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Malignant Melanoma - Deadly Skin Cancer


Gerard S. O'Connor, M.D.


Though skin cancer is the most common malignancy of the body, most are easily curable by surgical removal. Malignant melanoma, however, deserves particular attention because it can spread and its incidence is on the rise. About one in 90 Caucasians can expect to develop malignant melanoma in their lifetime; the incidence is much lower in African-Americans. Like all skin cancers, it is related to sun exposure. Surprisingly, you may find this cancer in a portion of the skin that is not overly exposed to the sun.

Most people have a number of brownish spots on their skin which include freckles, birthmarks, and moles. Freckles are usually quite small and flat, and birthmarks are easy to identify since they have been presence since birth. Moles, though most are benign (not cancerous), should be examined closely using the A-B-C-D diagnostic format.

"A" represents asymmetry. Common moles are round and symmetrical; malignant melanomas are not quite symmetrical. "B" represents borders which in melanoma are often uneven and have scalloped or notched edges. Common moles have smooth borders. "C" represents color. Common moles are usually a single shade of brown, where malignant melanomas can have up to six colors: white, red, light brown, dark brown, slate blue, and black. There are often different shades within the same lesion. Melanomas can also be red or white. Lastly, "D" represents diameter. Melanomas tend to be larger than common moles. If a mole is greater than inch you should consult your physician.

Skin cancers, including malignant melanoma, have long been known to be associated with prolonged sun exposure. Short-term effects of sunlight exposure include sunburn, tanning, and immunologic changes within the skin itself. Some long-term effects of sunlight include wrinkles, freckles, and various other skin changes.

The best way to avoid skin cancer is to avoid strong sunlight. Sunlight in the summer before 10 a.m. and after 4 p.m. is fairly non-toxic because the amount of ultraviolet-B radiation is low. Clothing is an excellent form of protection; any clothing that blocks visible light will also block ultraviolet radiation. However, transmission is increased when clothing is wet.

Probably the most important protection for the skin is using sunscreen; a sun protection factor (SPF) of 15 will provide protection against exposure up to 15 times the minimal sunburning time. The choices of sunscreen are non-waterproof, water-resistant, and waterproof. Clearly, waterproof is the best choice since most outdoor activities involve either perspiring or water contact. Sunscreen should be applied 15 minutes before exposure to the sun and should be reapplied after a couple of hours. A good rule of thumb is that a 4-oz. Bottle of sunscreen contains enough to coat the exposed area of a 155 pound male in a bathing suit only four times. Expensive brands, packages, and perfumes are not necessary; all sunscreens have to meet FDA standards, so the discount brand is just as good as the one at the cosmetic counter.

Prognosis for melanoma depends on the penetration of the skin by malignant cells. However, if identified early, melanoma is curable through new surgical techniques and other therapies available at Kent & Queen Anne’s Hospital.


Gerard S. O’Connor, M.D., F.A.C.S. is a general and vascualr surgeon at Kent & Queen Anne’s Hospital in Chestertown, Maryland. He received his medical degree cum laude from Georgetown University Scholl of Medicine in Washington, D.C.