The Melanoma Surveillance Clinic, under the direction of Arthur R. Rhodes, MD, MPH, professor of dermatology, has an innovative intervention strategy designed to carefully monitor patients who have a very high risk of developing melanoma.
Melanoma is a potentially life-threatening form of cancer that begins as a new mole, a pre-existing mole that changes, or a very unusual mole. People at highest risk for developing melanoma tend to be white adults, but no racial or age group is completely free of risk. Melanoma is curable with early detection and surgical removal, before the cancer has an opportunity to spread to internal organs. People at highest risk for developing melanoma commonly have one or more of the following traits:
Family history of melanoma
Personal history of melanoma
Presence of any atypical nevi
Having had any atypical moles removed
Presence of prominent numbers of moles, small or large, typical or atypical in appearance
Presence of a single high-risk mole (i.e. congenital nevus and nevus spilus, among others).
Self-Examination and Warning Signs of Melanoma
Melanoma can develop in any person and may be noticed by self-examination of the skin. The total skin surface should be self-examined at monthly intervals, enlisting the help of family members or partners for difficult-to-see areas, such as the scalp, back and buttocks. If you are an adult and have an unusual-appearing mole, develop a new mole, or develop any type of change in a pre-existing mole that lasts longer than two weeks and does not return to "normal," it's important to consult your physician. Most changes in moles, and most new moles, are not dangerous but may require expert consultation to be certain.
It's never too early to have a skin examination by a dermatologist. Almost all skin cancers are treatable with early detection and timely surgical removal. There are three things you should watch when examining your skin. Any spot that exhibits any of these signs should be checked by a physician:
Melanoma doesn't discriminate
Aside from what you may have been taught, melanoma does not just occur in light-skinned individuals. People of all races, male or female, are at risk for melanoma. Patients with fair skin and light eyes have a higher risk of developing melanoma, but anyone can develop this disease. Consult with your physician, if you are concerned about any changes to your skin.
Nevomelanocytic nevi, also called moles, are common skin growths that are composed of cells called nevomelanocytes. Nevomelanocytes are abnormal cells having a similar origin as melanocytes, the pigment-producing cells located in the epidermis, the skin's most superficial layer. Nevi (moles) are usually brown or pink in light-skinned people, or very darkly pigmented in dark-skinned people. The vast majority of nevi are acquired after the first six to 12 months of life. A congenital nevus is a nevus apparent at birth, apparent in 1 percent of newborns.
The tendency to form acquired or congenital nevi is commonly a familial trait. Nevi appear during early childhood and tend to enlarge with body growth. Nevi have no function, and most are harmless. Nevi are among the most common abnormalities of the skin of humans and animals. Nevi are important because of their relation to the potentially deadly form of skin cancer called melanoma. Melanoma may arise in a congenital or acquired mole, or as a new growth on previously unaffected skin.
Photographic Surveillance: a New and Practical Intervention Strategy
Unique to the Melanoma Surveillance Clinic is photographic surveillance, a procedure in which a specialist physician compares to photographic baseline each and every visible mole and all visible anatomic sites on the skin. This comparison is made during periodic surveillance examinations. Photographic baseline consists of pictures of the total skin surface. These pictures consist of approximately 36 poses, taken by the Rush Photo Group in their professional studio within the Medical Center.
Photographic surveillance helps physicians and patients focus on lesions at highest risk, namely moles that appear to be new or changing compared to photographic baseline. So unnecessary surgery may be avoided for moles that are deemed to be benign in appearance and stable photographically. Photographic surveillance examinations are conducted at four- to 12-month intervals, depending on the perceived degree of melanoma risk.
Photographic surveillance, combined with monthly partner/family-assisted examinations and self-examinations, facilitates the detection of new moles or changing moles that could be melanoma in an early and curable phase of development. Melanoma that is surgically removed in an early phase of development, before cancer cells have had a chance to spread, is tantamount to cure.
Patients who are most likely to benefit from the procedure of photographic surveillance have one or more of the historical or physical traits listed above.
Getting Started on Photographic Surveillance
Patients wishing to take advantage of the Photographic Surveillance Clinic require a screening examination by a dermatologist to assess melanoma risk and the need for photographic surveillance.
Arthur R. Rhodes, MD, MPH, is director of the Melanoma Surveillance Clinic at Rush University Medical Center and professor of dermatology. He is regarded internationally as an expert in the evaluation and management of infants, children and adults who have high-risk moles and melanoma.