In men, melanoma is found most often on the area between the shoulders and hips or on the head and neck. In women, melanoma often develops on the lower legs. It may also appear under the fingernails or toenails or on the palms or soles. The chance of developing melanoma increases with age, but it affects all age groups and is one of the most common cancers in young adults.

Melanoma - The ABC's Web site. Available at www.melanoma.com.

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The following are some of the risk factors associated with melanoma:

1. Sunlight (UV radiation): Too much exposure to UV radiation is a risk factor for melanoma. The main source of such radiation is sunlight. Tanning lamps and booths are another source.
2. Moles: A mole (nevus) is a benign (not cancerous) skin tumor. Certain types of moles increase a person's chance of getting melanoma. People with lots of moles, and those who have some large moles, have an increased risk for melanoma. These people should have frequent skin exams by a dermatologist (skin doctor). They should also examine their own skin every month and practice good sun protection.
3. Fair skin: People with fair skin, freckling, or red or blond hair have a higher risk of melanoma.
4. Family history: Around 10% of people with melanoma have a close relative (mother father, sibling, child) with the disease. This could be because the family tends to spend more time in the sun or because the members have fair skin, or both. Less often, it is because of a gene change (mutation) along with sun exposure. People with a strong family history of melanoma should have skin exams by a dermatologist and learn to examine their own skin as well. They need to be very careful about sun exposure.
5. Immune suppression: People who have been treated with medicines that suppress the immune system, such as transplant patients, have an increased risk of developing melanoma.
6. Age: Melanoma is more likely to happen to older people. But it is one of the few cancers that is also found in younger people.
7. Gender: Men have a higher rate of this cancer than women.
8. Xeroderma pigmentosum (XP): This is a rare, inherited condition. People with XP are less able to repair damage caused by sunlight and are thus at greater risk of melanoma.
9. Past history of melanoma: A person who has already had melanoma has a higher risk of getting another melanoma.

A self-examination of the skin every month is also important to detect new growths or other changes. If you notice an odd-looking mole or marking, contact your doctor as soon as possible. He or she will take a complete medical history and give you a physical examination.

If your doctor also thinks the mole or marking looks unusual, a procedure known as a biopsy will be performed. To perform a biopsy, a local anesthetic will be injected under the skin to numb the area. The entire mole, or a small sample of the mole, will be removed and examined in a laboratory to determine if the mole is cancerous.

¹American Cancer Society Web site. Available at http://www.cancer.org.

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Stages III and IV are the later stages, marked by the spread of the disease to the lymph nodes or to more distant parts of the body. Lymph nodes ó an important part of your body's immune system ó are the organs that help drain lymph fluid away from body tissue, carrying bacteria or cancer cells away with it.

There is a procedure called "Sentinel Lymph Node Mapping" that has been developed to help your doctor detect if the cancer has spread to the lymph nodes. The technique lets your doctor identify the specific lymph nodes to which the tumor area is draining, so that they can be removed and examined under a microscope to see if they have trapped any melanoma cells.

If these lymph nodes are clear, your doctor can assume that the melanoma has not spread. On the other hand, the presence of melanoma cells in the "sentinel" lymph node automatically classifies a melanoma as "high-risk."

Melanoma - The ABC's Web site. Available at www.melanoma.com.

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Since early detection of melanoma is an important part of prevention, you should examine your skin every month. The best time to do this is after a bath or shower, standing in front of a full-length mirror. Use a handheld mirror to help you view areas that are difficult to see. Examine all moles or markings, and look for any changes in the number, size, shape or color of these markings.

Melanoma - The ABC's Web site. Available at www.melanoma.com.

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In general, children should:

1. Avoid the sun from 10 AM to 4 PM
2. Cover up with clothing, including a broad-brimmed hat
3. Apply a broad-spectrum sunscreen ó sun protection factor (SPF) 15 or higher
4. Stay out of tanning salons
5. Have a skin check-up regularly
6. Keep babies 6 months or younger out of the sun whenever possible

Once a mole develops, it usually stays the same size, shape and color for several years. Most people have moles that are almost always harmless. However, it is important to recognize changes in a mole that may suggest melanoma is developing.

