Tuesday, 19 June 2018

Skin changes, moles....and melanoma

A melanoma is an aggressive form of skin cancer, which originates in the melanocytes or pigment cells and can be fatal when it spreads to other parts of the body. In the last decade the number of patients with malignant melanoma in Europe has increased enormously. The good news is that most melanoma can be cured, when they are removed in an early stage and most can even be prevented when we check our moles regularly. Your dermatologist can nowadays make a more accurate diagnosis with advanced dermatoscopy. In most European countries dermatologist organize screening days for melanoma during the months may and june

How does a melanoma develop?
Moles are brown or black coloured spots or elevations of the skin, which are formed by pigment cells. They can be congenital, but arise especially in childhood and puberty. A new mole that develops after puberty should always be monitored. Approximately 40% of melanomas develop in an existing mole. The color is mostly brown or black, but they can also have pink, red, blue or white tints.

Do I have an increased risk for Melanoma?

Somebody in the family with melanoma
A personal history of melanoma
A high number of moles
Irregular moles
Light skin type and /or blue or green eyes
Sunburns in childhood and after
outdoor activities

What should I pay attention to?
It’s Important that you get to know your own body. Melanomas can develop over the entire skin fig 1 and 2 so you have to look from the crown of your head to the soles of your feet, including mouth, nose and genitalia. To asses whether a mole is suspect, we usually the American ABCD rule (Figure 3). The A (Asymmetry) for irregular shape, the B (Border) for irregular edge, the C(Colour) for an irregular or very dark colour and the D (Diameter) for a diameter larger than 5mm. Finally, the E (Evolution) is added. Moles that change shape, color or size are in principle suspect as well as new moles.

Dermatoscopic examination by the dermatologist

Although a good self-examination is useful first step, it is sometimes very difficult to distinguish a melanoma form a mole or other pigmentation spots. Your dermatologist can make a more accurate diagnosis with a dermatoscope fig 4 ,a kind of microscopic instrument. When in doubt, a tissue examination is always necessary.

How are melanomas and suspicious moles treated?
Suspected moles or melanomas are always removed surgically. Subsequently, it is send to the pathologist for histologic examination, which confirms both the diagnosis and if the melanoma is completely removed. Usually In case of a melanoma a re excision is performed to create a safety margin in combination with further examinations to exclude metastases.Remember that a mole is principally an innocent and often asymptomatic spot, but a melanoma can be fatal. In any doubt check it out and show it to your dermatologist.

Ruud Valks, dermatologist,
member of the American Academy of Dermtology

Figure 1 Melanoma on the occipital area of the head

Figure 2 Melanoma on the sole of the right foot

Figure 3. ABCD Rule

Figure 4. Dermatoscopy

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