Signs and Symptoms of Melanoma and Skin Cancer

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Each year, more than two million Americans are diagnosed with skin cancer, 9,000 them with melanoma, the most dangerous form of skin cancer. Surgical oncologist Dr. Mark Gimbel, of Banner MD Anderson Cancer Center, explains who is most at risk and what you can do to decrease your risk. Dr. Gimbel goes on to discuss what happens after a skin cancer diagnosis including treatment options.

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Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello.  I’m Andrew Schorr for Banner MD Anderson Cancer Center. 

We’re talking about the signs and symptoms of skin cancer and also the most serious and deadly form of skin cancer, melanoma.  You know, about two million Americans each year are diagnosed with skin cancer, about 75,000 of them with melanoma.  And the name of the game is to recognize the signs and get treatment early.  Unfortunately, about 12,000 people a year die from skin cancer, about 9,000 of them from melanoma, you can see how serious that is when it advances. 

To help us understand this is a surgical oncologist at Banner MD Anderson Cancer Center, and that’s Dr. Mark Gimbel.  Dr. Gimbel, thank you so much for being with us. 

Dr. Gimbel:

Thank you, Andrew. 

Andrew Schorr:

Dr. Gimbel, let’s talk about what people should look for.  What should they look for on their body?  In Arizona where there’s so much sunshine, and that can be the villain here, what should they look for where they should go in and get checked? 

Dr. Gimbel:

And I think you hit the nail on the head.  Early detection is key here, being able to identify something on the skin that is new that might be a cancer is of utmost importance.  What somebody should look for is—although they have multiple moles or freckles on their skin normally when they see something start to change or see something that arises that wasn’t in a place before, that should put up their ears and say, we’ve got a little bit of a concern.  Let’s go ahead and get this checked out. 

Andrew Schorr:

Let’s say you had a mole or what you thought was an age spot on your skin but it started to bleed or ooze, I would think you should go get that checked. 

Dr. Gimbel:

Absolutely, and it doesn’t have to be just a mole.  A lot of the skin cancers come up as not having any color.  There’s a pink, a pearly looking papule that’s on the skin, there’s some other scaly lesions that are on the skin, those are signs of a new skin lesion that’s arising, and that would be somebody that you’d want to have looked at.  And especially if it starts to bleed or ooze, that may be something more concerning. 

Andrew Schorr:

Let’s talk about who is at risk.  I’ve often heard that people who have red hair, blond hair, pale complexion—I mean, we’re all at risk, but that they may be more at risk. 

Dr. Gimbel:

You’re correct.  People who have fair skin and who are more likely to burn are at much higher risk of getting skin cancers.  The skin makes its own protection using both carotene in the skin and then using something called melanocytes or the melanin-performing—melanin-producing cells in the skin, and those are what give you the tan that can protect the skin.  However, when you start to burn and the melanocytes can’t react, then you put yourself at a much higher risk.  And those patients who are fair or red haired do have a higher likelihood of burning and developing skin cancer. 

Andrew Schorr:

Now, the vast majority of people who develop skin cancer and I said, again, two million Americans a year, it’s a lot of us—develop basal or squamous cell cancers.  Now, how do you treat those?  Do you simply just cut them out, it’s not that big a deal?  Or what is the treatment for those when those are observed? 

Dr. Gimbel:

What you need to know about squamous cell and basal cell cancers is that they are pretty superficial cancers.  They don’t penetrate too deeply into the skin.  The treatment for those, and especially if they’re caught early, is simple excision.  You want to identify them.  Typically a dermatologist or your primary care physician can biopsy those and determine if this is a squamous cell.  Sometimes there’s some characteristic appearance where these lesions can either be frozen, burnt off or cut off.  And those are all appropriate treatments.  And they need to be done narrowly because they don’t penetrate too deeply in the skin. 

The problem becomes when they aren’t recognized they can grow bigger, and at late stage, albeit rare, they can spread. 

Andrew Schorr:

Let’s talk about melanoma since it is the deadliest form of skin cancer.  How is that different? 

Dr. Gimbel:

Well, melanoma is going to be different from the basal cell and the squamous cell.  Like I said, those first two are quite superficial in the skin, but melanoma has the propensity to grow deeper in the skin, and the deeper it grows into the skin the higher of a risk you have of it spreading, and once melanoma spreads it can become a very deadly disease.  But if you can catch it at the earlier stages where it hasn’t made that deeper penetration or spread to other areas, then you can really cure this disease. 

Andrew Schorr:

So early detection.  Now, people of course are familiar with Senator McCain who has had his journey with melanoma and aware that he’s had some surgery.  Tell us about the surgical procedures you would do for melanoma. 

Dr. Gimbel:

All right.  The surgical procedures for melanoma are actually going be more extensive than they are for the squamous cell cancers and the basal cell cancers.  With melanoma not only does it grow deeper into the skin but you can get little cells that spread around the actual lesion, when you excise the melanoma you want to make sure you’re taking a margin of normal tissue.  While your melanoma may be, say, the size of the head of a pencil you still need to take about a centimeter or more depending on the depth of the actual melanoma as a—as a margin around the whole entire tumor, eventually you’re looking upwards to at least something that’s the size of a silver dollar or even greater that needs to be excised. 

Andrew Schorr:

Okay.  And of course the concern is melanoma could spread to other parts of the body, right? 

Dr. Gimbel:

When the melanoma grows deeper there is that risk of having spread to other areas, and typically when melanoma spreads it spreads through the skin through lymphatics to lymph nodes.  And the lymph nodes are in areas that are either in the armpit or the groin or the neck that start to grow, and if there’s melanoma in it can grow quite large, and then it can spread from there.  With a deeper melanoma many times what we do is check—excise not only the melanoma itself but then we check the lymph nodes as well to make sure there hasn’t been any spread. 

Andrew Schorr:

Okay.  And of course when melanoma has advanced then that’s your teamwork with the medical oncologist to see, I imagine, if systemic therapy is needed. 

Dr. Gimbel:

Yes.  If we check the lymph nodes and there is melanoma within the lymph node the standard treatment is then to take all the lymph nodes out in that one area, which is a pretty big surgery, which shows you how aggressive this can be.  And then if it spreads beyond that then we’re talking about working with a medical oncologist, possibly a radiation oncologist to adequately treat the patient. 

Andrew Schorr:

Andrew Schorr here for Banner MD Anderson Cancer Center.  Remember, knowledge can be the best medicine of all. 


Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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