Selected Podcast
Melanoma: Understanding Stages, Types, Causes and Treatments
Dr. Quantel Rolle discusses Melanoma. He shares the symptoms, the different stages, treatment options available and prevention tips.
Featured Speaker:
Quantel V. Rolle, MD
Quantel V. Rolle, MD is a General Surgery Specialists. Transcription:
Melanoma: Understanding Stages, Types, Causes and Treatments
Introduction: Well Within Reach is brought to you by Riverside My Chart, your simple secure and confidential online health connection. With just a click, Riverside My chart lets you stay well connected to the same information your doctor sees. You can request prescription refills, pay your bills, schedule your next appointment, and more. Manage your care from your laptop, tablet or phone, whether for yourself, your kids or the grandparents. My chart makes your busy life just a little easier. Learn more and enroll today at Riversidemychart.org, just another way to stay well connected from Riverside Healthcare. Riverside Healthcare puts the health and wellness information you need well within reach.
Sean O'Connor: Welcome to Well Within Reach. I'm Sean O'Connor, I'm a Marketing Communications Rep here at Riverside Healthcare and today I'm joined by Dr. Rolle who is a General Surgeon at Riverside. How are you doing today, Dr. Rolle?
Dr. Rolle: Doing well. Good afternoon Sean. How are you?
Host: I'm doing great. Thanks for having us on.
Dr. Rolle: Oh absolutely. Thanks for having me.
Host: Today we're going to be talking about melanoma. So what it is, understanding the stages, the types, the causes and the treatments available to it. So give us a little background about yourself and what kind of brings you into the realm of melanoma?
Dr. Rolle: So yeah, absolutely. So I trained at Carolina's Medical Center. It's Levine Cancer Institute out there. So it's a very large institution, does a lot of education for the community, a lot of caring for the community, and provides services where the community outside of what you would consider normal. And so it was ingrained in me, training with people like Dr. Richard White, Dr. Sarah Sorrento, surgical oncologist extraordinaire. I work very closely with the National Comprehensive Cancer Network to develop the national standards. And so it's in my training.
Host: Excellent. Fantastic. So for anybody who doesn't know, what is melanoma?
Dr. Rolle: So melanoma is an abnormal growth from normal pigments and cells in the superficial layer of the skin called the epidermis. Normally the cells can help protect us from harmful ultraviolet rays, UV rays. And there are four different types of melanoma, but the most common two types are superficial spreading and Akrolentiginoses. So the Akrolentiginoses is located in the palms of the hands and the soles of the feet, including the fingernails and toenails. And the superficial spreading is just the rest of the skin that you normally think about. Melanomas are different from normally occurring skin moles or other skin lesions or stains as they're called. Skin cancers are divided by the cells from which they derive and thus how aggressive or likely to spread to other parts of the body they are.
Host: Interesting. So what are some identifiers we see with melanomas?
Dr. Rolle: Absolutely. So as previously stated, melanomas can sometimes be mistaken for normally occurring skin moles. Thankfully we have the A, B, C, D, E, signs of melanomas. So let's talk about them, and let's work them down. A stands for asymmetry. If you cover half of the lesion, it appears to have a different shape compared to the other half of the lesion. B stands for border irregularity, so the edges of the lesion are not smooth and appear jagged. C stands for color. The lesion has different colors in different parts of the lesion. D is for diameter, the lesion is larger than five millimeters, who really knows millimeters. So we use pencil eraser size, it's about larger than the size of the eraser tip on your pencil. E stands for evolving. The lesion changes with time. So those are the A, B, C, D, E's of melanoma.
Host: Interesting. Very good to know that there's kind of a good acronym that people can remember now. When we say time with the lesion changing, what kind of span of time are we looking at for changes?
Dr. Rolle: Absolutely. A great question. So it depends on the melanoma type and how aggressive that particular melanoma is. It could be weeks, it could be months, it could be years.
Host: Okay. Very cool. So are melanomas deadly necessarily?
Dr. Rolle: So if they're caught early and not have certain aggressive types, melanomas are curable and not deadly with surgery and or chemotherapy.
Host: Interesting. And what kind of surgeries and kind of treatments do we see with melanomas?
Dr. Rolle: Absolutely. So the treatments for melanoma vary. It depends on the type of melanoma and how aggressive the lesion is when it is identified. So it can be anywhere from surgery for the melanoma itself and the surrounding area or surgery for that melanoma, the surrounding area and lymph nodes or chemotherapy or some combination thereof.
