Menacing melanoma

Tags: kadir, cancer, melanoma, screening

By Lamia Kadir, M.D.
Private practice, Austin

As our patients head to the beach for their final flirt with summer, let’s remind ourselves that melanoma is on the march. The incidence of melanoma of the skin, the most commonly fatal form of skin cancer, is increasing faster than any other potentially preventable cancer in the United States.

Remembering risk factors
Major risk factors necessitate a full body skin exam and teaching of the thorough skin self exam by a family physician or dermatologist.

Major risk factors

  • Many moles, large moles, or atypical moles
  • Family history of melanoma in a first degree relative
  • Personal history of melanoma

Other Risk Factors

  • Age: 95 percent of melanoma deaths occur in people diagnosed after 40
  • Male gender
  • Light features: fair skin, red/blonde hair, blue eyes
  • Extensive sun exposure
  • Sun sensitivity: tendency to freckle or burn
  • Indoor tanning: increases risk by 75 percent if before age 30
  • Immunosuppression
  • Xeroderma Pigmentosum
  • History of nonmelanoma skin cancer

Getting Naked
The primary objective of the skin examination is to detect early melanoma. Melanoma diagnosed early in its evolution is associated with an excellent prognosis but melanoma diagnosed late in evolution is generally fatal. Several clinical features of a skin lesion are suggestive of melanoma and prompt referral to a specialist or biopsy. Most of us are familiar with the ABCDE rule: Asymmetry, Border irregularities, Color variegation, Diameter > 6 mm, or Evolution (a lesion that is changing in size, shape, or color).  The duration of change most associated with melanoma is a change over months to years. Another diagnostic aid is the Glasgow seven point checklist. The presence of any major feature is an indication for referral; the presence of the minor criteria reinforces the need for referral.


  • Change in size/new lesion
  • Change in shape
  • Change in color


  • Diameter > 7 mm
  • Inflammation
  • Crusting or bleeding
  • Sensory change

For a refresher, click here for a web program developed to train clinicians in the early detection of melanoma.

“We all need to take an active role,” the acting U.S. surgeon general warned in a report released in July.  Let’s heed the call and remind our patients to “Slip, Slop, and Slap.” Slip on a shirt, slop on sunscreen (Broad Spectrum, 30 or greater) and reapply periodically, and slap on a hat (ideally broad rimmed).

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