Summer Safety: What You Should Know About Melanoma
Q&A With Cedars-Sinai Chief of Dermatology Nima Gharavi, MD, PhD
After a cold and rainy winter, it’s refreshing to plan summertime outdoor activities or a day at the beach soaking up the sun. But it’s important to remember that too much sun exposure can be harmful.
According to Nima Gharavi, MD, PhD, chief of the Department of Dermatology at Cedars-Sinai, too much exposure to ultraviolet rays, or UV rays, can increase your risk for melanoma—a type of aggressive skin cancer.
“With every sunburn, the risk for melanoma increases slightly,” said Gharavi, who also serves as the director of Dermatologic Surgery and Mohs Micrographic Surgery and associate clinical professor of Medicine and Pathology.
Gharavi recently spoke with Cedars-Sinai Newsroom on how to spot melanoma, treatment options and steps you can take to lower your risk of skin cancer.
What is melanoma?
Melanoma is cancer that arises from the melanocyte, which is the cell type that makes up moles and pigments that give skin its color.
What are the signs and symptoms of melanoma?
The most important clue is a mole that’s changing. One of the criteria we typically follow is called the ABCDE of melanoma.
A stands for Asymmetry. Moles are asymmetric if one half doesn’t equal the other half.
B is for the Borders. Are the borders irregular?
C is for Color. If there are multiple colors within a mole, get it checked.
D is Diameter. If the mole is bigger than six millimeters, which is about the size of a pencil eraser, it should be evaluated.
E is for Evolving. Has the mole evolved or changed recently?
How do you diagnose melanoma?
Some patients, when they notice something suspicious, will present it to the primary care doctor, who will then refer the patient to a dermatologist. Others may present directly to the dermatologist.
A dermatologist would look at the mole and see if there’s anything clinically suspicious about it. If it meets clinical criteria for a biopsy, a biopsy would be performed to rule out atypical features and to rule out melanoma.
Based on the biopsy, it’ll tell us not only the diagnosis, but also what type of melanoma the patient has. And more importantly, you get some information about how deep the melanoma has spread into the skin. That information is probably the most important because it determines what stage of cancer the patient has.
Who’s at risk for melanoma?
Melanoma can affect every skin type. That being said, there are certain people who have a higher risk for developing melanoma. Patients who have light skin, light eyes or red hair are at a higher risk.
Patients who have a previous history of skin cancer or a family history of skin cancer, including melanoma, are at higher risk. Genetics obviously plays an important role.
Some patients also have a large number of moles on their body. So, if you have a lot of larger abnormal-looking moles, then usually there’s a higher risk associated with that as well. Lastly, patients who have either had a lot of sun exposure throughout their life or use or have used indoor tanning in the past are at higher risk for melanoma.
How do you treat melanoma?
If a patient is diagnosed with early-stage melanoma, the treatment is surgery and surgery alone. The amount of skin that’s removed is also determined by how deep that melanoma has spread into the skin. Surgery is typically performed by either a dermatologist/dermatologic surgeon or a surgical oncologist. As melanoma starts spreading deeper into the skin, patients might be candidates for other options.
For aggressive cases that are stage 3 and beyond, using systemic medications like immunotherapy—medications that activate the immune system to fight off any remaining melanoma cells that may be circulating through the bloodstream—seems to be the best option.
What is Mohs micrographic surgery?
Mohs micrographic surgery (MMS) is an option for a subtype of melanomas—those that are predominantly on the head and neck or on other cosmetically sensitive areas with extensive sun damage. So, typically we’re talking about melanomas on the scalp, forehead, cheeks, nose or ear.
With MMS, the surgeon is the pathologist, and the lab is right there in the office. This allows the surgeon to perform the examination in real time. So, what you do is you surgically remove the melanoma tissue along with a small border of healthy tissue and send it to the lab for processing slides. The lab processes it within 45 minutes and sends the slides back to the surgeon. The surgeon looks at the tissue under the microscope and determines if the border that was removed is free of melanoma. The advantage of that is you get the results a lot quicker. The other advantage is, if you need to do more surgery, you can do it right away. You don’t have to bring the patient back in two to three days later. Lastly, MMS allows for a high level of precision when removing skin cancer, which leads to superior cure rates for these types of melanomas.
Can you prevent melanoma?
There are a few things that we can do to minimize the risk of getting melanoma. No. 1 is to avoid the sun during peak hours, which are typically between 10 a.m. and 2 p.m.
If you’re going to be out during the peak hours, seek shade. If you can, wear sun-protective clothing, such as long sleeves and pants. There is also clothing out there with a UV protective factor. Also, wear hats, ideally a wide-brimmed hat that covers the ears as well. Lastly, wear sunscreen. The recommendation is at least SPF 30 or higher.
If you do have a history of sun damage or skin cancer or a personal or family history of melanoma, then visiting a dermatologist routinely for skin checks is invaluable because the sooner we can diagnose melanoma, the treatments afterwards might be less debilitating.
One of the things we tell patients to do is do skin checks at home. When you’re in the shower, maybe once a month, just take a look at the skin, look at any moles, see if anything looks out of the ordinary. You can take a picture of it with your phone or have your significant other or family member take a picture of it. And then maybe a month later, take another picture and compare the pictures and see if there is any noticeable change.