Host: Okay. And so with most cancers it has different stages. So it can go from stage one to four, correct?
Dr. Rolle: Correct. And the staging is an internal classification for physicians that we use to help us understand where our patients are on the treatment spectrum.
Host: And are melanomas something that only occur on the skin or do they occur elsewhere in the body?
Dr. Rolle: So no, melanomas can also be located in various places such as, for example, uveal melanoma. They may be detected during your annual eye exam by your optometrist or your ophthalmologist. Melanomas of the lymph nodes are found when a patient presents with complaints of a swollen lymph node to their primary care provider and a clinical history is taken and a thorough exam performed. If your primary care doctor is concerned, you will subsequently be referred to a specialist such as myself for a lymph node biopsy consult in order to confirm the diagnosis or rule it out. So that's when you will have a swollen lymph node without an external skin lesion that you can see.
Host: Okay. Very cool. Interesting. And we already touched on some of the treatment options. Are there other kind of treatment options available beyond surgery? I know a lot of times you can do a quick search on the internet and the internet is a dangerous place, but you always see the black sabz or something like that. Are those viable options or are they?
Dr. Rolle: So Dr. Google, we like literature. We believe in science. We're very evidence based and science and evidence support surgery as the primary modality for the treatment of melanomas. Now that being said, we also work with a multidisciplinary tumor board. So that includes the medical oncologist, the dermatologist, the medical radiation oncologist, the plastic surgeon, and of course the general surgeon specialists. And then we form a very specific, very individualized treatment plan for individual patients.
Host: Okay. Interesting. And some people more at risk than others when it comes to melanomas?
Dr. Rolle: Absolutely. So individuals with less melanocytes in their skin, for example, lighter eye colors or lighter skin complexions. Also those with increased UV radiation exposure between the hours of 10:00 AM and 4:00 PM, that's when the sun's maximally out or tanning bed exposure. Also any immunocompromised patient is at increased risk.
Host: Okay. And does that risk increase over age or is it kind of, it really comes down to the melanoma or sorry, your skin type?
Dr. Rolle: So it comes down to the risk factors that we just mentioned. Like you said, your skin type. It also comes down to your exposure. So individuals that are more in the sun, more in tanning beds or immunocompromised.
Host: Are more likely to see in any increased risk in melanomas, correct?
Dr. Rolle: Correct. Now most melanomas do occur in individuals greater than the age of 60. However, melanoma is also very common in individuals less than the age of 30, believe it or not.
Host: Really? Very interesting. And why is that?
Dr. Rolle: Well, I don't really know why, but that is an observed incident.
Host: Okay, interesting. What are some ways we can prevent melanomas and other kinds of skin cancers?
Dr. Rolle: So melanomas are best prevented by maximally limiting exposure to UV radiation. If you have to be outside during the hours of 10:00 AM and 4:00 PM stay in maximally shaded areas, if at all possible. Wear long sleeves, pants, hats, sunshades, and gloves. Utilize SPF 30 lotions, that's sun protection factor 30 or above, and reapply as appropriately. This is an area where people forget you must reapply. How often should you reapply? Usually every hour or as listed on the directions on the container. Smoking is a risk factor for virtually every single cancer. If you smoke, please stop. Smoking also increases the risk of cancer for all those around you, including the scent of tobacco smoke on your clothing. If you are immunocompromised, your risk is automatically increase as previously stated. Be sure to work with your oncology care team to minimize your risk. If you have a large number of skin moles or fall into one of these high risk groups, be sure you visit your primary care doctor and dermatologist for annual skin exams and monitoring. Be sure to follow the National Comprehensive Cancer Network patient information guidelines by visiting nccn.org and select patient information for melanoma, to learn more information and also to see pictures for examples of melanoma.
Host: And I think it's worth reminding too, for all of the men out there who are like myself who are little thin on the top of the head that it's important to make sure you get the sunscreen on top of your head as well. Because when I first started shaving my head, that was the first time I didn't realize I had to put sunscreen on and I got a really bad sunburn. And I've really learned my lesson the hard way I think with that, so.
Dr. Rolle: That's an excellent point, Sean. Absolutely. Thanks for highlighting that. It's from different personal experience.
