Guest: Dr. Bruce H. Thiers – Dermatology
Host: Dr. Linda Austin – Psychiatry
Announcer:Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Bruce H. Thiers, who is Professor and Chair of Dermatology at MUSC. Dr. Thiers, we have been talking about several different kinds of skin cancer, one of the most well known for most lay people is melanoma. What is a melanoma?
Dr. Bruce H. Thiers: Melanoma is a tumor of the pigment producing skin cell called the melanocyte.
Dr. Linda Austin: Now, melanocytes make skin turn dark and they also makes regular moles dark. What if it’s different though when they start making a melanoma?
Dr. Bruce H. Thiers: That’s actually an excellent question because investigators are actively studying what makes a good melanocyte go bad and it’s probably a combination of genetic or inherited and environmental factors. We know that sun exposure plays a role, but we don’t know exactly what the sun does to turn a normal-behaving melanocyte into a tumor cell.
Dr. Linda Austin: So then can you have a mole that you may have had your whole life and that you have always thought of as an ordinary mole become a melanoma?
Dr. Bruce H. Thiers: There is certainly a melanocyte in a mole can evolve towards melanoma or melanocytes in otherwise normal appearing skin can become melanoma and that’s a very important point. Not all melanomas come from moles; some melanomas come from previously normal appearing skin.
Dr. Linda Austin: I recall hearing someone, who developed a melanoma in their ear canal of all places, a place that you wouldn’t even think about having a cancer.
Dr. Bruce H. Thiers: Melanoma could occur in very unusual areas including the eye.
Dr. Linda Austin: Now, how does a mole that is harboring a melanoma, if that’s a correct way I am saying it, how does that look different from a regular mole?
Dr. Bruce H. Thiers: We talked about the ABCDs of melanoma and when we teach patients to examine their skin, we tell them to look for certain factors. ?A? stands for asymmetry. Any mole that was previously symmetrical that starts to grow with one end or the other becomes asymmetrical, this lesion is considered suspicious for melanoma. ?B? is border irregularity. If the border of the lesion changes or becomes more irregular, that causes to be suspicious for melanoma. ?C? is color. Any change in color makes a mole suspicious for melanoma. We talk about the colors of the flag, red, white, and blue; any of those in a mole is suspicious for melanoma. Many people have the misconception that melanomas are only brown or black. Melanomas can have any of the colors in them and when they do have these colors, we become suspicious for melanoma. ?D? is diameter. Any mole that grows or enlarges in diameter is suspicious for melanoma. So, remember the A, B, C, and Ds and this helps you examine your skin and pick up the suspicious lesions.
Dr. Linda Austin: Now, I know that sometimes some dermatologists follow a given patient, they will take photographs. Would it be wise for a person, who thinks they may be at risk for melanoma to ask their family doctor to take photographs on a regular basis and look?
Dr. Bruce H. Thiers: Well, you are taking about mole mapping and mole mapping is usually done in patients, who have many, many moles or nevi, which is the term dermatologists like to use. Mole mapping is not something that could be done by amateur photographers. It is usually done by professional photographers and I wouldn’t recommend it being done by their physician. It is probably best done by photographers, who are trained in this technique, who take good high-quality photos of the moles.
Dr. Linda Austin: Who is particularly at risk for melanoma?
Dr. Bruce H. Thiers: People at highest risk for melanoma are those who have many moles, those with a family history of melanoma, and those who have been subjected to excessive amounts of sun exposure. When we talk about the phenotype or appearance of people, who have a tendency to melanoma, we think about people with blue eyes, blond hair, and fair skin.
Dr. Linda Austin: How about red hair?
Dr. Bruce H. Thiers: Red hair as well.
Dr. Linda Austin: How do you treat melanoma?
Dr. Bruce H. Thiers: Melanoma now is a common tumor. It affects approximately 1 in 70 people. When treated early, it is 100% curable. When treated at the point where it is spread beyond the skin, it’s really not curable. So, the way we treat melanoma is prompt excision.
Dr. Linda Austin: So, in other words, it makes a lot of sense if you are even suspicious that a lesion might be a melanoma to go and get that biopsied and checked.
Dr. Bruce H. Thiers: Absolutely, if you have any suspicious lesion, it is important to come in as soon as possible to get a check. I have had many patients, whose spouses haven’t heard of dental lesions and remember that the most common area to see melanoma is on the back. So, many people are not aware of it until someone else alerts them to it. So, examine your own skin, have your spouse examine your skin, and the most of all if you see a suspicious lesion, have it checked immediately.
Dr. Linda Austin: Let’s talk about the treatment for those whose melanoma has spread beyond the skin, how is that treated?
Dr. Bruce H. Thiers: Melanoma that’s spread beyond the skin is very difficult to treat. If they are isolated distant lesions, what we call metastatic lesions, sometimes they are excised. Unfortunately, the chemotherapeutic agents we have had available to treat melanoma have not had a good track record of success.
Dr. Linda Austin: So, it must be a very important area of new research than if we have a long way to go still with melanoma.
Dr. Bruce H. Thiers: Well, that states it perfectly. We really have a long way to go in terms of how we can treat metastatic melanoma and melanoma therapeutics is a very, very hot and active area of research.
Dr. Linda Austin: Do we have any research going on here at MUSC in that area?
Dr. Bruce H. Thiers: I am glad you asked. We?ve just endowed a chair for melanoma research and we are looking to recruit a good melanoma therapeutics programs as soon as we reasonably can.
Dr. Linda Austin: Dr. Thiers, thank you so much for talking with us today.
Dr. Bruce H. Thiers: My pleasure.
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