Melanoma Archive Questions

Below are Dr. Hausner’s answers to Melanoma questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 18.

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Q : 1 06/08/2009	I had retnioblastoma as a child. Now, at 33, I have a pre-cancerous mole. Is there a relation between the two? Should I see an oncologist? Yes, these two entities could be related. Retinoblastoma increases the risk of developing different cancers in the future. All of the cells in your body carry a mutation of the Rb gene, a tumor suppressor, and if such a cell loses the other copy of the gene, it might be prone to carcinogenesis. You have to watch yourself carefully and avoid sun exposure between 11:30 A.M and 4:30 P.M. If you find any new skin lesions, you should show them to a dermatologist immediately.
Q : 2 04/22/2009	Is melanoma ever misdiagnosed as a skin infection and treated as such? Do dermatologists typically use the dermascope for diagnosing skin lesions suspected of being cancerous? Melanoma is rarely misdiagnosed as a skin infection. Melanoma has different features and a different time line from most skin infections. The exception is an advanced and ulcerated primary melanoma which might be mistakenly considered to be a pyogenic granuloma. The dermascope is very useful for dermatologists who are trained to use it. It is commonly used in Europe, but lately the number of dermatologists using dermascopy is rising in the U.S.
Q : 3 02/20/2009	My husband has been told that he has metastatic melanoma which was found during a heart scan. The PET scan showed several areas that varied in size, but no biopsy was performed. The treatment options that were proposed are chemotherapy including clinical trials or an autologous vaccine which would require removal of a lung nodule. However, there is a thoracic surgeon who is confident that he can remove the nodule with minimal damage to the lung. How can we be sure it's melanoma? Which treatment option is the best? Your husband likely had a melanoma removed from his skin at some point in the past. If it was a long time ago, 3-5 years or more, and the metastasis is single, I would consider surgery. Otherwise, if he is in good shape, has normal kidney, liver, heart and lung function and is younger than 65, a high dose of interleukin 2 should be given because it carries the chance of cure. Unfortunately, most tumor vaccines have been proven to be harmful, rather than helpful and I would stay away from them. Chemotherapy might buy your husband time and quality of life, but it can not cure the cancer and should only be used if nothing else is available.
Q : 4 10/10/2008	I have a dear friend who, in the last 3 months, has consistently manifested squamous cell cancers on his body. They have come in rapid succession, mainly 3-4 at a time, and when he goes to his skin specialist--at least 3 or 4 times a year, recently more--there are always biopsies to be done and at least half are squamous. Recently he has had up to 20 squamous--on his legs (with pigskin grafts), and other places, but mainly on his neck and face, forehead (with graft), and now on the top of his head. He can hardly recover from the Moh's before he is diagnosed with more. What can cause cancers like this to manifest in such rapid succession? And what action is appropriate, other than to continue Moh's-ing them off. Some have returned two and three times. The reason for the relentless occurrence of squamous skin cancers is sun exposure that have done cumulative damage to the DNA of his skin cells over years and years of sun exposure. Avoiding sunlight is important. There might be a genetic predisposition e.g. a DNA repair defect. Alternatively, patient might be immunosuppresed as in patients post transplant. Actinic keratosis might be treated with imiquimod.
Q : 5 09/30/2008	Are there are any treatments to help with the fading of kaposis sarcoma lesions, short of trying to have them removed surgicaly? My viral load and cd4 are now in tact. Any help? Systemic therapy, including chemotherapy and immunotherapy, should be considered for Kaposi Sarcoma that is involving internal organs or to large areas of the skin to be dealt with locally. If you CD4 count is over 250, interferon could be used, in particular the liposomal interferon, though it is not approved for that indication. If it would be lower than 250, chemotherapy, either paclitaxel or doxil, could be used.
Q : 6 07/30/2008	I am a 50-year-old male with brown/olive skin. Three months ago, I noticed a brownish purple macule on my upper arm. It from 1 to 6 mm in three months. Now it has a crater in the center with a keratinized substance and a fusiform pinkish red colored wheal-like elevation about 2.5 cm in longest dimension. The papule is symmetrical with regular borders. Does that sound like a melanoma or keratoacanthoma, or something else? This might be a "cornum cutaneum" or skin horn. Nevertheless every skin lesion suspicious for a malignancy should be inspected by a dermatologist. Make an appointment as soon as possible.
Q : 7 07/29/2008	My 19-year-old daughter has had seven basal cell carcinoma sites removed over the past two years, but she does not show any other symptoms associated with Nevis. She has never sunbathed or tanned, and her mother's family has some history, but not at such a young age. Should she see a multidisciplinary team of experts, or just continue monitoring with her current dermatologist? In the absence of a melanoma, one does not need a multidisciplinary team. A skilled dermatologist can advise about her skin lesions. In case of uncertainty, a sample can be taken and inspected under the microscope. This is called histology.