Host: Yep, yep. You've got to make sure you put it everywhere where your skin is exposed, not, not just where your face and your hands. Do melanomas occur in certain areas more likely than others?
Dr. Rolle: So the most common type of melanomas previously mentioned is the superficial spreading melanoma. So that's all of the skin that you normally think of when you look at your arms, your legs, the back of your hands, also on the trunk or if you think of your chest and your back and your abdomen, those areas as well. But there are other melanomas like we talked about, the Akrolentiginoses melanomas that can occur on the palms of the hands, the soles of the feet, the fingernails and the toenails. Those usually occur in people that have more melanin in their skin. So darker complected people or people with darker eye color.
Host: Okay. Interesting. And that's something that I don't think a lot of people realize. I think when people talk melanoma they really just think of fair skin, you know, blue eyed people who are at risk. But really across the spectrum, everyone is at risk for melanomas.
Dr. Rolle: Absolutely. If you have Milena sites, you are at risk for melanoma.
Host: Interesting. And so when we go through treatment, if we were to have a melanoma removed, what does that entail as far as the procedure?
Dr. Rolle: So treatment once again is individualized for the patient. First you come in as a referral. There is a thorough skin exam that is performed. We may choose to take a biopsy of the area. Sometimes we just excise the entire area and sometimes we'd take a piece of it and send it off to the pathologist. The pathologist will then take a look at it. Tell us what degree of melanoma or how thick the melanoma is in the skin and that tailors the rest of the treatment. You branch off in different algorithms. From there, we speak about you at the multidisciplinary tumor boards. As previously stated, evidence shows us that you have the best outcomes that way and we go from there.
Host: Interesting. Now, if someone suspects they might have a melanoma or other type of skin cancer, what's a good first step? Should they see their CP, their primary care provider? Should they go see a dermatologist? Should they go directly to you?
Dr. Rolle: Your primary care provider is your best friend. You have to think of your primary care provider as the person who sees you on a very frequent basis and can get you to the appropriate consultant that you need.
Host: Very good, very good. Interesting. Anything else we should know about melanomas?
Dr. Rolle: No, that pretty much sums it up. For more information, again, I refer you to the National Comprehensive Cancer Network @nccn.org or speak with your primary care provider or make an appointment and come see us. We'd love to have you.
Host: Interesting. Thank you for coming on. We appreciate it.
Dr. Rolle: The pleasure is mine.
Melanoma: Understanding Stages, Types, Causes and Treatments
Introduction: Well Within Reach is brought to you by Riverside My Chart, your simple secure and confidential online health connection. With just a click, Riverside My chart lets you stay well connected to the same information your doctor sees. You can request prescription refills, pay your bills, schedule your next appointment, and more. Manage your care from your laptop, tablet or phone, whether for yourself, your kids or the grandparents. My chart makes your busy life just a little easier. Learn more and enroll today at Riversidemychart.org, just another way to stay well connected from Riverside Healthcare. Riverside Healthcare puts the health and wellness information you need well within reach.
Sean O'Connor: Welcome to Well Within Reach. I'm Sean O'Connor, I'm a Marketing Communications Rep here at Riverside Healthcare and today I'm joined by Dr. Rolle who is a General Surgeon at Riverside. How are you doing today, Dr. Rolle?
Dr. Rolle: Doing well. Good afternoon Sean. How are you?
Host: I'm doing great. Thanks for having us on.
Dr. Rolle: Oh absolutely. Thanks for having me.
Host: Today we're going to be talking about melanoma. So what it is, understanding the stages, the types, the causes and the treatments available to it. So give us a little background about yourself and what kind of brings you into the realm of melanoma?
Dr. Rolle: So yeah, absolutely. So I trained at Carolina's Medical Center. It's Levine Cancer Institute out there. So it's a very large institution, does a lot of education for the community, a lot of caring for the community, and provides services where the community outside of what you would consider normal. And so it was ingrained in me, training with people like Dr. Richard White, Dr. Sarah Sorrento, surgical oncologist extraordinaire. I work very closely with the National Comprehensive Cancer Network to develop the national standards. And so it's in my training.
Host: Excellent. Fantastic. So for anybody who doesn't know, what is melanoma?
