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New York City

Melanoma Surgery in New York

What is Melanoma?

Melanoma is the most serious type of skin cancer, and the fifth most common cancer in men and seventh most common cancer in women. In the United States, the rate of melanoma is rising more rapidly than any other potentially preventable cancer.

There are four subtypes of melanoma: superficial spreading, nodular, lentigo maligna, and acral lentiginous.

Superficial spreading melanoma is the most common subtype of melanoma. Superficial spreading melanoma can occur in any area, but arises more commonly on the lower legs in women and on the back in men.


Nodular melanoma is the second most common subtype. Nodular melanoma is the hardest to diagnose at an early stage.

The lentigo maligna melanoma subtype occurs most commonly in sun-damaged skin in the older population. Lentigo maligna lesions start as beige/brownish patches that later get larger and form darker, uneven areas with differences in color. Lentigo maligna lesions also develop elevated areas, which indicate that the lesion is growing vertically.

Acral lentiginous melanoma is the most common subtype of melanoma in people with darker skin. Acral lentiginous melanoma usually occurs on the palms of the hands and soles of the feet, as well as under the nails. When in the nail, acral lentiginous melanoma appears as a black or brown band.
melanoma_acral lentiginous

What does melanoma look like?

The appearance of melanoma varies dramatically, so it is nearly impossible to describe exactly what melanoma looks like. However, there are some important early traits of melanoma to be aware of. These are best remembered using the acronym “ABCDE:”

Asymmetry: an imaginary line down the center of the lesion is a good indicator of symmetry, and melanoma is often asymmetrical.

Border irregularity: Melanoma often does not have a consistent, even border.

Color differences within the lesion: Colors in melanoma can range from black, brown, red, blue, gray, and white. Note the range of colors in the same lesion depicted below.

Diameter: Melanoma diameter is often larger than 6 mm

Evolution: Melanoma lesions often exhibit changes in size, color, or shape.

What are the risk factors for developing melanoma?

The most important factor for developing melanoma is sun exposure. People who have had more sun exposure, including tanning beds, are at increased risk. Other risk factors include having atypical nevi (moles), a large number of atypical nevi, and having blond or red hair, many freckles, or light eye color. A small percentage of patients with melanoma have a genetic predisposition that puts them at increased risk.

The most important factor that decides the prognosis is the tumor thickness. Survival rates decline as tumor thickness increases. Regular skin exams by a licensed dermatologist are important in maintaining skin health and can allow early detection of melanoma.

Melanoma surgery FAQ

What causes melanoma?

Melanoma is a type of skin cancer that develops when melanocytes, the cells that produce melanin, start to grow out of control. This uncontrolled growth can be triggered by damage to the DNA within the melanocytes, which can be caused by various factors such as exposure to ultraviolet (UV) rays from the sun or indoor tanning, family history of melanoma, and certain genetic mutations.

UV rays are known carcinogens and can damage the DNA in skin cells, affecting certain genes that control how the cells grow and divide. If these genes no longer function properly, the affected cells may become cancerous. Melanoma can also arise from existing moles or develop in normal skin.

How to prevent melanoma?

First and foremost, limiting your exposure to UV radiation is key to reducing your risk of melanoma. This means practicing sun safety when you are outdoors, seeking shade, wearing protective clothing, and using a broad-spectrum sunscreen with an SPF of at least 30.

It’s also important to be aware of the warning signs of skin cancer and to perform monthly self-exams of your skin. You should also schedule regular skin exams with a board-certified dermatologist to detect any changes early on.

How to spot melanoma?

Melanoma can develop anywhere on the skin, even in areas that are not exposed to the sun. Here are some signs to look for when examining your skin:

  • Asymmetry: One half of a mole or birthmark does not match the other half.
  • Border irregularity: The edges are often ragged, notched, or blurred in outline.
  • Color changes: The color of the mole is not uniform and may include different shades of brown or black, or may have patches of pink, red, white, or blue.
  • Diameter greater than 6mm (about the size of a pencil eraser or 0.6 cm).
  • Evolving: The mole or spot changes in size, shape, color, or texture.

It is important to examine your skin regularly and to see a board-certified dermatologist if you notice any changes or suspicious spots on your skin. A dermatologist can examine your skin using a dermatoscope, which can help distinguish between harmless moles and melanoma. If melanoma is suspected, a biopsy will be performed to confirm the diagnosis.

What are the symptoms of melanoma?

The most common symptoms of melanoma are changes in the appearance of an existing mole or the development of a new pigmented or unusual-looking growth on the skin. These changes can include a mole that becomes larger, changes shape, or changes color. It may also have irregular edges or multiple colors within the same mole. In some cases, melanoma can also occur on otherwise normal-appearing skin.

Other symptoms of melanoma can include the development of new spots on the skin that are different from other moles or freckles. These spots may be darker or lighter in color and may have an irregular shape or border. Melanoma can also cause itching, tenderness, or pain in the affected area. In advanced stages, melanoma can spread to other parts of the body, which can cause additional symptoms such as swollen lymph nodes, unexplained weight loss, or fatigue.

