Melanoma - When a Freckle is Not a Freckle

Melanoma, a type of skin cancer, is a topic of significant concern in today's society. It has been extensively covered in various magazines, especially with the imminent implementation of a new healthcare system that includes a tax on tanning salon businesses. The rationale behind this taxation lies in the fact that tanning salons expose individuals to concentrated, unprotected UV light, which can be likened to stepping into a cancer machine. While I don't write here as an activist, it is prudent to caution against frequenting these establishments and urge buyers to be aware of the associated risks.

When we think of skin cancer, we immediately imagine it occurring on the skin's surface. However, what may not be immediately apparent is that the definition of skin extends beyond what meets the eye. Skin is described as the body's outer covering, protecting against heat, light, injury, and infection. It plays a role in regulating body temperature, storing water, fat, and vitamin D. Weighing approximately 6 pounds, the skin is the largest organ in the human body and comprises two main layers: the outer epidermis and the inner dermis.

The epidermis, the outer layer of the skin, primarily consists of flat, scale-like cells known as squamous cells. Beneath the squamous cells lie round cells called basal cells. The deepest part of the epidermis contains melanocytes, the cells responsible for melanoma. These melanocytes produce melanin, the pigment that gives skin its color. The dermis, the inner layer of the skin, contains blood and lymph vessels, hair follicles, and glands. These glands produce sweat, which helps regulate body temperature, and sebum, an oily substance that prevents the skin from drying out. Sweat and sebum reach the skin's surface through tiny openings called pores.

This comprehensive definition of our largest organ emphasizes that our skin extends beyond the areas we commonly expose to the sun for tanning, wrinkle reduction, or tattooing. It includes the linings of our body that are not readily exposed to sunlight, such as the oral mucosa, scalp, vaginal lining, and nail beds (a particularly dangerous location for melanoma). It is my sincere hope that this information can potentially save lives.

While dermatologists are the recognized experts in matters pertaining to the skin, it is crucial for other healthcare professionals, including dentists, podiatrists, gynecologists, and proctologists, to regularly check for skin cancers as well. Patients should be aware that melanoma can manifest on any skin surface, not exclusively on sun-exposed areas, although these are indeed the most common sites for its occurrence.

Allow me to share a memorable patient case that highlights the importance of vigilance in detecting melanoma. A patient presented to my office with what she believed to be a stubborn wart on her heel. She had undergone several topical treatments administered by different doctors, all of which failed to resolve the lesion. Observing some abnormal pigmentation in the "wart," I deemed it prudent to perform a biopsy. The pathology results revealed Malignant Nodular Melanoma, a highly aggressive form of skin cancer that necessitated immediate removal.

The patient underwent surgery, which involved the excision of a significant amount of tissue from the back of her heel, followed by a skin graft to facilitate wound closure. Staging examinations, comprising both pathological and surgical evaluations of the patient and the skin specimen, indicated that the melanoma had not yet entered her bloodstream. It has been five years since the operation, and I recently spotted this patient in the neighborhood, pushing a stroller with her three-year-old son. The knowledge that I not only saved her life but also played a role in bringing a new life into the world fills me with immense satisfaction.

It is crucial for individuals to perform monthly self-examinations to identify any suspicious moles using the ABCDE characteristic method. If you notice any of the following characteristics on your skin, promptly schedule an evaluation with your doctor:

A - Asymmetry: One half of the mole is unlike the other half.
B - Border: The border of the mole is irregular, scalloped, or poorly defined.
C - Color: The mole exhibits varied shades of tan, brown, and black, with occasional appearances of white, red, or blue.
D - Diameter: Melanomas are typically larger than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.
E - Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape, or color.

In conclusion, melanoma is a formidable threat that can arise in unexpected locations on the skin. The importance of regular skin examinations performed by dermatologists and other healthcare professionals cannot be overstated. By remaining vigilant and promptly addressing any suspicious changes, we can increase the chances of early detection and successful treatment. Remember, a freckle isn't always just a freckle; itcan be a potential sign of a serious condition like melanoma. Stay informed, take proactive measures, and prioritize your skin health for a brighter and safer future.

Note: The information provided in this article is for educational purposes only and should not be considered as medical advice. If you have concerns about your skin or suspect any abnormalities, please consult with a qualified healthcare professional for proper evaluation and diagnosis.