Dr. Rolle: So melanoma is an abnormal growth from normal pigments and cells in the superficial layer of the skin called the epidermis. Normally the cells can help protect us from harmful ultraviolet rays, UV rays. And there are four different types of melanoma, but the most common two types are superficial spreading and Akrolentiginoses. So the Akrolentiginoses is located in the palms of the hands and the soles of the feet, including the fingernails and toenails. And the superficial spreading is just the rest of the skin that you normally think about. Melanomas are different from normally occurring skin moles or other skin lesions or stains as they're called. Skin cancers are divided by the cells from which they derive and thus how aggressive or likely to spread to other parts of the body they are.
Host: Interesting. So what are some identifiers we see with melanomas?
Dr. Rolle: Absolutely. So as previously stated, melanomas can sometimes be mistaken for normally occurring skin moles. Thankfully we have the A, B, C, D, E, signs of melanomas. So let's talk about them, and let's work them down. A stands for asymmetry. If you cover half of the lesion, it appears to have a different shape compared to the other half of the lesion. B stands for border irregularity, so the edges of the lesion are not smooth and appear jagged. C stands for color. The lesion has different colors in different parts of the lesion. D is for diameter, the lesion is larger than five millimeters, who really knows millimeters. So we use pencil eraser size, it's about larger than the size of the eraser tip on your pencil. E stands for evolving. The lesion changes with time. So those are the A, B, C, D, E's of melanoma.
Host: Interesting. Very good to know that there's kind of a good acronym that people can remember now. When we say time with the lesion changing, what kind of span of time are we looking at for changes?
Dr. Rolle: Absolutely. A great question. So it depends on the melanoma type and how aggressive that particular melanoma is. It could be weeks, it could be months, it could be years.
Host: Okay. Very cool. So are melanomas deadly necessarily?
Dr. Rolle: So if they're caught early and not have certain aggressive types, melanomas are curable and not deadly with surgery and or chemotherapy.
Host: Interesting. And what kind of surgeries and kind of treatments do we see with melanomas?
Dr. Rolle: Absolutely. So the treatments for melanoma vary. It depends on the type of melanoma and how aggressive the lesion is when it is identified. So it can be anywhere from surgery for the melanoma itself and the surrounding area or surgery for that melanoma, the surrounding area and lymph nodes or chemotherapy or some combination thereof.
Host: Okay. And so with most cancers it has different stages. So it can go from stage one to four, correct?
Dr. Rolle: Correct. And the staging is an internal classification for physicians that we use to help us understand where our patients are on the treatment spectrum.
Host: And are melanomas something that only occur on the skin or do they occur elsewhere in the body?
Dr. Rolle: So no, melanomas can also be located in various places such as, for example, uveal melanoma. They may be detected during your annual eye exam by your optometrist or your ophthalmologist. Melanomas of the lymph nodes are found when a patient presents with complaints of a swollen lymph node to their primary care provider and a clinical history is taken and a thorough exam performed. If your primary care doctor is concerned, you will subsequently be referred to a specialist such as myself for a lymph node biopsy consult in order to confirm the diagnosis or rule it out. So that's when you will have a swollen lymph node without an external skin lesion that you can see.
Host: Okay. Very cool. Interesting. And we already touched on some of the treatment options. Are there other kind of treatment options available beyond surgery? I know a lot of times you can do a quick search on the internet and the internet is a dangerous place, but you always see the black sabz or something like that. Are those viable options or are they?
Dr. Rolle: So Dr. Google, we like literature. We believe in science. We're very evidence based and science and evidence support surgery as the primary modality for the treatment of melanomas. Now that being said, we also work with a multidisciplinary tumor board. So that includes the medical oncologist, the dermatologist, the medical radiation oncologist, the plastic surgeon, and of course the general surgeon specialists. And then we form a very specific, very individualized treatment plan for individual patients.
Host: Okay. Interesting. And some people more at risk than others when it comes to melanomas?
Dr. Rolle: Absolutely. So individuals with less melanocytes in their skin, for example, lighter eye colors or lighter skin complexions. Also those with increased UV radiation exposure between the hours of 10:00 AM and 4:00 PM, that's when the sun's maximally out or tanning bed exposure. Also any immunocompromised patient is at increased risk.
Host: Okay. And does that risk increase over age or is it kind of, it really comes down to the melanoma or sorry, your skin type?
Dr. Rolle: So it comes down to the risk factors that we just mentioned. Like you said, your skin type. It also comes down to your exposure. So individuals that are more in the sun, more in tanning beds or immunocompromised.
