Medical Minute – Malignant Melanoma

Malignant melanoma represents a significant and increasing health problem. It is the leading cause of skin cancer deaths and one of the few remaining cancers with increasing incidence and death rates. In 2022, there will be 99,780 new cases of malignant melanoma, accounting for 7,650 deaths in the U.S. alone. Celebrities who have had malignant melanoma include Troy Aikman, Clint Eastwood, Andy Cohen, Khloe Kardashian, Whitney Carson (Dancing with the Stars), Summer Sanders (Olympic swimmer), Jeff Rossen (NBC correspondent). Writer Stephen J. Cannell, NFL players and coaches Bruce Snyder and Jim Johnson, and singers Bob Marley and Eva Cassidy all died of malignant melanoma.

Malignant melanoma is a potentially lethal cancer that can spread both at the site of the lesion and throughout the body. Early detection is the most important factor in increasing survival. Currently, 90% of patients will survive five years or more. The factors that determine survival in malignant melanoma are thickness of the lesion, presence of ulceration and whether the melanoma has spread to the lymph nodes. Survival is more likely for thin, early, melanomas than for patients with thick melanomas.

Public education, early detection and self-screening programs are important but should not take the place of a yearly complete skin survey by a physician. Medical studies have shown several factors that predict individuals at high risk for melanoma. These include increasing age, a personal or family history of malignant melanoma, people with certain features such as red or blond hair, freckling, three or more blistering sunburns prior to age 20, three or more years of an outdoor summer job as a teenager, and weakened immune system. Melanoma is more than 20 times more common in whites than in African Americans. It is more common in men overall, but the rates are higher in women before the age of 50. Patients with one or two of these risk factors have a 3.5-fold increase in the incidence of melanoma, while those having three or more have a 20-fold increase in the development of melanoma. The best defense against skin cancer is protection from the sun and ultraviolet light. People should avoid excessive and continuous sun exposure, including tanning beds, and use protective clothing and sunblock.

Melanoma can appear as a new skin lesion or an existing skin lesion or mole that changes. Melanoma can be recognized by looking for skin lesions with:

Asymmetry-Not round or oval
Border Irregularity-Notching, scalloping or poorly defined lesions
Color -shades of brown, tan, red, white, blue/black or combinations
Diameter-Diameter greater than 6mm

Surgery remains the mainstay of treatment for malignant melanoma. Other therapies including chemotherapy and radiation have been disappointing. Recently immunotherapy and targeted drugs have shown more effectiveness against melanoma. However, early detection of melanoma increases the chance it will be cured by surgical removal alone.

The sentinel lymph node biopsy technique allows physicians to predict whether melanoma has spread to the lymph nodes through only a small incision. Previously patients either underwent removal of the entire group of lymph nodes draining the area of the melanoma or waited to see if the melanoma spread to the lymph nodes and then removed them. The removal of the group lymph nodes can have complications. Now only those patients with evidence of spread to the sentinel lymph node undergo removal of all the lymph nodes in the area.

Ongoing studies of the treatment of melanoma provide hope for the future treatment of malignant melanoma. Until then, improved education, public awareness, continued early detection and a multidisciplinary approach to melanoma are the keys to decreasing the incidence and death rate of malignant melanoma.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.

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