melanoma

This melanoma has all the features: large, irregular edges, multicolored, with some very dark black areas.

Melanoma

Melanoma is a potentially fatal neoplasm of the skin originating from melanocytes. It is the most deadly of the common skin cancers and its incidence is on the rise. However, in countries with aggressive sunscreen use (e.g., Australia), rates may be leveling off.

The current lifetime risk of melanoma in the US for a non-Hispanic Caucasian is about 1 in 50.
Approximately 70% of melanomas arise from normal skin. About 30% of melanomas arise from preexisting moles.
All patients should be aware of their moles and perform a self skin check periodically. If any spots are suspicious, medical help should be obtained promplty. See Mole vs. Melanoma for more information.

Risk Factors

The average lifetime risk of a person born in the US today to develop a melanoma is as follows:

Race	Risk
Non-Hispanic Caucasian male	1 in 41
Non-Hispanic Caucasian female	1 in 61
Hispanic	1 in 200
Asian and Black	1 in 1000

The following table tries to quantify the risk for various factors. A relative risk (RR) of 2 means double the risk. An RR of 1.5 means a 50% elevated risk.

Feature	Relative Risk
Personal history of and a parent with melanoma	30
Personal history of melanoma	9
Two or more first degree relatives with melanoma	5.5
Over 100 moles	5
Red hair (compared with dark hair)	3
Always burns, never tans	2.3
One first degree relative with melanoma	2.24
Prior use of Viagra (for men)	2.2
The presence of 2 large (dysplastic) nevi	2
Airline pilot or crew	2
Parkinson's disease	2
Freckles	2
History of BCC or SCC	2
History of 10 or more severe sunburns	2
Usually burns, tans some	2
Blonde hair (compared with dark hair)	2

Other factors that increase risk include:

Immunosuppression, e.g., transplant patients, HIV infection
Drugs, e.g., Viagra, natalizumab.

Body Site

In a study of melanoma in the US from 1975-2006 [Cancer Epidemiol Biomarkers Prev. 2010;19:2401], the specific body site distribution was as follows:

Site (Men)	Percentage
Trunk	40%
Head/Neck	24%
Arms	21%
Legs	9%
Other	5%

Site (Women)	Percentage
Legs	32%
Arms	26%
Trunk	25%
Head/Neck	14%
Other	4%

What does a Melanoma look like?

ABCDE Criteria

 A      Asymmetric shape        
 B      Border, irregular        
 C      Colors, multiple or dark black        
 D      Diameter, 7 mm. or greater
 E      Evolving

Any lesion with 2 or more should be removed. See also Mole vs. Melanoma and pictures below..

The "ugly duckling sign" of melanoma refers to the fact that a melanoma often looks different from the other moles. This spot on the upper back was a melanoma.

A melanoma is often assymmetry in shape (or color).

An irregular, notched border is a worrisome sign (here a melanoma).

A very dark black or a multi-colored mole is a worrisome sign (here a melanoma).

Diameter 7 mm or greater ("larger than a pencil eraser") is a worrisome sign (here a melanoma).

The dark growth in this "mole" was new (and turned out to be a melanoma).

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