Host: Are more likely to see in any increased risk in melanomas, correct?
Dr. Rolle: Correct. Now most melanomas do occur in individuals greater than the age of 60. However, melanoma is also very common in individuals less than the age of 30, believe it or not.
Host: Really? Very interesting. And why is that?
Dr. Rolle: Well, I don't really know why, but that is an observed incident.
Host: Okay, interesting. What are some ways we can prevent melanomas and other kinds of skin cancers?
Dr. Rolle: So melanomas are best prevented by maximally limiting exposure to UV radiation. If you have to be outside during the hours of 10:00 AM and 4:00 PM stay in maximally shaded areas, if at all possible. Wear long sleeves, pants, hats, sunshades, and gloves. Utilize SPF 30 lotions, that's sun protection factor 30 or above, and reapply as appropriately. This is an area where people forget you must reapply. How often should you reapply? Usually every hour or as listed on the directions on the container. Smoking is a risk factor for virtually every single cancer. If you smoke, please stop. Smoking also increases the risk of cancer for all those around you, including the scent of tobacco smoke on your clothing. If you are immunocompromised, your risk is automatically increase as previously stated. Be sure to work with your oncology care team to minimize your risk. If you have a large number of skin moles or fall into one of these high risk groups, be sure you visit your primary care doctor and dermatologist for annual skin exams and monitoring. Be sure to follow the National Comprehensive Cancer Network patient information guidelines by visiting nccn.org and select patient information for melanoma, to learn more information and also to see pictures for examples of melanoma.
Host: And I think it's worth reminding too, for all of the men out there who are like myself who are little thin on the top of the head that it's important to make sure you get the sunscreen on top of your head as well. Because when I first started shaving my head, that was the first time I didn't realize I had to put sunscreen on and I got a really bad sunburn. And I've really learned my lesson the hard way I think with that, so.
Dr. Rolle: That's an excellent point, Sean. Absolutely. Thanks for highlighting that. It's from different personal experience.
Host: Yep, yep. You've got to make sure you put it everywhere where your skin is exposed, not, not just where your face and your hands. Do melanomas occur in certain areas more likely than others?
Dr. Rolle: So the most common type of melanomas previously mentioned is the superficial spreading melanoma. So that's all of the skin that you normally think of when you look at your arms, your legs, the back of your hands, also on the trunk or if you think of your chest and your back and your abdomen, those areas as well. But there are other melanomas like we talked about, the Akrolentiginoses melanomas that can occur on the palms of the hands, the soles of the feet, the fingernails and the toenails. Those usually occur in people that have more melanin in their skin. So darker complected people or people with darker eye color.
Host: Okay. Interesting. And that's something that I don't think a lot of people realize. I think when people talk melanoma they really just think of fair skin, you know, blue eyed people who are at risk. But really across the spectrum, everyone is at risk for melanomas.
Dr. Rolle: Absolutely. If you have Milena sites, you are at risk for melanoma.
Host: Interesting. And so when we go through treatment, if we were to have a melanoma removed, what does that entail as far as the procedure?
Dr. Rolle: So treatment once again is individualized for the patient. First you come in as a referral. There is a thorough skin exam that is performed. We may choose to take a biopsy of the area. Sometimes we just excise the entire area and sometimes we'd take a piece of it and send it off to the pathologist. The pathologist will then take a look at it. Tell us what degree of melanoma or how thick the melanoma is in the skin and that tailors the rest of the treatment. You branch off in different algorithms. From there, we speak about you at the multidisciplinary tumor boards. As previously stated, evidence shows us that you have the best outcomes that way and we go from there.
Host: Interesting. Now, if someone suspects they might have a melanoma or other type of skin cancer, what's a good first step? Should they see their CP, their primary care provider? Should they go see a dermatologist? Should they go directly to you?
Dr. Rolle: Your primary care provider is your best friend. You have to think of your primary care provider as the person who sees you on a very frequent basis and can get you to the appropriate consultant that you need.
Host: Very good, very good. Interesting. Anything else we should know about melanomas?
Dr. Rolle: No, that pretty much sums it up. For more information, again, I refer you to the National Comprehensive Cancer Network @nccn.org or speak with your primary care provider or make an appointment and come see us. We'd love to have you.
Host: Interesting. Thank you for coming on. We appreciate it.
Dr. Rolle: The pleasure is mine.