Melanoma

Although there are several different types of skin cancer, most don’t become life-threatening because they aren’t likely to spread to other parts of the body. Unfortunately, melanoma is different. If not caught early, melanoma can spread from the skin to other organs — often with deadly results.

And this serious skin cancer is no longer considered just an older person’s disease. Rates are on the rise — especially among people in their teens and 20s — and research shows that the increase may be partly related to ultraviolet (UV) sun exposure during childhood. In the United States alone, the percentage of people who develop melanoma has more than doubled in the past four decades.

If there’s any good news about melanoma, it’s this: You have the power to greatly lower your family’s risk of getting it by protecting kids from the sun, paying attention to the moles on their skin, and making sure they know from an early age that it’s important to take sun safety seriously.

About Melanoma

Melanoma is a type of cancer that begins in the melanocytes — the cells deep within the epidermis (the outermost layer of the skin) whose function is to produce melanin, the pigment that gives skin its color. Dark-skinned people have cells that naturally produce a lot of melanin, while fair-skinned people produce much less.

Melanocytes commonly cluster together to form skin growths called moles (or nevi, in medical terms). Most people have several moles — maybe even dozens — and in most cases they don’t cause any problems. They may be flat or raised, large or small, light or dark, and can appear anywhere on the body.

Melanoma.jpg

Sometimes, though, melanocytes can stop working normally. Because of a genetic change (mutation), they can begin growing out of control, sticking together to form lesions or tumors, crowding out healthy cells, and damaging surrounding tissue. This condition is known as cancer.

Melanoma that’s caught early, when it’s still on the surface of the skin, can be cured. But if melanoma is not treated, it can grow downward into the skin until it reaches the blood vessels and lymphatic system. These two systems can act like a highway for the cancer cells, allowing them easy access to distant organs like the lungs or the brain. That’s why early detection is so important.

How People Get It

How does a normal melanocyte turn cancerous? Researchers believe it’s probably a combination of genetic and behavioral factors. But one of the most important common contributors is UV sun damage. Cells that have been damaged by UV rays are more likely to become cancerous over time.

And though you might think that ongoing exposure — being in the sun because you work outside, for example — would increase someone’s risk of melanoma, it’s actually occasional exposure that has the potential to do the most damage. So short bouts of bad, blistering sunburn that a child may get during a day at the beach or the park or even on the family vacation may be more harmful than lower-level, everyday exposure.

Among teens and young adults who are diagnosed with melanoma, most are tanning bed users who are exposed to “concentrated” doses of UV rays. Just one tanning session can make someone more likely to develop skin cancer.

Of course, there may be other reasons for the increase in overexposure to harmful rays. The thinning of the ozone layer or clothing styles that expose more skin also may have contributed to the risk. And it’s thought that as people live longer and become more are aware of the disease, more cases of skin cancer will be diagnosed.

But today’s melanoma rates also have a lot to do with false beliefs about tanning from years ago. Most people — including some doctors — once thought it was safe and even healthy for people to lather up with oil and tan as much as they wanted. In the 1960s and ’70s, metallic reflectors and baby oil were all the rage. Then, in the 1980s, tanning beds and sun lamps became popular, and many people began believing it was actually safer to get a “base tan” indoors before heading out into the summer sun or going on a tropical vacation.

Risk Factors for Melanoma

Today we know better. Still, certain risk factors can increase a person’s chance of developing melanoma, including:

  • a fair complexion (light skin that freckles or burns easily, blue eyes, or blond or red hair)
  • having many moles (usually, more than 25)
  • UV exposure (whether from the sun or a tanning bed)
  • having a history of frequent or severe sunburns
  • having a relative with melanoma or a family history of irregular moles
  • age (older people are still at greater risk)
  • having a previous melanoma (moles typically don’t grow back after being removed, but a person who’s had melanoma once is more likely to have a recurrence somewhere else)

But melanoma doesn’t discriminate. Though less likely, people can still get it even if they’re young, have no family history of cancer, or have dark skin. People of African heritage are more likely to get melanoma under the nails, or on the palms and soles. This condition, called acral lentiginous melanoma, is not related to sun exposure.

