Expert Commentator: Dr. Murad Alam 11/18/2009

Malignant melanoma is the most serious form of skin cancer. Occurring most often in fair-skinned people, melanoma is more likely in those who have had blistering sunburns in childhood, but anyone can get melanoma. In terms of appearance, melanoma looks like an unusual mole or brown-black patch on the skin. It is usually flat, can have several colors or shades within it, and may have a jagged, irregular border that resembles the "Coast of Maine" rather than a smooth, rounded edge. In people who have many moles and brown spots, melanomas can stand out as "ugly duckling" lesions that look different from the other moles. But some melanomas look ordinary, and sometimes strange looking spots are nothing to worry about. Everyone should have a yearly skin examination with a dermatologist, who is expert in detecting melanomas.


From a scientific standpoint, melanoma happens when the melanocytes, the cells that give our skin color, become abnormal and develop into cancer. Normal skin can become melanoma, or moles that were previously normal can change into melanoma over time.  Ultraviolet sun rays can cause this change in normal melanocytes. Sunscreen and sun avoidance reduce the risk of melanoma. The bad news is that melanoma is a very serious disease, and if detected late, is often not curable by surgery, chemotherapy, or radiation.  The very good news is that melanoma is over 90% curable if it is found early. This is why it is important to have your skin checked regularly. Getting checked by a dermatologist could literally save your life. In the meantime, if you have a spouse or significant other, they can help keep an eye on parts of your body you cannot see yourself.
 
Women get melanoma more often on the backs and legs, and men on the back. In African-Americans, melanoma is less likely, but most commonly occurs on the soles of the feet. Moles sometimes change appearance during pregnancy, and these should be checked promptly by a doctor. 
 
In recent years, the rates of melanoma have been increasing in the US. Some believe this is because people are spending more time outdoors, swimming, playing sports, and sunbathing. A complete sun-safety program includes also a wide-brimmed hat, sunglasses, and sun-protective clothing.

Sunscreen can also help, but it is important to use enough and reapply it. It is also important to understand that if you are outside in the sun for many hours day after day, no sunscreen will be able to protect you completely. Indeed, there are cases where people using sunscreen have been found to have a high chance of getting melanoma; there is nothing wrong with the sunscreen they are using, but since sunblock is really only “sunslow,” too much sun will overwhelm the protective benefit of even the most effective sunscreen. Finally, it is important to use sunscreen year-round because even on cloudy, rainy days, ultraviolet rays are damaging our skin. Areas that should get sunscreen include the areas that are usually exposed to the sun, including the head, neck, v-neck of the chest, and backs of arms and hands. 


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