Why Might People With Dark Skin Get Diagnosed With Skin Cancers Later
Dermatologist Shyamalar Gunatheesan puts this down to three things.
She says the first is that it’s common for people with darker skin to dismiss the possibility they could develop skin cancers, like I did, because of our skin’s tendency to burn less and because of the way we’re taught about skin cancer.
Dr Gunatheesan says the second is that it can be common for practitioners to do the same.
And the third is that skin cancers in people with dark skin often develop in areas that aren’t often or ever exposed to the sun, and that we don’t routinely look at.
This means changes go unnoticed for longer than they might have if they’d occurred somewhere more visible.
This happens, Dr Gunatheesan says, because “not all skin cancer is sun-related”.
This isn’t always the case, of course.
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“With basal cell carcinomas in darker skin types, sun exposure tends to be the most common cause,” fellow dermatologist Stephen Shumack explains.
“They’re rare, but they do occur in “type four” skin particularly, usually in people who’ve worked for many years outdoors without sun protection.
“With squamous cell carcinomas in people with dark skin, the cause is predominantly related to infection with the HPV virus, and also ulcers. So somebody gets a cut, the area of skin doesn’t heal over a period of years, and sometimes, as part of that non-healing process, it can develop into squamous cell carcinoma.
“This is very rare in Australia.”
What To Look For The A B C D And Es Of Skin Malignant Melanomas
A equals asymmetry, one-half is unlike the other.B equals border, which is scalloped or irregular.C equals colour. Variation of colour from one area to another with different shadesof light brown, dark brown even white patches or red patches or blue.D equals diameter. If the pigmented lesion is greater than 6 mm, it is more likely tobe a melanoma, though some melanomas can be smaller.E equals evolving. A mole or skin lesion that is beginning to look different from itsprevious appearance by changing in shape, size or colour.Dr Darrell Rigel, MD was one of the co-creators of the A, B, C, D and E of melanoma. He realised that you have to detect melanomas early because if they measured over 6 mm, there was an only 50% 5-year survival rate. He came up with a template for inexperienced people to have the same facility to look at skin lesions as experienced people.
You can download a body mole map from the American Academy of Dermatology. You can download their PDF and check pictures of the A, B, C, D and E so that you can check your skin for signs of skin cancer. It also has some diagrams of soles of feet, the front of the body, back of the body, face, straight ahead, side faces and top of the head, where you can draw the location of moles. If possible get somebody else to help you examine your skin, otherwise do a self-examination.
Can Melanoma Be Prevented
You can’t control how fair your skin is or whether you have a relative with cancerous moles. But there are things you can do to lower your risk of developing melanoma. The most important is limiting your exposure to the sun.
Take these precautions:
- Avoid the strongest sun of the day between 10 a.m. and 4 p.m.
- Use broad-spectrum sunscreen whenever you’re in the sun.
- Wear a wide-brimmed hat and cover up with long, loose cotton clothing if you burn easily.
- Stay out of the tanning salon. Even one indoor tanning session increases your risk of getting melanoma.
Also, be sure to check your moles often . Keep dated records of each mole’s location, size, shape, and color, and get anything suspicious checked out right away.
Not all skin cancer is melanoma, but every case of melanoma is serious. So now that you know more about it, take responsibility for protecting yourself and do what you can to lower your risk.
You can find more information online at:
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Biological Therapies And Melanoma
Biological therapies are treatments using substances made naturally by the body. Some of these treatments are called immunotherapy because they help the immune system fight the cancer, or they occur naturally as part of the immune system.
There are many biological therapies being researched and trialled, which in the future may help treat people with melanoma. They include monoclonal antibodies and vaccine therapy.
Sentinel Lymph Node Biopsy
If melanoma has been diagnosed and has any concerning features , a sentinel lymph node biopsy is often done to see if the cancer has spread to nearby lymph nodes, which in turn might affect treatment options. This test can be used to find the lymph nodes that are likely to be the first place the melanoma would go if it has spread. These lymph nodes are called sentinel nodes .
To find the sentinel lymph node , a doctor injects a small amount of a radioactive substance into the area of the melanoma. After giving the substance time to travel to the lymph node areas near the tumor, a special camera is used to see if it collects in one or more sentinel lymph nodes. Once the radioactive area has been marked, the patient is taken for surgery, and a blue dye is injected in the same place the radioactive substance was injected. A small incision is then made in the marked area, and the lymph nodes are then checked to find which one became radioactive and turned blue. These sentinel nodes are removed and looked at under a microscope.
