Posted by Bill Sandweg on 09 November 2020.
If you, like me, live in Arizona, you are exposed to intense solar radiation nearly all year, but especially in the summer. Exposure to solar radiation is one of the major risk factors for melanoma.
Melanoma is a cancer, which most often appears on the skin. It is a cancer of the melanocytes, the cells that produce brown pigment. It can appear anywhere in the body there are melanocytes. The most common area affected, other than the skin, is the eye.
Melanoma is forty times more common in whites than in blacks. Men are more likely to develop it than women and people with many moles are at higher risk as well. Fair-haired, white people, who burn easily or freckle, are among those at highest risk for development of melanoma. Melanoma is the sixth most common cancer in Arizona and it is becoming more common all the time.
There is a good memory device to help you recognize melanoma, should it appear on your skin: “ABCDE.”
A is for Assymetry. The two halves of the spot on the skin do not match. You can see that clearly in the image above.
B is for Border. The spot has an irregular or scalloped border.
C is for Color. The spot may have different colors, including black, brown, red, white or blue. The image above shows different colors.
D is for Diameter. Although they can be smaller, melanoma spots are usually at least the size of a pencil eraser.
E is for Evolving. Watch for spots that are changing in size, color or shape.
The spot in the image above is a classic presentation for melanoma. However, melanomas don’t always have classical presentations. When they do not, they present the greatest chance for misdiagnosis arising out of a failure to recognize the presence of the melanoma. Most of the melanoma cases I have handled have been failures by the physician to recognize a non-traditional presentation of melanoma.
One of my first melanoma cases involved a melanoma on the bottom of the patient’s foot. Its location was probably the first thing which threw off the physician. The bottom of the foot is not usually exposed to much solar radiation and is an uncommon location for a melanoma. The failure to diagnose the melanoma was also a reaffirmation of the problem of unconscious biases, in this case confirmation bias. The doctor did not expect to find a melanoma on the bottom of the patient’s foot and looked for and found a diagnosis that fit his pre-existing conclusion that this was not going to be a melanoma; he concluded it was a wart and tried unsuccessfully to burn it off. The patient, a lovely, young woman with young children died shortly after we concluded her case.
When melanomas first appear on the skin, they tend to spread and may spread quickly. During this phase of lateral spreading, they typically do not also grow deeply into the skin. However, after growing out, they quickly begin to grow deep into the lower layers of the skin and the tissue below it. It is when melanomas grow down that they also begin to metastasize to other parts of the body.
A melanoma, which is still on the top layers of the skin and has not begun to grow down, is a Stage I and can be treated with excision. Melanomas addressed at this stage have good survival rates, usually exceeding 90% at five years. If the melanoma has spread into the local area by the time of diagnosis, more than just excision will be necessary to treat it. The 5 year survival rate for local melanomas is almost 60%. On the other hand, if the melanoma has already spread to a distant site by the time of diagnosis, the 5 year survival rate is only 14%.
The lesson here is to be alert to the presence of possible melanomas and to see a dermatologist as soon as you recognize a spot which may be a melanoma. If you see the doctor and he or she mistakenly says what you have is not a melanoma, you should go see an experienced malpractice lawyer. Virtually any delay in the recognition of the presence of a melanoma can have fatal consequences as those 5 year survival rates show. You need to see a lawyer as soon as possible after diagnosis. Your claim is far more valuable to you and your family while you are still alive than it would be after you have passed.