115 Melanoma 54 Definition The most serious form of skin cancer that begins in the melanocytes. Because most melanocytes still produce melanin, melanoma tumors usually are brown or black. Melanoma accounts for about 4 percent of all skin cancers and causes a large majority of skin cancer deaths it is also more likely to metastasize. The chance of developing melanoma increases with age but the disease affects individuals at all ages. If detected and treated early, melanoma potentially is curable. Characteristics Melanoma usually appears as an irregular brown, black, and/or red spot, or an existing mole that begins to change color, size, or shape. It can occur on any skin surface. In men, melanoma is often found on the trunk or the head and neck. In women, it often develops on the lower legs. Anyone can develop melanoma on the palms of the hands, soles of the feet, and under the nails. Early signs of malignant melanoma are: Asymmetry—most early melanomas are asymmetrical. Border irregularity—borders are uneven or may be scalloped or notched. Color variation—common moles usually are a single shade of brown. A variety of colors (brown, tan, or black) is a warning sign. As melanomas progress, other colors such as red, white, and blue may appear. Diameter greater than 6 millimeters—watch for a mole that suddenly or continuously gets larger. Evolving—any change (size, shape, color, elevation, or new symptom like bleeding, itching, or crusting) needs to be evaluated. Risk factors for melanoma are described on page 117. Types of melanoma are described on page 118. Policy Evaluate in the occupational health unit any employee with signs or symptoms of melanoma and refer for further medical evaluation. Objectives Clinical Assessments and Interventions Referral for Medical Action ● Any suspicious symptoms or signs of skin cancer. Follow-up Actions If examination findings are negative, counsel employee regarding the impor- tance of: ● Checking skin at least monthly (see figure, page 36) for ABCDE character- istics. Obtain pertinent history. Assess area of skin where change is noticed. Advise regarding fur- ther evaluation. ● Inquire about symptoms (see Characteristics above) and risk factors (see page 117). ● Inspect skin for ABCDE. Asymmetry. Border irregularity (uneven borders or rough edges). Color variation (shades of brown, black, tan, red, white, blue—alone or in any combination). Diameter 6 millimeters (size of pencil eraser, about 1/4 inch). Evolving (changing lesion). ● Arrange for medical evaluation with employee personal health care provider or dermatologist im- mediately. Guideline continues on next page