If there are no melanoma cells in the sentinel nodes, no more lymph node surgery is needed because it is very unlikely the melanoma would have spread beyond this point. If melanoma cells are found in the sentinel node, the remaining lymph nodes in this area are typically removed and looked at as well. This is known as a lymph node dissection .
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Lab Tests Of Biopsy Samples
Samples from any biopsies will be sent to a lab, where a doctor called a pathologist will look at them under a microscope for melanoma cells. Often, skin samples are sent to a dermatopathologist, a doctor who has special training in looking at skin samples.
If the doctor cant tell for sure if melanoma cells are in the sample just by looking at it, special lab tests will be done on the cells to try to confirm the diagnosis. These might include:
- Immunohistochemistry
- Fluorescence in situ hybridization
- Comparative genomic hybridization
- Gene expression profiling
If melanoma is found in the samples, the pathologist will look at certain important features such as the tumor thickness and mitotic rate . These features help determine the stage of the melanoma , which in turn can affect treatment options and prognosis .
Fine Needle Aspiration Biopsy
FNA biopsy is not used on suspicious moles. But it may be used, for example, to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread to them.
For this type of biopsy, the doctor uses a syringe with a thin, hollow needle to remove very small pieces of a lymph node or tumor. The needle is smaller than the needle used for a blood test. A local anesthetic is sometimes used to numb the area first. This test rarely causes much discomfort and does not leave a scar.
If the lymph node is just under the skin, the doctor can often feel it well enough to guide the needle into it. For a suspicious lymph node deeper in the body or a tumor in an organ such as the lung or liver, an imaging test such as ultrasound or a CT scan is often used to help guide the needle into place.
FNA biopsies are not as invasive as some other types of biopsies, but they may not always collect enough of a sample to tell if a suspicious area is melanoma. In these cases, a more invasive type of biopsy may be needed.
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When To Call Your Dermatologist
You want to call your dermatologists office immediately if you find anything on your skin that is:
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Similar to any of the ABCDEs of melanoma
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Growing
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Bleeding
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Changing in any way
Be sure the person who answers the phone knows that youve had melanoma and just found a suspicious spot. The earlier melanoma is found and treated, the greater the likelihood that it can be completely removed.
Related AAD resources
Tuesday 27 March 2018
How many moles do you have on your body? If you spotted a freckle on the back of your arm, would you know if it had always been there, or had changed shape or colour? What about one in your hair?
Without checking your skin regularly, it can be hard to notice changes that might indicate skin cancer. And when it comes to skin cancer, there are a few good reasons for Queenslanders to stay vigilant.
Year-round high UV levels and a warm climate that entices us to spend time in the great outdoors mean that the Queensland lifestyle can lend itself to high levels of sun exposure. Its no surprise then that Queensland has the highest rate of skin cancer diagnosis in the world.
Skin cancer can be deadly, but is often curable if found early. Its important to check your skin regularly for signs of skin cancer.
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What To Look For When Checking Your Body For Skin Melanomas
In its initial stages, a skin melanoma doesnt hurt, so the first thing to look for is any sign of change or any new growths.
You probably have several moles or birthmarks on your body that have been there since childhood. If these start to grow in size and thickness or change color and texture, ask your doctor to check them out as soon as possible. Moles of different colours or ones that are irregular and asymmetrical in the outline are more likely to be precancerous, especially if they appear after the age of 21.
Moles larger than 6 mm in diameter also present a higher risk. If you have hurt yourself or have an open spot or sore that wont heal and continues to itch, hurt, scab or bleed for more than three weeks, this needs checking out quickly.
Some doctors will advise you to use the ABCDE approach as an aid to memory when checking for skin melanoma. In short, this stands for:
- Asymmetry
The Umskincheck Mobile App Features
- Guidance on performing a skin cancer self exam and full body photographic survey
- Tracking detected skin lesions and moles for changes over time.
- Notifications/reminders to perform self exams on a routine basis
- Storage of photos for baseline comparisons during routine follow-up self exams
- Informational videos and literature on skin cancer prevention, healthy skin as well as a skin cancer risk calculator function
- Version # – 1.2
- Requirements – Requires iOS 4.3 or later. Compatible with iPhone, iPad, and iPod touch. This app is optimized for iPhone 5.
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How To Do A Skin Self
You dont need x-rays or blood tests to find skin cancer early just your eyes and a mirror. If you have skin cancer, finding it early is the best way to make sure it can be treated successfully.
Although the American Cancer Society does not have guidelines for the early detection of skin cancer, many doctors recommend checking your own skin regularly, typically once a month.
Regular skin self-exams are especially important for people who are at higher risk of skin cancer, such as people with reduced immunity, people who have had skin cancer before, and people with a strong family history of skin cancer. Talk to your doctor about how often you should examine your skin.