Q : 8 07/20/2008	I just got diagnosed with squamous cell carcinoma in situ. It is under my chin. Could I have gotten it from the radiation for breast cancer 10 years ago? How serious is this? It is very unlikely that this cancer is related to radiation of your breast. The squamous cell carcinoma needs to be removed by surgery with clean margins (about 1 cm margins).
Q : 9 06/17/2008	My friend has been diagnosed with melanoma stage 2b . The brestlow was 6mm. His doctors are currently debating on high dose or low dose interferon. Would you suggest interferon treatment, and if so at which level for how long? My friend had total thyroidectomy about 4 years ago. I think his thyroid functions are under control with medicine. I keep reading that patients with thyroid problems are not accepted to control groups on immunotherapy. Is the usage of interferon more risky for my friend due to this condition? "High dose interferon" (20 M units into the vein daily on weekdays over one month, followed by 10 M units under the skin three times a week for the rest of the year) is the standard of care. Depression, low blood counts and liver function abnormalities are the biggest problems. Clinical trials are exploring the question of whether it is the first one month of high intensity therapy or the 11 months of lower intensity that make the difference. The thyroid hypofunction is not in the way of getting the therapy safely and benefiting from it.
Q : 10 04/03/2008	I had a melanoma (Breslow 1.2 mm, Clark's Level IV) removed from my right flank in May 2006. The subsequent sentinel node biopsy and wide local excision were both negative. I am currently seeing my dermatologist every six months for skin examinations. Should I also be following up with an oncologist? An oncologist would examine carefully your lymph nodes and possibly get a chest X-ray once a year. A dermatologist can obviously watch for these signs of recurrence as well, but at the same time can look out for new primary melanomas or other skin cancer lesions.
Q : 11 03/31/2008	I have just reurned from Thailand where my face got severely sunburned. Since then (5 days ago), there are no signs of the blisters healing or the swellings around my eyes decreasing. I am a man aged 62. Do you think I could have given myself skin cancer? Most likely not. Melanoma may be a consequence of blistering sunburns in childhood -- usually from intermittent insolation. Nonmelanoma skin cancers, which are much more common than melanoma skin cancers, are usually related to the cumulative sun exposure. It is important to avoid noon sun or protect the skin effectively.
Q : 12 03/29/2008	I have a skin lesion which extends from my axilla to my forearm. It is dark brown in color, has been the same color for 15 years, and is flat, not elevated. Should I be worried? You might have a large inborn pigmented mole. The pigment cells of these moles have a low likelihood of changing into melanoma, but because there so many of them, there is a possibility. It is important to look out for any change, in particular growth above the level of the skin. Taking a picture with a digital camera and comparing your skin from time to time would help you to identify changes. Altogether the risk is very low. Alternatively, if the spot has the color of coffee with milk, these are innocent.
Q : 13 03/02/2008	I saw a mole online that is similar to one I have on my arm. Online it was a benign juvenile melanoma. Should I be concerned? I could not find information on it. There are many pigmented lesions on the skin of most fair-skinned persons. The one you mentioned is also called Spitz nevus and is mostly benign. If you have any new pigmented lesion, a growing or elevating lesion, or a lesion that is bleeding or seeping fluid, it should be inspected by a dermatologist. If suspicious, it should be taken out with clean margins (excisional biopsy) and inspected under the microscope. Melanoma is usually cured if found early, but a very dangerous disease when advanced.
Q : 14 01/31/2008	My mother was just diagnosed with squamous cell cancer on her face. At the time she had also reported spots on her arms that were unusual and growing (they look like psoriasis). She was told these were nothing, but I am wondering if she ought not to get these biopsied also. The other lesions might be seborhoic dermatitis -- completely innocent -- or solar keratosis. You should trust the judgment of a dermatologist. When in doubt, they tend to remove the lesion so that it can be better studied under the microscope.
Q : 15 01/07/2008	I have been taking tyrosine for a couple of weeks now and am amazed by my increased energy level and my elevated mood. My concern is that I have read it can increase the chance of skin cancer. I take 1,000mg a day and wonder if this dosage in the long term may increase my chances of getting skin cancer. I reaaly don't want to stop taking it. The black/brown pigment of the skin, melanin, is made from tyrosine, a non-essential aminoacid. Tyrosine is a precursor of dopamine made in your brain. I am not aware of any information about tyrosine increasing the incidence of cancer or causing cancer. Obviously as everything else, it should be done with moderation. Chicken broth or beef broth is all aminoacids in a natural and balanced form. It is more advisable than poorly studied food additions.

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