Remember: May Is Melamona Month

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Screen Shot 2013-05-01 at 3.16.11 AMThis is just a classic image of a nevis – mole – that is cancerous with melanoma.  It looks so much like the one on my back that I still say prayers of thanksgiving that I was able to catch mine before it began spreading.  In the life of every early melanoma, there is about a six months period when the cancer cells first appear and when they begin to spread.  That early stage is called insitu.  When mine was caught, there was no real cure, and no real treatment beyond doing the proper excisions, and cross your fingers.

The Pink Flamingo is a fifteen year survivor of melanoma.  Of all the deadly cancers, melanoma is one of the easiest to detect at an early stage.  Of all the deadly cancers, if you catch melanoma the way I did, there is a 100% cure rate – as long as the proper excision has been made and the pathology on the disease is accurate.  That’s the real killer, having a physician who doesn’t know what they are doing.  It is how Diana Ashby, wife of astronaut Jeff Ashby died.  Her physician, an old family retainer did bad path.  He misdiagnosed the level of the cancer, basically killing her.

If you have a mole that is flat, irregular, larger than a pencil eraser, with spots of black in it, and you do nothing about it, YOU WILL DIE.  You will die a horrible, miserable, obscene death by cancer with the end stages being brain cancer.  There are those of us who believe that quite often, brain cancer is the result of misdiagnosed melanoma that has spread to the point where you can’t tell what it is.

Are you at risk?  If you answer ‘yes’ to any of these questions, go see your dermatologist.  If everyone would visit their derm once every six months, we could basically end melanoma as a deadly cancer.  It’s that simple.

  1. Has anyone in your family ever had melanoma?
  2. Do you now have, or have you ever had, noncancerous, but unusual looking moles?
  3. Have you been diagnosed with melanoma in the past?
  4. Are you taking any medications that might weaken your immune system (for example, corticosteroids)?
  5. Do you have more than 50 ordinary moles?
  6. Did you have one or more severe, blistering sunburn as a child or teenager?
  7. Do you have many freckles?
  8. Do you have fair skin and light eyes?
  9. Do you live in the Southwestern United States?
  10. Do you frequently spend time in the sun between 10 AM and 4 PM without skin protection?

I must answer yes to #1, #2, #3, #5, #6, and #8.  Scary, isn’t it?  For every primary, there is usually a secondary.  John McCain is the perfect example of someone who had had more than one melanoma primary removed, at different times in his life.  I’ve managed to catch a second primary in 2000 or so.  We caught it just as the cells were beginning to start their evolutionary process into cancer.  Because I caught it so early, it wasn’t even ‘pre-cancer’.   Like many others who have had melanoma, I’ve had every possible primary mole removed.  There’s nothing left but a number of small battle scars of honor.

If you even suspect that you have a bad nevis you must never ever ever allow the site to be removed by “punching”, freezing, or a casual cut.  You want a specific “wide excision” that, at times can be performed with a razor blade, if your derm thinks you are catching the nevis before it goes bad.  I only recommend this if you know that your derm is board certified and specializes in melanoma.  Mine specializes in the early recognition of the disease, so I am more comfortable with him.  But, he will listen to me.  If I want a wide excision, he will do one.

Melanoma stages: 5 year survival rates:
Stage 0: Melanoma in situ (Clark Level I), 99.9% survival
Stage I / II: Invasive melanoma, 89–95% survival
T1a: Less than 1.0 mm primary tumor thickness, without ulceration, and mitosis < 1/mm2
T1b: Less than 1.0 mm primary tumor thickness, with ulceration or mitoses ≥ 1/mm2
T2a: 1.01–2.0 mm primary tumor thickness, without ulceration
Stage II: High risk melanoma, 45–79% survival
T2b: 1.01–2.0 mm primary tumor thickness, with ulceration
T3a: 2.01–4.0 mm primary tumor thickness, without ulceration
T3b: 2.01–4.0 mm primary tumor thickness, with ulceration
T4a: Greater than 4.0 mm primary tumor thickness, without ulceration
T4b: Greater than 4.0 mm primary tumor thickness, with ulceration
Stage III: Regional metastasis, 24–70% survival
N1: Single positive lymph node
N2: Two to three positive lymph nodes or regional skin/in-transit metastasis
N3: Four positive lymph nodes or one lymph node and regional skin/in-transit metastases
Stage IV: Distant metastasis, 7–19% survival
M1a: Distant skin metastasis, normal LDH
M1b: Lung metastasis, normal LDH
M1c: Other distant metastasis or any distant metastasis with elevated LDH
Based upon AJCC five-year survival from initial melanoma diagnosis with proper treatment.

The very term “biopsy” should never even be used in conjunction with melanoma.  There are those of us who think that the very practice of cutting into the cancer causes it to spread.  If you even suspect there is melanoma, a wide excision should always be done, even if it is literally a pain.  I recommend an in office surgical procedure that includes going at least a quarter to half inch around the entire area.  Personally, I opt now, for a half inch.

“…Following a visual examination and a dermatoscopic exam, or in vivo diagnostic tools such as a confocal microscope, the doctor may biopsy the suspicious mole. A skin biopsy performed under local anesthesia is often required to assist in making or confirming the diagnosis and in defining the severity of the melanoma. If the mole is malignant, the mole and an area around it need excision. Elliptical excisional biopsies may remove the tumor, followed by histological analysis and Breslow scoring. Punch biopsies are contraindicated in suspected melanomas, for fear of seeding tumor cells and hastening the spread of the malignant cells…”

What you are looking for are the ABCDE’s of Melanoma:

  • Asymmetrical skin lesion.
  • Border of the lesion is irregular.
  • Color: melanomas usually have multiple colors.
  • Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
  • Enlarging: Enlarging or evolving

Screen Shot 2013-05-01 at 3.43.04 AM

“…ABCD rule illustration: On the left side from top to bottom: melanomas showing (A) Asymmetry, (B) a border that is uneven, ragged, or notched, (C) coloring of different shades of brown, black, or tan and (D) diameter that had changed in size. The normal moles on the right side do not have abnormal characteristics (no asymmetry, even border, even color, no change in diameter)….”

There are different opinions about how the initial removal of the nevis should be performed.  I’m not a fan of Mohs Surgery.

“...Excisional biopsies may remove the tumor, but further surgery is often necessary to reduce the risk of recurrence. Complete surgical excision with adequate surgical margins and assessment for the presence of detectable metastatic disease along with short- and long-term followup is standard. Often this is done by a wide local excision (WLE) with 1 to 2 cm margins. Melanoma-in-situ and lentigo malignas are treated with narrower surgical margins, usually 0.2 to 0.5 cm. Many surgeons consider 0.5 cm the standard of care for standard excision of melanoma-in-situ,but 0.2 cm margin might be acceptable for margin controlled surgery (Mohs surgery, or the double-bladed technique with margin control). The wide excision aims to reduce the rate of tumor recurrence at the site of the original lesion. This is a common pattern of treatment failure in melanoma. Considerable research has aimed to elucidate appropriate margins for excision with a general trend toward less aggressive treatment during the last decades. Mohs surgery has been reported with cure rate as low as 77%and as high as 98.0% for melanoma-in-situ. CCPDMA and the “double scalpel” peripheral margin controlled surgery is equivalent to Mohs surgery in effectiveness on this “intra-epithelial” type of melanoma….”

The good news – it looks like there is a cure on the horizon.  I’ve heard stories, talked to people in trials.  There is reason to be very, very hopeful.

Melanoma is the most curable of all the deadly cancers.  If you catch it early, there is a 99% cure rate.

 

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