A skin self-exam is best done in a well-lit room in front of a full-length mirror. You can use a hand-held mirror to look at areas that are hard to see, such as the backs of your thighs. A spouse, partner, or close friend or family member may be able to help you with these exams, especially for those hard-to-see areas like your back or scalp.
The first time you examine your skin, spend time carefully going over the entire surface. Learn the pattern of moles, blemishes, freckles, and other marks on your skin so that youll notice any changes next time. Be sure to show your doctor any areas that concern you.
Follow these step-by-step instructions to examine your skin:
What Are The Melanoma Survival Rates
It is very important to check your skin for signs of melanoma because when it is found early, it has a cure rate of more than 90 percent, one of the highest cure rates of all cancers, according to the Canadian Dermatology Association. One important way to help prevent skin cancer is to apply sunscreen correctly as part of a sun protection strategy.
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Medical History And Physical Exam
Usually the first step your doctor takes is to ask about your symptoms, such as when the mark on the skin first appeared, if it has changed in size or appearance, and if it has been painful, itchy, or bleeding. You may also be asked about your possible risk factors for melanoma skin cancer, such as your history of tanning and sunburns, and if you or anyone in your family has had melanoma or other skin cancers.
During the physical exam, your doctor will note the size, shape, color, and texture of the area in question, and whether it is bleeding, oozing, or crusting. The rest of your body may be checked for moles and other spots that could be related to skin cancer .
The doctor may also feel the lymph nodes under the skin in the neck, underarm, or groin near the abnormal area. When melanoma spreads, it often goes to nearby lymph nodes first, making them larger.
If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, a doctor who specializes in skin diseases, who will look at the area more closely.
Along with a standard physical exam, many dermatologists use a technique called dermoscopy to see spots on the skin more clearly. The doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is used with this instrument. The doctor may take a digital photo of the spot.
Biopsies Of Melanoma That May Have Spread
Biopsies of areas other than the skin may be needed in some cases. For example, if melanoma has already been diagnosed on the skin, nearby lymph nodes may be biopsied to see if the cancer has spread to them.
Rarely, biopsies may be needed to figure out what type of cancer someone has. For example, some melanomas can spread so quickly that they reach the lymph nodes, lungs, brain, or other areas while the original skin melanoma is still very small. Sometimes these tumors are found with imaging tests or other exams even before the melanoma on the skin is discovered. In other cases, they may be found long after a skin melanoma has been removed, so its not clear if its the same cancer.
In still other cases, melanoma may be found somewhere in the body without ever finding a spot on the skin. This may be because some skin lesions go away on their own after some of their cells have spread to other parts of the body. Melanoma can also start in internal organs, but this is very rare, and if melanoma has spread widely throughout the body, it may not be possible to tell exactly where it started.
When melanoma has spread to other organs, it can sometimes be confused with a cancer starting in that organ. For example, melanoma that has spread to the lung might be confused with a primary lung cancer .
Biopsies of suspicious areas inside the body often are more involved than those used to sample the skin.
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Medical Tests For Early Detection
A painless medical technique being used for early detection of melanoma is epiluminescence microscopy, or dermoscopy. Using a handheld device, a doctor can evaluate the patterns of size, shape, and pigmentation in pigmented skin lesions. Among trained, experienced medical professionals, dermoscopy may reduce the number of biopsies of pigmented lesions to rule out melanoma, although more research is needed.
Confocal scanning laser microscopy is another new technology that may improve the examination of possible melanoma lesions. Currently, it is only used in research studies, called clinical trials, and is available in a few major medical centers.
The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems melanoma can cause. Use the menu to choose a different section to read in this guide.
Seek Shade When The Sun Is High
You donât have to stay inside forever, but itâs a good idea to avoid the sun from 10 a.m. to 4 p.m. when UV rays are strongest. If you are outdoors during this time, take an umbrella and donât lie in direct sunlight. Wear sunscreen, too. UV rays can go through fabrics or reflect off nearby surfaces, even if youâre in the shade.
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Risk Of Further Melanomas
Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups.
Your doctor will decide how often you will need check-ups everyone is different. They will become less frequent if you have no further problems.
After treatment for melanoma it is important to limit exposure to the sun’s UV radiation. A combination of sun protection measures should be used during sun protection times .
As biological family members usually share similar traits, your family members may also have an increased risk of developing melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using a combination of sun protection measures during sun protection times.
It is important to monitor your skin regularly and if you notice any changes in your skin, or enlarged lymph glands near to where you had the cancer, see your specialist as soon as possible.