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Bill Klaproth: Melanoma is the rarest form of skin cancer. However, it is also the most aggressive form of skin cancer because it often spreads. Here to talk with us more about melanoma and skin cancer is Dr. Diana Stephens, a dermatologist at Cayuga Medical Center. Dr. Stephens, thanks for your time. So what causes melanoma?

Diana Stephens, MD: So, melanoma is actually caused by mutations in the specific cell called a melanocyte, which we all have, which is a cell that makes the pigment that we see in our skin. What happens is usually if you get too much sunlight, that UV ray causes the DNA in the cell to be damaged. Then the cell starts growing uncontrollably and you get what’s called a melanoma.

Bill: So, the areas of the body that are affected are the areas that are exposed to the sun—arms, face, legs. Is that right? 

Dr. Stephens: So, you can pretty much get it anywhere where.

Bill: Hence the importance of sunscreen. So, what are the signs and symptoms of melanoma? How can someone tell the difference between melanoma and other forms of skin cancer? What should we be looking for?

Dr. Stephens: Right. So that is another good question because the signs and symptoms. So, like I said, usually a melanoma starts as a new mole or somebody sees something that they haven’t seen there before. Even if it didn’t start, it’s a mole that’s changing per se. So, we have what we call the ABCDE of melanoma. So, I go through those with my patients on a regular basis. So, A stands for asymmetry. So, if you see something that’s kind of growing and it’s not this nice perfect round mole, or if you couldn’t cut it in half and the sides would look the same if you folded them. If there's a spike coming out of it somewhere, that’s something to look for. 

The B stands for borders. So, kind of going along the same path. If the borders are a little bit fuzzy or irregular, if they don look perfectly round, that’s something to look out for as well.  The C stands for color. It’s actually not so much color changes. Although color changes are important, color variegation is the term that we use, and that just means that there are multiple colors within the same mole. So generally, most people’s moles are like a light brown, or some are dark brown depending on the color of the skin. That’s okay. It’s when you start to see a little bit of light brown, a little bit of dark brown, maybe even some red in there. That’s when you kind of start to worry a little more.

The D stands for diameter. So generally, if the mole is starting to get a little bit bigger and it’s kind of at that 5-millimeter mark, that should be something that should worry you a little bit more. It’s kind of the size of a pencil head eraser is how I like to think about it. If it’s bigger than that, then it’s probably reasonable to come in and have it checked. Then E is kind of a catch all because it stands for evolution. So, again, any kind of changes or evolving of the mole is something that you’d want to come in and have looked at. 

Bill: That is great information Dr. Stephens. So, we’re kind of looking for something new. Kind of a weird shape, multi-color, bigger than a pencil head, and something that’s evolving. Generally, that’s what to look for. 

Dr. Stephens: Yeah. I also love to tell people, and it sounds really silly, but I love to tell people to look for an ugly duckling. Most people make a signature type of mole or a couple different signature type of moles. What I mean by that is that they have one or two mole types. So, all of my moles maybe look light brown and they're a little bit oval shaped or something. All of your moles would be a little bit light brown and maybe they're more rounded and they have a little dot in the center or something. As long as all of your moles look generally similar, that’s okay. If you look out for that one that looks different, that ugly duckling, that’s also something that’s really easy for people to identify that is different than the rest of what’s going on. So that’s another thing to look for and come in to see me for.

Bill: So, look for that ugly duckling. If you see that and you go into the doctor, then how do you diagnose this?

Dr. Stephen: So, this is diagnosed with a biopsy. So usually when I see somebody, I do a full skin exam with particular tension to any new moles or changing moles. I use what’s called a dermatoscope. That’s basically just a little device that has a light and a magnifying glass on it so I can actually go in and look closely at the mole and see how the pigment network looks under that microscope. If it looks a little bit suspect, then what happens is I would take a biopsy. So, what that involves is local numbing of the skin, then you kind of take the piece of skin off and we send it to our dermatopathologist who looks at it under the microscope to tell me is it a mole. Is it an atypical mole—which we call despotic mole—or is it melanoma? 

Bill: So then if it is melanoma, what are the treatment options?

Dr. Stephen: So, the treatment options for melanoma generally, it’s based on [INAUDIBLE] and it’s based mainly upon the depth of the melanoma. So, a thinner melanoma—and we’re talking in like the 0.1 to 0.7-millimeter type of melanoma—those are generally treated with surgery alone. That’s okay. You go in and you get usually about a centimeter or so margin around the mole, where it was the whole mole. Then you get closed up. Then if it’s a thicker melanoma—so something over a 0.7- or 0.8-millimeter melanoma—usually what happens is we would send our patients to a surgical oncologist. They would not only get the same excision done, but they would get a lymph node check. So, what’s called Sentinel Lymph Node Biopsy. All that means is the first lymph node that would catch any cells coming out of that site. They have ways to detect which lymph node that is based on the body location. They would check that and see if it had cancer or not. Then from there, depending on if it was positive or negative, you would either need more surgery or possibly chemotherapy or immune therapy or you would need nothing else.

Bill: So, if it is melanoma, surgery is in order then. 

Dr. Stephens: Yep. Most melanoma’s the biopsy is a little scrape off. If it does show up as a melanoma, you will be guaranteed to get more surgery at that point.

Bill: So how can we examine ourselves? What should we be looking for? I know the ugly duckling, but what is your recommendation? Once a month? Every six months? Should we really be looking our bodies over or having our partners look at our back? How do we do this?

Dr. Stephens: No, that’s perfect. That’s exactly what I was going to say. So, it’s very, and people are different, and skin is different. Some people have a little bit of a genetic predisposition towards developing melanomas compared to other people. So, it’s important that definitely if you are somebody that is light skinned and blue eyes, blonde hair that you are checking yourself maybe a little bit more often than somebody who has darker skin. It is definitely important for everyone to check. Like you said, having someone that’s able to kind of look you over. Especially your back. Backs are a big location because nobody ever looks at their back. So, if you have somebody that looks at your back often. You know every couple of months you just kind of look over each other, look at your moles. Say, “Oh hey. This one is a little bit different. Maybe we should see the dermatologist.”

The other thing that works pretty well for people if they have a lot of moles. Maybe it’s not just one that they're watching. Maybe they have tons all over the body is you can actually take pictures. So, in this era of cellphones and pictures everywhere, you can sort of just snap some shots or have somebody snap of shots of either particular moles you're worried about or just kind of allover and just keep track of them. That’s a really good way to keep track of somebody with a lot of moles.

Bill: That’s great advice. To wrap it up, I think it’s important to stress that if you see something that looks, as you said, an ugly duckling. Weird, new, multi-color don’t wait. Go and have it checked. Is that the good message to make sure that we get across?

Dr. Stephens: Absolutely. Absolutely. If there is anything that is changing, different, or if you're just not even sure if it’s a mole. If it’s something new, definitely come see us. We’re not going to be upset or angry or that you wasted our time. I would much rather you come in, so I can say oh this is not a big deal as opposed to you waiting and not getting something diagnosed in time, then having it become much more serious than it could have been.  

Bill:Dr. Stephens, this has been very valuable. Thank you so much for your time. For more information, please visit cayugamedicalassociates.org. That’s cayugamedicalassociates.org. This is To Your Health from Cayuga Medical Center. I’m Bill Klaproth,