Much energy is expended—by patients, parents, publishers, and providers—in obsessing over, looking for, and preventing malignant melanoma. A day rarely goes by without a story in the media purporting to inform the reader about this dreaded cancer.
On the one hand, who can argue with the provision of information that has the potential to save lives and reduce suffering? The answer is: I can.
What I see in the popular media is a veritable cornucopia of misinformation—often rehashed myths, vast generalizations, and the like—that all too often serves to confuse, obfuscate, and generally perpetuate the most dangerous misconceptions. Many of them lead to totally unnecessary deaths.
I know this not only because I read these articles but also because I see the worried patients who’ve read them. They come in to “get their moles checked,” for example, since they’ve been told “that’s where melanomas come from.” As with all myths, there is a grain of truth in that concept, but it is dangerously misleading, as is much of the other information passed on in these pieces.
Unfortunately, many medical providers are as influenced by these reports as the general public. And while I can’t reach the general public, I can reach a few hundred thousand medical professionals with some facts that have the potential to save lives (maybe even their own).
MYTH # 1: MELANOMAS COME FROM MOLES
Easily the most common “melanoma myth,” this is possibly the most dangerous. While patients are busy watching their “moles,” the melanoma is on its way to killing them.
The problem, of course, is the word mole, which means different things to different people. Most patients who use this word mean the raised, fleshy, often hair-bearing papule or nodule on their face, arm, or back, that can be present without changing for years. When that is the case, there is little or no potential for these lesions—usually compound versus intradermal nevi—to undergo malignant transformation. No physical event (trauma, chemicals, or sun exposure) can turn a benign nevus into a cancer.
What we as medical professionals are looking for in any lesion is a history of change: growth, color, elevation, erosion/ulceration. When these are present, our course is clear: We remove the lesion and send it for pathologic evaluation. Just because malignant transformation of a nevus is unlikely doesn’t mean it can’t happen.
MYTH # 2: SUN CAUSES MELANOMA, SO LESIONS ON NON–SUN-EXPOSED SKIN CAN’T BE MELANOMAS
The truth is that about 80% of melanomas are found in areas normally covered by clothing, such as legs, abdomens, thighs, and even the bottoms of the feet, in the scalp, and on genitals. Yes, sun is unquestionably the cause, but the sun does not necessarily have to strike the affected area.
This is only one of a number of seeming contradictions about melanoma. It’s important to understand and accept this fact even if it makes no sense, because lives are in the balance. Many tragic deaths have occurred because of a failure to understand and accept this reality.
MYTH # 3: MELANOMAS MANIFEST AS RAISED LUMPS ON THE SKIN
Dermatology providers see and hear this all day, every day. Seborrheic keratoses typify this misperception. However, they also serve as a terrific example of the benignancy of most epidermal lesions (ie, ones that are “stuck on” the outer layer of skin and thus easily peeled off), which are usually warty, rough and colored brown, tan, gray, or a combination of these colors. They’re usually present in multiples, another good sign (in general), but they are the source of endless worry for patients and providers.
The truth is that at least 80% of melanomas are essentially macular (flat) enough to be difficult to palpate, and they almost never appear in multiples. Having said this, I should note that melanomas can certainly be raised on the skin—but these are in the minority of cases. Again, change is the key thing to watch for/ask about, but not change that occurs overnight or from known trauma.