Melanoma: Prevention, Detection, and Treatment (cont.)

MEMBER QUESTION:
I am 20 years old and had a mole on my face that the doctor said would likely turn into melanoma if it wasn't removed. I had to go back and get more taken off. He said all of it was gone now. Do I have to worry more about melanoma than most people?

GUERRY:
A good question. Because I don't know what the mole that was taken off looked like under the microscope it's hard for me to give a definite answer.

Let's pretend though, that this was an atypical mole, abnormal, dysplastic mole. Then that would mark you as someone a little more likely to get a melanoma over the rest of your lifetime, maybe a twofold chance or if you had lots of big funny moles, maybe a tenfold chance. Remember, this is two times or 10 times a lifetime risk of something like 1 percent, so that would be like a lifetime risk of 2% or 10%. Sounds like a lot, but if you keep your eye on your skin, see your physician once a year and moderate your sun exposure, then the likelihood of getting a melanoma is still pretty small and the likelihood of getting a bad melanoma is very small.

A professional should look at your skin top to bottom and tell you whether you have lots of funny looking moles. If you have a difficult skin examination because you have lots of moles, then consider having photographs taken of your skin by a dermatologist, someone who does skim imaging, and that will help you and your doctor keep an eye on your skin.

MODERATOR:
To establish a baseline?

GUERRY:
That's to establish a baseline, yes, because once you've had a funny mole taken off then you start to pay particular attention to your skin and you begin to think that a number of moles seem to be changing. Then there will be tendency to have many biopsies. You could avoid this by having photographs that assure you there is no change from baseline because melanomas really do change with time and stable spots are very reassuring.

MEMBER QUESTION:
I have had "precancer" spots removed. Are those hot spots for melanoma?

GUERRY:
I suspect that this person is talking about little reddish scaly patches in the skin that sometimes grow up to be common skin cancer -- nonmelanoma skin cancer. These are things called actinic keratoses and 1 in 1000 become the usual kind of skin cancer. These are often treated by dermatologists and primary care physicians with freezing.

"If you have a difficult skin examination because you have lots of moles, then consider having photographs taken of your skin by a dermatologist, someone who does skim imaging, and that will help you and your doctor keep an eye on your skin."

MEMBER QUESTION:
Does lentigo maligna turn into melanoma?

GUERRY:
Lentigo meligna is the earliest form of the kind of melanoma that happens generally in older people who have had a lifetime of plenty of sun. It's melanoma in the very top layer of the skin, the epidermis, and it's melanoma that has no ability to get inside you. If left alone for three years or five years or 10 years or more, it may become bigger and deeper and pose a threat. So it's a form of early melanoma that needs attention, but can't harm you until it's allowed to grow and grow and change.

MEMBER QUESTION:
Is it true that a melanoma can begin inside your body on your internal organs, without any visible moles on the outside?

GUERRY:
It's true, but it's really, really, really rare. It certainly has nothing to do with sunlight. It's a reminder there are some other causes of melanoma. It's also a reminder that melanocytes, the cells that can give rise to melanoma that are in the skin, are also in some other place. These are so rare that no one should be afraid this is going to happen to them.

MEMBER QUESTION:
How can melanoma show up in the vaginal/rectal tissue? My mother was diagnosed with this years ago and succumbed to it. I only thought that melanoma was evident on the skin, but not deep in the body. How does this occur?

GUERRY:
There are melanomas in the back of the eyeballs and in places like the mouth or the inside of the nose or the vagina or the rectum. These obviously have nothing to do with sunlight, are still very rare, and are generally treated with surgery. If they're caught early, just as in skin melanomas, then they're generally cured. They're often found late because you don't tend to peer in your mouth and nose and peer where the sun doesn't shine, but they are so rare that I don't think anyone would advise you check inside your nose, or your mouth or your vagina and so on.

MEMBER QUESTION:
I've had a large mole (brown not dark) on my back for years and years. It's right at my bra line and I have had it taken off once or twice but it always grows back. It's flattish and rough and itches once in awhile but not consistently. I just scratched it and so it has a scab on it right now. Should I have it looked at?

GUERRY:
Yes. It's probably benign, it sounds like it's been looked at under the microscope and reassuringly OK, but because it has grown back and changed I think someone should look at it.



STAY INFORMED

Get the Latest health and medical information delivered direct to your inbox!