Melanoma of the Skin

By: Zacharia Facaros, DPM

“Hey, what is that on your foot? Is it a mole?  Is it a scar?”

If you’ve had a family member or friend say this to you at some point, or if you’ve had these thoughts, you’re not alone. Please, do not shake this off as an unimportant concern.  Suspicious areas on your skin, also called lesions, can be one of numerous things, and even experts have a difficult time deciphering between which ones are harmful and which ones are not.

Melanoma is a common cancer of the skin, also known as malignant melanoma, and is the most deadly type of skin cancer because it can spread quickly (metastasize) throughout the body. The incidence of melanoma is growing faster because of the popularity of sunbathing and the use of tanning beds.  Thus, during this summer season in Chicago, when many are heading to the beaches or going away on vacation, proper sun protection is vital. You can often prevent melanoma by protecting your skin from sunburn and excessive sun exposure.    

The National Cancer Institute estimates that over 1 million people per year are diagnosed with skin cancer, approximately 7% of which is melanoma. More than 76,000 people will be diagnosed with melanoma in 2012, of which 9,000 cases will be fatal due to the severe effects on the body.  People in their 60s make up the median age group of those diagnosed with melanoma, with an age-adjusted incidence of 21 per 100,000 men and women.  Roughly 2% of men and women will be diagnosed with melanoma of the skin at some time during their lifetime and as of 2009, there were approximately 876,000 men and women who had a history of melanoma in the United States.

So what is melanoma? Typically, when cells that make melanin, the pigment that produces skin color, become ‘old’ or damaged, they stop dividing, die and are replaced with healthy young cells. A melanoma occurs when these ‘old’ or damaged cells don’t die, but rather continue to multiply and divide uncontrollably. The division and multiplication of cells results in the development of a malignant mass of tissue on the skin. This mass is more commonly known as tumor.  Melanoma can develop into a mole or freckle, or can actively grow within existing lesions. While melanoma can be pigmented, it is not uncommon to have a completely unpigmented melanoma (neutral color). Melanoma can develop anywhere on the body, even places that are not exposed to sun and sunburns.

The specific types of melanoma that pertain to the toenail or fingernail alone are called melanonychia and subungual melanoma. They are both most common in the thumb, great toe, and index finger.  It is important to note that approximately 20% of subungual melanomas are amelanotic (unpigmented) and thus require a close and meticulous inspection.

For those of you who are fans of Bob Marley, the famous Rastafarian and Reggae legend initially injured his foot while playing soccer. He developed a complicated, open wound that seemed unfamiliar.  After seeking treatment, he was diagnosed with a type of foot melanoma, and doctors advised surgical amputation of his toe.  He did not consent to an amputation and ultimately the cancer spread throughout his body.  He sought treatment with a holistic doctor but in the end, his cancer became terminal, and took his life in 1981.

The incidence of foot melanoma has been reported to be between 0.04–0.25 per 100,000 people per year.  Melanoma is the 6th most common cancer in men and women and is the 2^nd most common cancer in women ages 20 to 29 in the United States. 

Symptoms of melanoma include:

·      A mole or lesion that is asymmetrical or has an irregular border

·      A mole or lesion that is growing or enlarging

·      A mole or lesion with abnormal coloring or more than one color, such as white, blue, red, black, or brown

·      Appearance of a new mole, or black/brown ‘spot’

The widely taught mnemonic device for Melanoma is “ABCDE”:

A – asymmetry, as in uneven texture consistency within the spot or mole in question;

B – borders, as in the outer borders being jagged and irregular;

C – color, as in the lesion having an inconsistent or uneven color (variegated);

D – diameter, any spot or lesion greater than 6mm in length causes elevated suspicion; and

E – enlarging or evolving (changing) over time.

All such findings are consistent with Melanoma but are not always 100% definitive, nor do these findings guarantee the disease.  For example, the lesion may or may not be firm to touch.  Furthermore, there are numerous types of melanoma and again, one should not assume the abnormal spot on your skin is nothing to worry about. 

If you notice a ‘weird’ looking lesion, make sure you seek medical care immediately. This allows for the best evaluation of your risks in developing melanoma and the prompt ordering of diagnostic testing for questionable areas. These measures increase the chances of discovering melanoma in its earliest, most curable stage. If melanoma is detected and treated before it spreads, the 5-year survival rate is 99%.

Your physician will test the area to obtain a proper diagnosis. The gold standard of testing is to perform a biopsy, which involves examining a sample of cells from the area. The biopsy can be completed a few different ways. Depending on the size and location of the suspicious area, your doctor will discuss the best method of choice for your particular case.

After a proper diagnosis, your physician will work with you to develop the most effective course of treatment. Melanoma treatment plans use a multifaceted approach that is tailored to maximize treatment.  The factors involved in treatment depend on the person’s age, medical history, coexisting diseases and conditions, the type of melanoma and its stage of advancement. Regarding the spread of the disease to other parts of the body, testing of nearby lymph nodes is required to detect the presence of cancer cells.  Typically, a combination of treatments is implemented, which may include, but are not limited to: chemotherapy, immunotherapy, dietary counseling, and surgery.

As with any skin cancer, the goal of the treatment is to achieve complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later. 

If you have noticed a weird or funny looking spot or area on your foot/ankle/lower leg, or anywhere on your body for that matter, don’t put off seeking evaluation any longer and contact a Weil Foot and Ankle physician