Melanoma’s

Squamous Cell Carcinoma (SCC)

This is the second most common type of skin cancer. It is often found in fair skinned individuals with a history of prolonged sun exposure. Tanning beds can also lead to increased risk of SCC.

Males over the age of sixty have a higher incidence of this type of cancer. SCC can spread to other parts of body but this is a small percentage. When seen on the foot the lesion appears as a reddish, flat lesion, or ulceration.

Basal Cell Carcinoma (BCC)

This is the most common type of skin cancer with over a million new cases a year. This lesion grows very slowly and does not typically spread to other parts of the body. The lesion appears as a pearly, partially translucent, papule on the skin. It bleeds very easily and can ulcerated centrally. Sometimes the BCC can present as a superficial lesion which can commonly be mistaken for eczema or dermatitis. Biopsy is needed in these cases to differentiate the diagnosis.

Malignant Melanomas

This is a type of skin cancer that can be fatal. There are five different types of melanomas: aural, melanotic, cutaneous metastases, nodular melanoma, and superficial spreading melanoma.

Acral Melanoma

This melanoma is the most common subtype of melanoma in African Americans and Hispanic individuals. They typically can be found under the toe nail and look like a band of color. Sometimes the band of color can extend into the surrounding skin of the nail. This color leaching into the skin is called Hutchinson’s sign. The lesions can also appear on the bottom of the feet so close inspection of the skin is crucial for early detection.

Cutaneous Metastases

When a melanoma is excised its possible that the lesion will reoccur within or close to the surgical site. The melanoma may also appear away from the site most commonly on the chest, back, and extremities.

Nodular Melanoma

Nodular melanoma is a very aggressive form of melanomas. The nodular melanoma presents as a fast growing papule which is very well defined. This type of melanoma comprises of approximately 10 to 15 percent of all cases. It is commonly found on the trunk, head and neck of the body. This lesion typically occurs more frequently in caucasian, especially Japanese populations, occurs during midlife, and is equal risk for males and females. Bleeding can occur to these lesions since it is very easy to traumatize them.

Superficial Spreading Melanoma

Superficial spreading melanomas is the most common type in persons of white skin. It appears typically on the upper back and is a slow-growing lesion over a period of two years. Age of onset for this type of cancer is between 30 and 50 years of age. People will typically discover this lesion because it is the result of a change from a previously existing lesion. The lesion will typically look black or brown, with some variations in color, that has irregular borders, is elevated, and is asymmetrical.

ABCDE’s of Melanomas help to determine if the lesion is a cancerous type.

Asymmetry
If one half of the lesion is unlike the other half then this increases the chances of melanoma.

Borders
If the border is irregular, meaning the edges are shaped with notches and slopes but are well defined then melanoma may be in the differential diagnosis

Color
If the color is not uniform and has several different shades of brown, black, gray, red, and white. This increases likelihood of a melanoma.

Diameter
If the diameter of the lesion is greater than 6mm (pencil eraser tip) then this adds to the chance of melanoma.

Elevation
This feature is almost always present and is irregular. The height of the lesion is off of the skin and can typically be felt when palpating the lesion.

Treatment of Melanomas.

If a melanoma is suspected a simple biopsy can be used to determine what the skin lesion actually is. If the biopsy is positive then the podiatrist will excise the lesion in its entirety. The excised lesion will then be sent to the pathologist again to determine whether or not the entire lesion was removed. Healing of the surgical site is done by applying clean dressings to the area and also serial cleaning of the wound. Decreasing the chance of infection will greatly reduce the healing time of the surgical site.

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