Melanoma and Skin Cancer Multidisciplinary Clinic

About the Melanoma & Skin Cancer Multidisciplinary Clinic

The Melanoma Multidisciplinary Clinic at the Brown University Health Cancer Institute with locations throughout Rhode Island is staffed by medical specialists trained in dermatology, dermatopathology, melanoma, surgical oncology, radiation oncology, and medical oncology.  A multidisciplinary melanoma clinic and melanoma tumor board meet once a week to discuss patient care and formulate a customized treatment plan.

What is Skin Cancer?

One out of five Americans will develop skin cancer by the age of 70. Skin cancer is the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations. These mutations lead the skin cells to multiply rapidly and form malignant tumors.

The main types of skin cancer are:

• Basal cell carcinoma (BCC) – BCCs are abnormal, uncontrolled growths that arise from the skin’s basal cells in the outermost layer of skin (epidermis). These cancers most often develop on skin areas typically exposed to the sun, especially the face, ears, neck, scalp, shoulders and back. Most BCCs are caused by the combination of intermittent, intense exposure and cumulative, long-term exposure to UV radiation from the sun. BCC is the most common form of skin cancer.
• Squamous cell carcinoma (SCC) - SCC is an uncontrolled growth of abnormal cells arising from the squamous cells in the outmost layer of skin (epidermis). SCCs are common on sun-exposed areas such as the ears, face, scalp, neck, and hands, where the skin often reveals signs of sun damage, including wrinkles and age spots. Cumulative, long-term exposure to UV radiation from the sun and tanning beds causes most SCCs. SCC is the second most common form of skin cancer.
• Melanoma - is a cancer that develops from melanocytes, the skin cells that produce melanin pigment, which gives skin its color. Melanomas often resemble moles and sometimes may arise from them. They can appear on any area of the body, even in areas that are not typically exposed to the sun. Melanoma is often triggered by intense, intermittent sun exposure that leads to sunburn. Tanning bed use also increases risk for melanoma. Melanoma is the most dangerous of the three most common forms of skin cancer.
• Merkel cell carcinoma (MCC) - Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer. These tumors usually appear as firm, painless lesions or nodules on a sun-exposed area (about half of the time on the head and neck, and frequently on the eyelids). Usually associated with a virus called the Merkel cell polyomavirus, MCCs most often arise on sun-exposed areas in fair-skinned individuals over age 50. MCCs are at high risk of recurring and metastasizing throughout the body, so early detection and treatment are crucial.

What is Melanoma?

Melanoma is the most serious type of skin cancer. It develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control. Although it is much less common than some other types of skin cancers, it is dangerous because it is much more likely to spread to other parts of the body if not caught and treated early. Melanoma is the most invasive skin cancer with the highest risk of death. It is highly curable if caught before it grows more.

What are Symptoms of Melanoma and Skin Cancer?

Melanoma Symptoms

The first signs and symptoms of melanoma are often a change in an existing mole and/or the development of a new pigmented or unusual-looking growth on your skin. Symptoms of melanoma vary. It can develop anywhere on your body, but most often appears in areas that have had exposure to the sun, such as your back, legs, arms, and face.

On the other hand, melanoma also can occur in areas that do not receive much sun exposure, such as the soles of your feet, palms of your hands, and fingernail beds. These hidden melanomas are more common in people with darker skin. Other hidden melanomas can develop in the mouth, digestive tract, urinary tract, vagina, and eye (ocular melanoma).

Melanoma doesn't always begin as a mole. It can also occur on otherwise normal-appearing skin. To identify characteristics of unusual moles that may indicate melanomas or other skin cancers, follow the letters A-B-C-D-E:

A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves.

B is for irregular border. Look for moles with irregular, notched or scalloped borders — characteristics of melanomas.

C is for changes in color. Look for growths that have many colors or an uneven distribution of color.

D is for diameter. Look for new growth in a mole larger than one-quarter of an inch (about six millimeters).

E is for evolving. Look for changes over time, such as a mole that grows and/or changes color or shape. Moles may also evolve to develop new signs and symptoms, such as new itchiness or bleeding.

Other Skin Cancers

There are many types of skin cancer. Skin cancers that are not melanomas are sometimes grouped as non-melanoma skin cancers because they develop from skin cells other than melanocytes. They tend to behave very differently from melanomas and are often treated with different methods.

Here are some possible signs of non-melanoma skin cancer:

• A small, raised bump that is shiny or pearly
• A small, flat spot that is scaly, irregularly shaped, and pale pink, or red
• Sores that don't heal
• A growth with raised edges, a lower area in the center, and brown, blue, or black areas
• A wart-like growth that might bleed or crust over
• Scaly patches or bumps that are often red or purple and itch

Many of these may be caused by other health problems. But it is important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

When Should You Visit a Melanoma and Skin Cancer Expert?

Some doctors and other health care professionals include skin exams as part of routine health check-ups. Ask your primary care physician. Oftentimes, if your primary doctor finds any unusual moles or other suspicious areas, they may refer you to a dermatologist.

As part of a complete early detection strategy, the Skin Cancer Foundation recommends that you see a dermatologist once a year, or more often if you are at a higher risk of skin cancer, for a full-body, professional skin exam.

What to Expect at a Skin Cancer Screening.

Essentially, a visit to a skin cancer clinic involves a full skin cancer screening. This is a thorough examination of your skin — from the top of your scalp to the bottoms of your feet — by a dermatologist. They will look for suspicious spots that could be cancerous.

Take an active role in preparing for the appointment and make note of any spots on your skin that concern you. Mention them before your doctor begins the exam.

For the exam, you’ll be asked to remove all clothing and will be provided with a gown. Your doctor may use a use a bright light or hand-held magnification tool called a dermatoscope to look at skin lesions in more detail.