Each week we’ll tackle here a disease featured in that week’s episode of Grey’s Anatomy. Last night’s episode (Stand By Me, season 5, episode 18) dealt with Dr. Stevens’ Stage IV melanoma. We’ll try to explain what melanoma is, what the various stages mean, and what you can do to discover it on time.
Danger level: High
What is it?
Melanoma is a malignant tumor of the skin. It’s responsible for the majority of skin cancer deaths. While skin is where it usually arises, it can also start in the eyes, ears, gastrointestinal tract, the brain coverings, and around the mouth or genitalia.
Who gets it?
About 60,000 cases occur each year in the US, causing more than 8,000 deaths. It occurs mainly in white people. It’s much less common in people of African American origin and Hispanics, but when they do get the disease, it might be deadlier.
Until age 39 women are about twice as much likely to get melanoma, but after the age of 40 it’s more common in men.
Usually this cancer appears around age 50, but in women aged 25-29 it’s the most common cancer.
There are a few factors that can put you at risk for melanoma:
- Fair skin, red or blond hair, blue eyes, freckles or if you tan poorly and sunburn easily.
- Sun exposure
- Family history or a personal history of melanoma
- Increased number of skin moles (nevi)
What causes it?
Our skin is composed of several layers. In these layers are scattered cells of many types. One of those cell types are melanocytes – they produce a material called a pigment, which gives our skin color. That pigment is named melanin. When exposed to the sun, that pigment is created, which is why we get a tan: That pigment causes our skin to get darker.
On the left you can see a cut from the skin showing the layers. On the right is a magnification of the layer where melanocytes exist, producing melanin.
In melanoma, in a process which is not understood completely, melanocytes turn into malignant cells. These cells divide without dying, like normal cells would, and in this way spread in the area, enter blood vessels and send metastases (areas of tumor far from the original area) throughout the body.
About 50% of melanomas develop from moles on the skin, The rest can arise in any place where melanocytes exist: The skin, eye, ear, brain coverings, and so on.
How does it feel?
Melanoma starts on the skin. It looks like a dark spot. Below we will tell you how you can differentiate a normal mole and a melanoma. Here’s a picture of one -
Melanoma
Like mentioned above, it may start on the skin, but can spread throughout the body if not taken care of on time. Each level of spread is called a stage, and there are 4 of them:
- Stage 1 and 2: The melanoma is still on the skin area.
- Stage 3: The melanoma started spreading, and it exists in lymph nodes around the area it started. (A lymph node is an organ of our immune system. Many tumors find it easy to spread using them).
- Stage 4: The tumor sent metastases to far off places in the body.
How is it discovered?
If you have moles, or any of the risk factors listed above, you should get your skin examined at least once a year by a doctor. If a lesion on the skin looks like a melanoma, the only way to make sure about its true nature is to take a biopsy out of it (a biopsy is a cut made through the lesion, after which that piece will be looked at under the microscope).
How is it treated?
The main treatment is taking off the skin lesion surgically. The surgeon will take it off along with a margin around it, to make sure everything is taken out.
What happens if the tumor metastasized? Usually operation is not possible in these stages. There are cases when you can take out the metastasis itself. Chemotherapy and drugs called “biological therapy” might also be involved in treatment.
What happens after treatment?
The survival in cancers is usually counted for 5 years after the treatment, meaning how many people survive for 5 years after being treated, and is called the 5-year survival. In Stages 1-2, the 5 year survival is between 70-99%. In stage 4 it’s around 18%, but can go down according to the place the tumor has spread to.
The bottom line: How do I avoid it?
- Protect yourself from the sun: The best way is to avoid sun exposure between 10am-4pm, when it’s the most intense.
- Wear protective clothing when out in the sun: A hat with a brim, a shirt with sleeves and pants.
- Use sunscreen with an SPF of at least 15, and it should protect against both UVA and UVB sun rays. But please don’t think that this gives you full protection – you should always try to stay clear from the sun.
- Examine your skin regularly:
Performing a skin self-exam -
- Stand in front of a mirror and examine your body: front and back, right and left. Don’t neglect any areas, like the feet and even the space between your toes.
- Check for the ABCD’s:
A. Asymmetrical skin lesion: The lesion should be equal from all sides. If it isn’t, it is suspicious.
B. Border: The border of the lesion should be regular, without any notches. Any irregularities in the border are suspicious.
C. Color: It shouldn’t have more than 2 colors. More than that, and the lesion is suspicious.
D. Diameter: It shouldn’t be greater than 6 millimeters (0.24 inches).
Do you know of anyone with melanoma, or have you experienced it yourself? Share in the comments.
What next?
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March 20th, 2009 at 2:24 am
Should we take the above precautions in summer only or through the entire year?
March 20th, 2009 at 2:27 am
Rachel,
The sun should be avoided when possible throughout the year. Even on cloudy days, the sun’s rays are dangerous.
March 30th, 2009 at 10:23 am
“A. Asymmetrical skin lesion: The lesion should be equal from all sides.”
Is this correct? Asymmetrical would be not equal on all sides.
March 30th, 2009 at 10:23 pm
Scott,
You’re right. What I meant was what should be in a normal mole. I corrected it to give a better understanding. Thanks!
May 15th, 2009 at 3:57 pm
What about a birthmark? Like what if one is born with a mole that is larger than 6 milimeters and is oval shaped but edges are not like the one in the photo, no family history of melanoma, not white, no sun exposure and if any then tans easily, and never any new moles
May 15th, 2009 at 10:23 pm
@Summer,
If all of these are true, it sounds like the chances are low. BUT, in medicine there’s a phrase, translated here roughly from French: “In medicine, like in love, there’s never ‘always’ and never ‘never’”. Meaning that there’s always an exception to the rule. My best advice is to visit a dermatologist at least once to make sure that you’re indeed out of risk.