My Doctor Online
The Permanente Medical Group

Risk Factors

Risk factors for melanoma include:

• More than 50 moles on your body.
• Fair skin.
• History of using tanning booths, which use ultraviolet (UV) light that damages skin cells.
• Multiple sunburns, especially in childhood.
• Family history of melanoma or cancer.
• Abnormal moles (dysplastic nevi).
• Age, or being 65 years or older.

Skin cells (melanocytes) can grow together and form moles. Moles come in many sizes, shapes, and colors. Most moles are normal. When a mole changes significantly, it can be a warning sign of melanoma.

The strongest risk factors for melanoma are:

• Sunburn in childhood 
• Family history of melanoma

Prevention

Not all melanoma can be prevented. However, you can protect yourself and your family by reducing your exposure to ultraviolet (UV) light. 

• Avoid spending time in direct sunlight, especially in the middle of the day. Plan outdoor activities for the morning or evening when sunlight is less intense.
• Wear hats and loose-fitting, light-colored long sleeves and pants.
• Use sunscreen with a sun protection factor (SPF) of 30 or higher.
• Use sunglasses that have UV protection.
• Protect your skin from strong UV light reflected from snow, sand, or water. 
• Avoid smoking and tobacco products.

Symptoms

Know “ABCDE,” or signs that may indicate melanoma:

• Asymmetry. The mole or skin patch has an abnormal shape.
• Border. The mole or discolored portion of the skin appears to spread into the surrounding skin. It doesn’t have a clear border. 
• Color. The irregular patch of skin may be black and blue or other colors like pink or white.
• Diameter. The size of the mole or the irregular patch of skin is larger than one-quarter inch.
• Evolving. The mole or patch of skin looks different from skin near it, or is changing in size, shape, or color.

You may also notice itching or bleeding from the abnormal patch of skin. If you have any of these symptoms, contact us for a melanoma screening.

Screening and Diagnosis

Catching melanoma early increases the chance for successful treatment. It’s important that you regularly check your body for signs of small growths and changes in moles. Let us know right away if you have a suspicious growth or mole change.

To diagnose melanoma, we remove as much of the abnormal tissue as possible (biopsy). The tissue is evaluated under a microscope by a pathologist. If needed, we may order additional tests.

Staging

Staging means how far the cancer has spread. Your treatment is based on the stage of the cancer. 

The stage is based on the thickness of the tumor and if the cancer has spread within the skin or to lymph nodes or other parts of the body. 

• Stage 0. The cancer is only found in the top or outermost layer of the skin (epidermis). 
• Stage I. The tumor is 1 millimeter (mm) thick or smaller. There may be a wound on the skin, but the outermost layer of skin is still there. 
• Stage II. The tumor is larger than 1 mm to 4 mm thick. The outermost layer of the skin is gone (open wound or “ulceration”).  
• Stage III. The cancer has spread into nearby lymph nodes, tissues, or organs.
• Stage IV. The cancer has spread to other areas of the body, including skin and organs far away from the original melanoma. 

Treatment

Treatment depends on the location of the tumor and how far the cancer has spread. 

Treatment options may include surgery, radiation therapy, immunotherapy, targeted therapy, and sometimes chemotherapy. Once we know the stage of your cancer, we’ll develop the best treatment plan for you.

Follow-Up Care

One of the most important parts of your care is taking good care of yourself during and after treatment. 

• Eat a nutritious diet.
• Stay as active as possible.
• Attend your regularly scheduled follow-up appointments.
• Join a support group where you can talk to people who may have an experience similar to yours.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we may discuss your medical and family history, and I will examine your skin and ask questions about your symptoms. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.