<p>My brother had several Stage 1 melanomas removed in 2002. He never had any visible skin melanomas again, but in June 2007 he learned that the back pain he was experiencing reflected melanoma that had metastasized to his spine and numerous organs. He died five weeks later. At the time, his kids were a rising college junior, a freshman about to start college, and a rising high school junior.</p>
<p>Oh my, how tragic, JHS. So sorry.</p>
<p>Pathologist here: Watch those moles! Use your sunscreen! Wear a hat!</p>
<p>Melanoma is an unpredictable tumor. Many melanomas seem to have a complicated relationship with the immune system, or perhaps a complicated path of genetic mutation. For whatever reason, some low stage melanomas will recur after many years, some people with what appears to be high risk melanoma will never have distant mets, and some people will present with metastatic disease unfortunately and no identifiable primary. </p>
<p>Suspicious skin lesions should be excised with enough depth to allow the pathologist to visualize the deep margin of the specimen. It is acceptable for a benign mole to be shaved, and a thin melanoma can also be shaved, although we still prefer a deeper excision, because shaves are so thin, sometimes they don’t get oriented properly during processing and that is a disaster in a melanoma. We have to measure the thickness of the melanoma microscopically, and that requires a well oriented specimen.
Even the best dermatologist can get fooled by a mole, so we do the best we can.</p>
<p>Also we ask the clinician to NOT send the primary resection for frozen, that can mess us up too, very few do that nowadays. Sentinel nodes are sent for frozen, and rarely the wide local excision (which in our community is often the second excision).</p>
<p>African AMericans are not completely exempt from melanoma - they should watch their fingers and toes particularly, because there is a melanoma that develops under the nail that they can get.</p>
<p>When I first trained, we didn’t think of melanoma as a childhood disease, but in a rather small practice, I’ve seen a 12 year old who died at 15 and a 15 year old who died at 20, so watch your children, too, particularly if there is a family history.</p>
<p>cangel, at what age would one suspect the cause of a melanoma to be genetic in origin vs. of environmental origin? For example, if one is first diagnosed with a melanoma at age 65 is that environmentally caused, or is there a genetic component? What about if it were first diagnosed at 60, or 58, etc.? How about 70? Also, what is the increased risk to children of the patient, or to grandchildren? Significant increased risk, or not?</p>
<p>Also, I have been told that one can get a melanoma internally as well and it can’t be seen. Is this true, and where would one find melanomas internally?</p>
<p>JHS, I am so sorry for your family’s terrible loss. </p>
<p>Our dermatologist says that she is seeing a record number of cases of melanoma in young people. And yes, there is an increased risk within families. Environment and genetics can work together, so even if you have an older relative who has been diagnosed with this, it pays to be vigilant about screening and prevention. </p>
<p>They are making some progress on this in research, but not nearly fast enough. There was an excellent series of articles in the NY Times a few months ago: </p>
<p>[Target</a> Cancer - A Roller Coaster Chase for a Cure - Series - NYTimes.com](<a href=“http://www.nytimes.com/2010/02/22/health/research/22trial.html]Target”>http://www.nytimes.com/2010/02/22/health/research/22trial.html)</p>
<p>[Target</a> Cancer - After Long Fight, Melanoma Drug Gives Sudden Reprieve - Series - NYTimes.com](<a href=“http://www.nytimes.com/2010/02/23/health/research/23trial.html]Target”>http://www.nytimes.com/2010/02/23/health/research/23trial.html)</p>
<p>[Target</a> Cancer - A Drug Trial Cycle - Recovery, Relapse, Reinvention - Series - NYTimes.com](<a href=“http://www.nytimes.com/2010/02/24/health/research/24trial.html]Target”>http://www.nytimes.com/2010/02/24/health/research/24trial.html)</p>
<p>Northeastmom, I must be careful speaking of genetics with a lay audience (and I also can rapidly get beyond my knowledge base, too, :)).</p>
<p>All cancers involve gene mutations or disruptions of DNA, so we tend to use the word genetics somewhat loosely, when we are actually talking about mutations or other alterations of DNA.
Also many cancers, melanoma among them have a genetic component in the sense that the tendency to develop melanoma runs in families. But this is complicated because what is inherited may be coloring (fair hair and skin), or the tendency to develop lots of benign moles (the more you have the more likely one is to go bad) or actual dysplastic nevus syndrome which is lots of moles and some atypical nevi (moles). Also, since melanoma has a definite environmental component, what you may have inherited is actually behavioral (ie lots of outside activities). Finally, some children are born with certain types of congenital nevi that can go bad and develop into a malignancy. In this country, though these nevi would be removed if at all possible, so we don’t see “congenital melanoma”.</p>
<p>Having said all that, the vast majority of melanomas are multifactorial, with the biggest single risk being environmental exposure - amount of sun, and particularly painful sunburns in childhood/adolescence. For that reason, and because of the capriousness of this tumor and our vast ignorance, I think no matter the age of the person diagnosed with melanoma, their immediate blood relatives are at a higher risk (how much I don’t know) if they share coloring, past history, etc. </p>
<p>The other thing to remember is that even though people got sunburned in the past, they tended to wear long sleeves, long pants, long skirts, etc, most of the time. We will probably continue to see melanoma increasing for awhile, even with use of sunscreen, because comparatively speaking we run around half dressed for significant periods of time as children and young people…and don’t get me started on tanning beds, may as well hand them a cigarette.</p>
<p>Thanks Cangel. So what percentage caucasians have dysplastic nevii? What percentage of those go on to develop into a malignant melanoma? What are the causes of dysplastic cells?</p>
<p>JHS, I’m so sorry about your brother. How shocking it must have been to hear that news and so difficult for his family, especially his kids. Very scary. I plan to tell H (who had a IA melanoma removed) so he doesn’t disregard any nagging pain…
Thanks for sharing that.</p>
<p>JHS — very sorry to hear that news about your brother.</p>
<p>It was very sad. It’s been a long time now – almost three years. I hadn’t seen this thread before, but obviously it struck home a little.</p>
<p>JHS, I am so sorry too.</p>
<p>JHS, I am very sorry for your family’s loss. I had an employee who had melanoma on her back (luckily was caught in time). It’s amazing that what appears to be an innocuous mole can be so dangerous.</p>