Signs and Symptoms

Many melanomas start out as a mole or a bump on the skin. Of course, not every mole is cancerous — far from it. What’s more telling is whether a mole has undergone any kind of recent change, whether in size, shape, or color.

That’s why it’s important to look at your child’s skin (and, of course, your own) and take a mental snapshot — kind of like a mole roadmap — so you’ll know what’s normal. With that as a baseline, you’ll be able to spot any changes early.

The ABCDE Rule

Keep the ABCDE rule in mind when checking moles:

  • A for asymmetry: If you were to cut the mole down the middle, would the left and the right sides look different?
  • B for border: Are the edges blurry and undefined? Does it appear to be spreading sideways?
  • C for color: Does the mole look darker or lighter than usual, or does it have an area of new color — perhaps black, blue, purple, red, or white?
  • D for diameter: Is the mole larger than the eraser on a pencil top?
  • E for elevation: Does it have a raised or bumpy surface?

If you answered yes to any of these questions about an existing mole — or if you notice a new mole, or one that’s started to itch or bleed — see your doctor right away. Melanoma most commonly appears on the trunk, head, and neck for boys, and the lower legs for girls.

If melanoma is suspected, the doctor will do a biopsy by removing all or part of the mole and examining its cells under a microscope. A biopsy not only shows if the cells are cancerous, but also shows how deeply they’ve penetrated the skin and can predict the risk of spreading. Knowing these details will help the doctor map out a treatment plan.

Treatment

Once a doctor confirms melanoma, treatment depends on how big and deep the lesion is, what part of the body it’s on, and whether the cancer has spread to other parts of the body. This process is called staging. Although staging is a complicated procedure that involves both physical exams and lab tests, the basic idea is that the lower the stage, the better the chance of recovery.

Treatment for melanoma usually includes surgery to remove the lesion and, possibly, radiation (high-energy X-rays that are directed at tumors) or chemotherapy (cancer-fighting drugs) if the doctor suspects that cancerous cells may have traveled to other areas of the body.

Immunotherapy (also known as biologic therapy) — in which doctors stimulate the body’s own immune system to fight cancer cells — also may be used along with these other treatments.

Prevention

Although you can’t control how fair their skin is or whether they have a relative with cancerous moles, you can lower your kids’ risk of developing melanoma. The most important way is to limit sun exposure.

Keep kids younger than 6 months out of the sun entirely, because their skin is extremely sensitive. If any body parts of a child under 6 months must be exposed to the sun, use a small amount of sunscreen on those parts, such as the face and hands. For kids 6 months and older, use sunscreen with an SPF of at least 30 every day.

Other ways to help prevent skin cancer include:

  • avoiding the strongest sun of the day — between 10 a.m. and 4 p.m.
  • encouraging kids to wear wide-brimmed hats and long, loose cotton clothing, especially if they tend to burn easily
  • making sure your teen understands the dangers of tanning salons
  • being a good role model yourself

Also, encourage kids to check their moles often (they may need some help with those hard-to-reach areas, like the back and scalp). Help kids keep dated records of each mole’s location, size, shape, and color. Remind them to bring anything suspicious to your attention so you can have it checked out.

Just as important, encourage them from an early age to think about and take responsibility for their own sun safety. For very young kids, it helps to keep it fun. Make a game out of applying sunscreen, whether it’s racing each other to lather up or making up a silly song about slathering on the lotion. For older kids, keep some sunscreen by the front door and make putting it on a requirement for playing outside (you may even consider rewarding them every time they remember without being told).

For teens, seeing some pictures of normal vs. sun-damaged or cancerous skin can really drive the message home that the choices they make today can absolutely have an effect on their health tomorrow.

Not all skin cancer is melanoma, but every case of melanoma is serious. Do what you can to lower your kids’ risk and empower them to make smart choices about sun safety. After all, the best defense is a good offense.

Reviewed by: Rupal Christine Gupta, MD
Date reviewed: September 2014