Melanoma and its causes
Melanoma is a less common type of skin cancer, but the most dangerous. According to the Cancer Association of South Africa (CANSA) melanoma is the 5th most prevalent cancer in South African men and the 6th most prevalent among women.
It develops in the melanocytes – the cells that produce the pigment, melanin that gives people their colour. “The melanin in black people is round and black. It’s more protective against sun damage. It is called eumelanin or true melanin.
For white people this is oval and brown. It’s not very protective against sun damage. It is called pheomelanin or false melanin,” explains dermatologist, Dr Claudia Moloabi.
Speaking on the causes of melanoma, she says, “It is genetic. Exposure to ultraviolet (UV) radiation from the sun and tanning beds make it worse. When you get melanoma, it’s usually due to cumulative sun damage. This means sun damage over a number of years, when the genetic predisposition is being made worse by the radiation.”
How to spot it
Melanomas can occur anywhere on the body, in both sun-exposed and sun-protected areas. Doctors advise to look for any moles, lesions or skin growths that are new, changing or unusual.
“We have what we call the ABCDE of melanoma, which is not only for melanoma, but also for nonmelanoma skin cancers. If you see a lesion that is changing in size or shape, or it starts to bleed, you have to start thinking this could be cancerous,” Dr Moloabi says.
A is for asymmetrical shapes that are irregular like two different looking halves. B refers to uneven borders, moles with notched or scalloped edges. C is for colour that changes – from a tan, brown or black shade progressing into red, white or blue. D is for diameter. A mole larger than ¼ inch (or 6 millimetres) is a warning sign. E is for evolving. This means to look out for any changes over time in colour, size, shape or new symptoms such as itchiness, bleeding or crusting.
The different types
“Melanoma in most cases presents with a dark, black or unusual colour. But we have a rare melanoma that is colourless called Amelanotic melanoma. Mole mapping will give us the features of what we may be dealing with. Be it melanoma or any other nonmelanoma skin cancers like basal cell carcinoma and the squamous cell carcinoma. A skin biopsy will confirm the results,” says Dr Moloabi.
She adds, “For white people melanoma usually develops everywhere and anywhere. For black people or other people of colour it is common on the feet, under the nails or on the palm of hands. This is Acral lentiginous melanoma.”
Acral lentiginous melanoma is included in the four main types of melanoma that the Skin Cancer Foundation refers to. The organisation also lists Superficial spreading melanoma as the most common type commonly appearing on the torso in men, the legs in women and the upper back for both. Lentigo maligna is said to often develop in the elderly, typically occurring in sun-damaged skin on the face, ears, arms and upper torso.
Nodular melanoma, according to the Skin Cancer Foundation, is the most aggressive type, often recognized as a bump on the skin. The tumour, the Foundation says, grows deeper into the skin than other types of melanomas and frequently occurs on the torso, legs and arms, as well as the scalp in older men.
Early detection is key to surviving melanoma. The 5-year survival rate is more than 90% if the skin cancer is detected early according to CANSA. There are preventative ways to help reduce the chances of developing it.
“Sun care is paramount,” Dr Moloabi says. “Wear a wide brimmed hat. Try and avoid the sun between 10am and 3pm. If you have a genetic predisposition, do regular skin check-ups. As a general rule, include skin check-ups as part of your yearly check-up routine, if not twice a year.”
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