INTRODUCTION TO MALIGNANT MELANOMA

Malignant melanoma is the most serious of the common skin cancers. If ignored and not treated properly, it can be fatal. However if treated early while still flat and thin, the cure rate is practically 100%.

The symptoms caused by malignant melanoma are usually easily recognised early enough for curative treatment to be carried out. Malignant melanoma often, but not always, arises in a mole - a junctional or dysplastic naevus - which has been present for some years. However, whether the melanoma originates in an existing mole or not, the first symptom noticed by patients is growth.

There are five things to watch in melanoma:

1. Most importantly, is the rate at which it grows. Most moles in children enlarge as the child grows and those in adults grow slowly over the years. This is normal and not dangerous. If you look at a mole and think it might be a little bigger than it was a couple of years ago, keep an eye on it, but do not worry.

However, if a mole grows so rapidly that it doubles its size in three to six months, have it examined by a doctor, because this is the speed at which a malignant melanoma enlarges. If the growth of a lump or mark on the skin is very rapid, i.e. it doubles in size in a week, it is usually an infection and not malignant and is easily treated by your doctor.

2. It is important to note the direction of the growth in malignant melanoma. Usually, the melanoma starts its spread outwards, as a flat, enlarging stain on the skin and you will find difficulty in feeling its whereabouts when you pass your fingers over the area with your eyes closed. This is called horizontal growth in the skin and it is the very earliest stage of malignancy. It is also a very important sign since, so long as the melanoma is flat, it is normally, simply cured.

However, if an enlarging, flat, brown malignant melanoma is left untreated, it will grow upwards within months and form an easily-felt lump. This, predictably, is known as vertical growth. Vertical growth is a danger sign because, as the malignant melanoma becomes more raised it becomes more difficult to treat successfully.

3. Colour change is also a vital factor. As the malignant melanoma grows it usually becomes darker, sometimes almost black. Rarely it becomes pale pink as it grows.

4. Malignant melanomas tend to bleed, often after some negligible injury, such as rubbing with clothing or a towel.

5. Itching is the final clue to melanoma. This is a mild itchiness, usually around the exterior of the mole, and, most important, repetitive. That is to say, it comes and goes. A single episode of itching is not conclusive, because a mild infection or insect bite may be the cause, but if the itch is repeated, then have the mole examined.

In summary

You do not need to worry about a mole unless it starts to change. If it grows, gets darker, bleeds or itches repeatedly over a period of three to eight months, consult your doctor. The results from early treatment of malignant melanoma are excellent, but if it becomes very lumpy and this is ignored, then it can be a very dangerous disease. It is a good idea, if you have a family history of melanoma and have many of the larger (1cm) flat moles, to consult your doctor for peace of mind.

There are some precautions you can take for yourself if you are worried:

1. Remember the symptoms outlined above, but do not become over-anxious about minor changes - your mole is most likely to be harmless.

2. Keep a watch on your skin. It is advisable to have a relative or friend (the same person each time) examine your back and front, especially any obvious moles, once every four months and note this on your calender or diary. Ask this person to read this pamphlet so they know what to look for. As long as your moles look much the same at each inspection, professional advice is not required.

It is quite a simple matter to measure a mole with a transparent ruler and keep the measurement for future reference. Your friend or relative can help you with those inaccessible places like your back. If changes are noticeable or measurable, seek medical advice.

3. If you are a parent of a young family and are anxious about their moles, you can draw a simple diagram of each child's features, mark in the site of all the moles and the measured size of any worrying ones. DO NOT FORGET TO PUT THE DATE ON THE DIAGRAMS AND DO NOT PUT THEM IN SUCH A SAFE PLACE THAT YOU CANNOT FIND THEM AGAIN. In one or two months time, check the moles against the diagram for changes.

4. There is no advantage in having large numbers of innocent looking moles removed, especially from children. Sometimes it reduces anxiety if you have one or two removed and analysed, but the wholesale removal of moles is nearly always unnecessary and sometimes leaves unsightly scars.

Above all, if a mole has any of the tell-tale melanoma features described here, make sure you visit an experienced skin specialist. It must be removed carefully and sent for analysis, not burnt off or discarded without the opportunity for examination and subsequent treatment. In Australia, luckily, our doctors and skin specialists are so experienced in diagnosing skin cancer, including melanoma, that a mistake is unlikely.

In conclusion, remember that by using common sense, care and observation, you need not feel greatly threatened by melanoma in spite of its bad reputation, but, if you are anxious, consult your doctor.