Melanoma Monday ABCDEF

My weekend snapshot post is below this one for any of the WS participants who are here for that. The photographs in my Melanoma Monday post are from my garden. The subject is less pleasant but hopefully contains useful information. I thought this would be a good time to discuss the E and F of skin awareness which are new categories being suggested by some dermatologists as additions to the ABCD awareness campaigns.Today is Melanoma Monday, an event created by the American Academy of Dermatology to increase awareness of melanoma. Melanoma Monday is always the first Monday in May. Euro Melanoma is a similar event which is also on the first Monday in May and included 16 different countries in 2007. Most melanoma and skin cancer awareness campaigns include the ABCDs (asymmetry, border, color, diameter) for melanoma detection but increasingly there is a call to add E and F to that group (evolutionary changes, funny looking). Melanoma isn't always easy to recognize without a biopsy because it can present in many different ways. Of course without a biopsy you never know for sure if even suspicious looking lesions are malignant. There is no reason to panic but I think information can help people know when to show something to their doctor, or to request a dermatology referral.
The type of melanoma I have, nodular melanoma (NM), is often diagnosed later than other forms of cutaneous melanoma because it can be symmetrical, one color, and it may grow rapidly in thickness (under the skin) rather than having a visible growth phase on top of the skin. I am sensitive to these issues because my melanoma was dismissed as nothing, based on its symmetry and it took me a long time to go to another dermatologist who did a biopsy and diagnosed me with a deep melanoma which a surgical oncologist found had spread into the closest lymph node basin. NM accounts for about 15% of all diagnosed melanomas in the U.S. My melanoma definitely fit the E for evolutionary change and the F for funny looking.
The most common form of melanoma is superficially spreading melanoma (SSM) and it accounts for about 70% of all diagnosed melanomas in the U.S. This type of melanoma can strike at any age and a typical SSM lesion has irregular borders and variations in color. Lentigo maligna melanoma (LMM) typically occurs on sun damaged skin in the middle aged and elderly and in its early stages can be mistaken for sun spots or age spots. LMM accounts for about 10 percent of all diagnosed melanomas in the U.S.
The fourth form of melanoma is acral lentiginous melanoma and it accounts for about 5% of all diagnosed melanomas in the U.S. It can start as an irregular shaped spot on the palm or sole; it can develop in the mucosal membranes; it can develop under the nails. The reason this form of melanoma often carries a poor prognosis is because it is often diagnosed later than other forms. I have read articles theorizing that some of the more deadly melanomas have a similar prognosis to others, if they are caught early.Any of the hidden melanomas can be problematic regardless of which type they fall into because they are often diagnosed late. Melanomas in the scalp are often hard to see because they are hidden by hair. Mucosal melanoma can hide in the nose, mouth, female genitals, anus, urinary tract, and esophagus. Ocular melanoma arises in the lining of the eye, or on the pigmented coating of the eyeball.
According to this rather comprehensive article, while melanoma accounts for roughly 4% of all skin cancers, it is responsible for more that 74% of all skin cancer deaths. One reason that awareness is so important is that when melanoma is caught in its early stages the prognosis is excellent. However, when it is caught late the treatment options are not that great or effective. People with all stages of melanoma do beat the odds and there are new treatments in clinical trials but early diagnosis greatly improves the prognosis.
If anyone reading this post has melanoma or is interested in more information, a friend who I got to know through the MPIP set up a site which has both of our links on a variety of subjects pertaining to melanoma as well as organizations and sideline issues. That site is Melanoma Resources. I think part of the key to early diagnosis is when in doubt, go see an experienced doctor. Also, if you have a lesion you are concerned about (noticed changes etc.) and the first doctor you see says it's benign based on a visual exam, there is nothing wrong with getting a second opinion or even requesting a biopsy to be safe. If I had done that with my nodular melanoma, I would have been diagnosed much earlier. I'm not suggesting you shouldn't trust your doctor, I am only saying that we sometimes will have an awareness of subtle changes which send us to a doctor in the first place.