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

Interestingly, we don't think rubbing moles, physical trauma, having a bra strap over a mole makes them misbehave -- they irritate them but that doesn't make them go from good to bad. I suspect all is well, but I would see the doctor.

My sister had melanoma two years ago on her leg. We used to visit tanning beds a lot. Are tanning beds a major cause of melanoma?

What we know is that lots of people use tanning beds and that among people who use tanning beds there are more people with melanomas than among people who do not. We also know that tanning beds produce ultraviolet rays that are implicated in making melanomas happen.

What we don't know is whether tanning beds simply mark people as sun worshippers. After all, people who go to tanning beds tend to think tans are beautiful. They tend to maintain a tan, spend time out in the sun, both use tanning beds and go to Florida and lie on the beach.

So, it's very hard to know the extent to which tanning beds make melanomas vs. tanning beds. Tanning salons identify people who are likely to get the kind of sun exposure that makes for more risk of melanoma.

"Melanomas that are in the very top layer of the skin, or that have just broken through to the second layer of the skin."

I am 25 and have had approximately 12 moles removed from my chest, shoulders, back and legs. I am fair skinned and stay out of the sun. When I was younger I spent my summers on the lake.

My dermatologist requires I see her every six months, which is fine but my last appointment she decided not to take any off. All the others have come back abnormal. She said because I have such a variety of moles, and they always come back abnormal, they probably always will be abnormal so keep an eye on them and let her know. I think there is more to it than just that. I guess to me, abnormal is just that, abnormal!

Should I see someone else? Is it possible there's more to it than just having several "abnormal" cells? I know cancer can be beat but it is best to catch early. Please advise!

I think my advice is to find a dermatologist who will, themselves, do photographs of all your skin or send you to a skin imaging center to get photographs done. You should have a copy of those photographs and your physician ought to have a copy or plan to take your photographs into your follow up appointments with your dermatologist. If you have the same old dots and they haven't changed, you don't need a biopsy. If one or more is bigger, darker, different, then I would think of a biopsy.

It's true people who have abnormal moles are more likely to get melanoma, but it's also true they don't need to have all their moles taken off. It's an impossible task, because in part, it's the whole skin that's at somewhat elevated risk of melanoma.

The best plan is to do self-examination aided by high-quality photographs.

Once you have malignant melanoma, what is the likelihood that it will metastasize internally?

The likelihood of metastases in any group of people goes all the way from tiny to nonexistent, in people with early melanomas. Melanomas that are in the very top layer of the skin, or that have just broken through to the second layer of the skin. For people who have bigger melanomas or later melanomas, melanomas that are into the deeper layer of the skin that are bigger in volume and bigger in diameter, the risk goes from smallish to largish, up to 80% to having metastases some later time.

If you have a melanoma that is more advanced then you're likely to have your lymph nodes examined -- the lymph glands that are nearest to where the melanoma is -- and this is a procedure called a sentinel node biopsy. If the lymph nodes have some melanoma in them it means the disease has gone from where it began to another place and that means the risk of metastasis elsewhere is higher.

What is the recommended treatment for recurrence of melanoma which appears in the lymph node?

The first thing to do if you have just had one or two lymph nodes taken out is to make the diagnosis of melanoma in the lymph nodes. You then have a lymph node dissection, where the adjacent lymph nodes in the region -- under the arm, for example -- are taken out. You might have involvement of one or two nodes but you would have an additional 15 to 20 nodes taken out to make sure that you have gotten it all. That operation will greatly decrease the likelihood of the disease growing back in that area. And it at least opens the possibility of being cured.

Some people live forever after having involved-lymph nodes taken out, but people with lymph node involvement are more likely than people without to have seeds in their garden elsewhere to sprout at some later time. Therefore, some people with lymph nodes will get adjuvant therapy, or additional therapy, and this might be with a kind of immunological hormone, alpha interferon, or because that doesn't work very well and is fraught with side effects, you might choose to go on a clinical trial of, for example, a vaccine.

My 23-year-old daughter had a mole removed recently in which the pathology report showed a compound melanocytic nevus with severe architectural disorder and recommended a wider excision. Does re-excising "stir up" the possible melanoma cells to spread into other areas?

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