How is melanoma diagnosed?

Melanoma, a type of skin cancer, is typically diagnosed through a combination of physical examination and skin biopsy. During a physical exam, Dr. Cameron Rokhsar will carefully examine your skin and ask about your medical history to look for signs of melanoma. If any suspicious moles or lesions are identified, Dr. Rokhsar may recommend a skin biopsy, which involves removing a small sample of tissue from the affected area for testing in a laboratory. In some cases, if the melanoma has been diagnosed and has any concerning features or is of a certain histologic depth, a sentinel lymph node biopsy may also be recommended to check if cancer has spread to nearby lymph nodes. Additional diagnostic tests, such as Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET) scans, may be used to check for melanoma tumors in the brain or other parts of the body that are distant from the original skin spot.

How fast does melanoma spread?

Melanoma can spread very quickly, and the rate of spread depends on various factors unique to each individual and their cancer. Once a melanoma spot reaches the size of a dime on your skin, it has a 50% chance of spreading. Melanoma can grow extremely quickly and can become life-threatening in as little as six weeks if left untreated. It can spread to almost any area of the body, including lymph nodes, lungs, liver, bones, brain, and gastrointestinal tract. Melanoma is staged from 0 to 4, and the lower the number, the less cancer has spread. The five-year survival rate for people with melanoma is about 99% if the cancer is detected early, but it drops to about 15% if the cancer has spread to other parts of the body. Once a tumor has spread to distant body sites such as organs, it is considered a stage IV melanoma, with an estimated five-year survival rate of only 18% in the US.

How is melanoma treated?

Treatment options for melanoma depend on the stage of cancer and other factors, such as the size, location, and depth of the tumor. Surgery is usually the main treatment for melanoma, and it may involve removing the melanoma and some surrounding tissue. If melanoma has spread beyond the skin, surgery to remove affected lymph nodes may be recommended, and additional treatments such as immunotherapy, targeted therapy drugs, chemotherapy, or radiation therapy may also be used before or after surgery.

Early detection is key to the successful treatment of melanoma. If you notice any changes in your skin, such as new moles or changes to existing moles, or if you have a family history of skin cancer, it’s important to have your skin checked by a board-certified dermatologist. Regular skin checks and sun protection measures, such as wearing protective clothing and using sunscreen, can also help prevent melanoma from developing.

How quickly should melanoma be removed?

Melanoma should be removed as soon as possible. Early detection and prompt treatment are key when it comes to melanoma, as waiting even a few weeks may have a negative impact on survival rates. One study showed that those who waited more than 90 days for surgical treatment were more likely to have a negative outcome. Postponing surgery for more than 29 days led to lower survival rates.

How common is melanoma?

According to the American Cancer Society’s estimates for 2023, about 97,610 new melanomas will be diagnosed in the United States alone, with about 58,120 cases in men and 39,490 cases in women. While melanoma accounts for only about 1% of all skin cancers, it causes the great majority of skin cancer-related deaths. Melanoma incidence has dramatically increased over the past 30 years, making it one of the most common cancers in young people under 30, especially in young women. It’s important to remember that melanoma can develop anywhere on the body, not just in areas that have had exposure to the sun.

What is metastatic melanoma?

Metastatic melanoma is a type of skin cancer that has spread from the original site of the tumor to other parts of the body, such as the lungs, liver, or brain. This occurs when the cancerous cells break away from the primary tumor and travel through the lymphatic system or bloodstream to form new tumors in other parts of the body. It is also known as stage 4 melanoma and is the most advanced form of skin cancer.

Metastatic melanoma is a serious and potentially life-threatening condition that requires prompt medical attention.

What is malignant melanoma?

Malignant melanoma is a type of skin cancer that arises from the pigment-producing cells known as melanocytes. These cells are responsible for the production of melanin, the pigment that gives color to the skin, hair, and eyes. Melanoma typically develops in the skin, but it can also occur in other locations such as the mouth, intestines, or eye. The disease is more common in fair-skinned individuals, and it often appears as a dark mole or lesion on the skin that changes in size, shape, or color. Melanoma is the deadliest form of skin cancer, and it can spread quickly to other parts of the body, including the lymph nodes and internal organs.

What is nodular melanoma?

Nodular melanoma is a type of skin cancer that is considered the most aggressive form of melanoma. Unlike other subtypes of melanoma, nodular melanoma tends to grow more rapidly in thickness than in diameter. It can also appear in a spot where a lesion did not previously exist, making it harder to detect in its early stages. Nodular melanoma can occur anywhere on the body, but it commonly appears on exposed areas such as the head and neck. It is often characterized by a fast-growing lump or skin lesion, which may increase in size over weeks or months. Only about 15% of all melanomas are nodular, but it is responsible for nearly half of the melanoma-related deaths.

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