people leave the room. (And yes, I’m aware it’s fuzzy math right now – just go with it.) Those 20 within 500 would break down like this: 14 of them would have SSM; 3 of them would have lentigo maligna melanoma (and probably be pretty old); 1 of them would have acral lentiginous melanoma; and 2 of them would have nodular melanoma.

In the next post, I’ll talk more about my specific subtype – amelanotic nodular melanoma. And you can see why it’s important to be aware of it, but also get a sense of exactly how uncommon it is (and understand why my mom freaking out about everyone else in the family having it is probably a classic mom overreaction…)