The following ABCD system can help tell a normal mole from one that could be melanoma.

	A = Asymmetry: melanoma lesions are typically asymmetrical, whereas benign (non-cancer) moles are typically round and symmetrical.
	B = Border: melanoma lesions frequently have uneven or irregular borders (I.e., ragged or notched edges), whereas benign moles have smooth, even borders.
	C = Color: melanoma lesions often contain multiple shades of brown or black, whereas benign moles are usually a single shade of brown.
	D = Diameter: early melanoma lesions are often more than 6 mm in diameter, whereas benign moles are usually less than 6 mm in diameter.

Spots on the skin that are changing size, shape or color must be evaluated promptly. Any unusual sore, lump, blemish, marking or change in the way an area of the skin looks or feels may be a sign of skin cancer or a warning that it might occur. The skin might become scaly, crusty, oozing or bleeding. It may feel itchy, tender or painful. Redness and swelling may develop.

Step-by-Step Self-Examination

What you'll need:

1. A bright light
2. A full-length mirror
3. A hand mirror
4. 2 chairs or stools
5. A blow dryer
6. Body maps
7. A pencil

	1. Examine your face, especially the nose, lips, mouth and ears ó front and back. Use one or both mirrors to get a clear view.
	2. Thoroughly inspect your scalp, using a blow-dryer and mirror to expose each section to view. Get a friend or family member to help, if you can.
	3. Check your hands carefully: palms and backs, between the fingers and under the fingernails. Continue up the wrists to examine both front and back of your forearms.
	4. Standing in front of the full-length mirror, begin at the elbows and scan all sides of your upper arms. Don't forget the underarms.
	5. Next focus on the neck, chest, and torso. Women should lift breasts to view the underside.
	6. With your back to the full-length mirror, use the hand mirror to inspect the back of your neck, shoulders, upper back, and any part of the back of your upper arms you could not view in step 4.
	7. Still using both mirrors, scan your lower back, buttocks and backs of both legs.
	8. Sit down; prop each leg in turn on the other stool or chair. Use the hand mirror to examine the genitals. Check front and sides of both legs, thigh to shin; ankles, tops of feet, between toes and under toenails. Examine soles of feet and heels.

Body Maps

On the first exam, make a dot corresponding to the location on your skin of each freckle, mole, birthmark, bump, sore, scab or scaly patch. Draw a line out to the margin and indicate its approximate size (use a scale) and color and the date.

For each exam after that, find the spot on your skin, record the new date next to the old one, and note any change in size, color or shape. Record any spots you did not see on last examination. Use a calendar to keep track of the dates on which you examined yourself. Indicate year, month and day.

See a physician, preferably one who specializes in diseases of the skin (known as a dermatologist), if you note any change in an existing mole, freckle or spot, or if you find a new one with any of the warning signs of skin cancer.

Melanoma - The ABC's Web site. Available at www.melanoma.com.

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For any stage melanoma, surgery ó removal of the tumor ó is the first treatment. Surgery is often sufficient to cure people with early-stage melanoma ó patients with small, thin tumors that have not spread to other parts of the body.

In later stages of the disease, surgery is generally followed with additional therapy. Chemotherapy, radiation therapy, or immunotherapy are the most frequent kinds of "adjuvant" (additional) therapies in widespread use for melanoma.

Melanoma - The ABC's Web site. Available at www.melanoma.com.

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American Cancer Society  -  (www.cancer.org)

National Cancer Institute  -  (www.cancer.gov)

For more cancer trials, visit the Web sites of Philadelphia's cancer centers:

1. University of Pennsylvania
   www.oncolink.com
2. Fox Chase Cancer Center
   www.fccc.edu
3. The Kimmel Cancer Center at Thomas Jefferson University
   www.kcc.tju.edu

The Pennsylvania Department of Health  -  (www.dsf.health.state.pa.us)

Melanoma's Patient Information Page  -  (www.mpip.org)

Gilda's Club of Delaware Valley  -  (www.gildasclubdelval.org)