Malignant Melanoma of the Foot

Definition

Malignant Melanoma is a cancer (growth) of the skin. It occurs as a change of normal skin cells (melanocytes) that contain melanin. Melanin is the factor that provides color to our skin. The more melanin present in the skin, the darker the skin. Melanin provides a protective factor to our skin. By its production, there is an increase in protection against UV waves from the sun and their damaging effect.

Malignant Melanoma is out of control growth of the skin cells that produce the melanin. Approximately 160,000 new cases of malignant melanoma are diagnosed each year and approximately 48,000 deaths are attributed to melanoma each year.

Classification

Malignant Melanoma is always classified as a malignancy. It is not benign. Its severity is based on the depth of penetration into the epidermis and dermis. There are two classifications present that define the depth of invasion. Clark’s classification describes the depth of penetration one sees on a histological slide. The depths are classified from 1-5 depending on the level progressing from superficial epidermis (level 1) to deep dermis/subcutaneous tissue (level 5).

The second classification is the Breslow classification which stages the tumor based on the measured depth of penetration of the growth from the epidermis into the dermis/subcutaneous tissue. The measurement is from level 1 (.75mm) to level 5 (Greater than 4mm)..Generally, the deeper the penetration of the disease into the subcutaneous tissue, the greater the severity and gravity of the condition.

Spread of the malignancy occurs, traveling in the blood to other parts of the body eventually to settle in the liver and lung.

The presentation of malignant melanoma can often be readily seen. The appearance of a dark or discolored lesion usually is the first warning sign. A raised surface, friability (easy to bleed), pain or burning are all signs of concern. The surface of the lesion often gives the first signs of danger. There are other forms of malignant melanoma that can make the diagnosis difficult to make. Acral Lentiginous melanoma invades the subungal area of the toes and may not be seen due to the toenail. Amelanotic melanoma has no pigment and therefore may not even be seen. Lentigo maligna is often mistaken for a ‘stain of the skin’ in older patients.

Use of the ABCD’s can help in identifying a malignant melanoma. A, Asymmetry, or uneven shaped with one side larger than the other; B, Boarders, irregular like the coast of Maine and not smooth like the coast of California; C, Color, changes from the normal skin color with usually a mix of color; D, Diameter, a melanoma will enlarge over time whereas a mole will remain the same.

The definitive diagnosis for malignant melanoma is a biopsy. Once submitted to pathology an accurate diagnosis can be performed.

Preventions and early detection

Melanoma is a cancer of the usually from overexposure to UV waves of the sun. Adequate protections from the rays are necessary to prevent damage.

Cover up around water. The damaging effect of the UV light is pronounced by reflected waves. Wear a shirt or sandals to provide skin protection. Also wear sunscreen to protect exposed areas. Inspect your feet for growths and colored lesions that are present and/or are getting larger. Wearing sunglasses and wide brimmed hats also are an easy and stylish way to gain protection from the sun.


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