My Doctor Online
The Permanente Medical Group

Risk Factors

Risk factors for melanoma include:

• A high number of moles (greater than 50)
• Fair skin
• Use of tanning booths
• Repeated sunburns
• A family history of melanoma or cancer
• Dysplastic nevi (moles that appear to be abnormal)
• Age (65 or older)

The most significant risk factors for melanoma are childhood sunburn and family history of melanoma. Use of tanning booths may be considered harmful because the ultraviolet (UV) light can damage skin cells.

Prevention

While not all melanoma can be prevented, there are steps you can take to reduce your exposure to harmful ultraviolet (UV) rays. Some simple steps you can take to protect your skin against harmful UV exposure include: 

• Avoid unnecessary or direct sun any time of the day. Schedule outdoor activities for the morning or evening when the 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.
• Choose sunglasses that are labeled for UV protection.
• UV rays can also be reflected from snow, sand, or water. Use caution when in these environments.
• Avoid smoking and tobacco products.

Symptoms

Changes in the size, shape, or color of a mole or other skin abnormalities can signal melanoma. Here are some signs that may signal a melanoma, often referred to as "ABCDE":

• Asymmetry. The patch may be an abnormal shape.
• Border. The mole or discolored portion of the skin may appear to "spread" into the surrounding skin without a clear border.
• Color. The irregular patch may be black and blue, or may even have 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. A mole or skin lesion looks different from the rest or is changing in size, shape, or color.

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

Screening

One of the most effective tools in the fight against melanoma is self-screening and early diagnosis. Self-screening and reporting any suspicious growth may promote the early diagnosis of skin cancer. When the cancer is found early, there is a better chance of a successful treatment outcome.

Whole-body skin exams look for signs of small growths on the skin or changes in moles. Most moles are benign (noncancerous), and melanoma can develop in moles on what seemed to be normal skin.

Diagnosis

If we locate an unusual mole or lesion, we will conduct a further test known as a biopsy. During the biopsy, we will remove as much of the abnormal tissue as possible and also send it for further testing. The biopsy sample will be sent to the pathology laboratory to help better identify the type and severity of the cancer, if it is present.

Based on assessment of the biopsy, additional tests may be ordered. Then the staging of the melanoma is determined. The stages of melanoma can differ based upon the general type. The staging process is important to help determine the best treatment plan for you. The most common stages are:

Stage 0. Also known as melanoma in situ. The abnormal melanocytes are found in the epidermis (the top or outermost layer of the skin).

Stage I. The cancer has formed. Stage I can be divided into 2 stages:

• IA: The tumor is not more than 1 mm thick with no ulceration, meaning the outermost layer of skin is still present. 
• IB: Either the tumor is not more than 1 mm thick with ulceration, or more than 1 mm and not more than 2 mm thick with no ulceration.

The tumor has not spread to any lymph nodes.

Stage II. Stage II is divided into 3 stages:

• IIA: The tumor is either more than 1 but not more than 2 mm thick with ulceration or more than 2 but not more than 4 mm thick with no ulceration. 
• IIB: The tumor is either more than 2 but not more than 4 mm thick with ulceration or more than 4 mm thick with no ulceration. 
• IIC: The tumor is more than 4 mm thick with ulceration (the outermost layer of skin is absent).

The tumor has not spread to any lymph nodes.

Stage III. The tumor has spread into neighboring lymph nodes. The cancer may have also spread to nearby tissues or organs. The tumor may be any thickness, with or without ulceration with additional features:

• Cancer has spread to 1 or more lymph nodes.
• Lymph nodes may be joined together (matted).
• Cancer may be in lymph vessel between the primary tumor and nearby lymph nodes.
• Very small tumors may be found on or under the skin, not more than 2 cm away from where the cancer first started.

Stage IV. The cancer has spread to other places in the body. It may also have spread to places in the skin far away from where the cancer first started.

Treatments

While there are a variety of treatment options for melanoma, the methods depend upon the type and severity of cancer. Following a full diagnostic analysis, we will work with you to create the best treatment plan for you.

Follow-up Care

One of the most important aspects of cancer therapy is good self-care throughout the treatment period and beyond. There are several things that you can do:

• Eat a nutritious diet, even though treatment-related side effects, such as mouth sores, can make this difficult.
• Stay as active as possible.
• Continue your regularly scheduled follow-up appointments.
• Join a support group where you can talk to people who may have had an experience similar to yours.

Follow-up care is very important.

Clinical trials

We may also discuss the possibility of enrolling you in a clinical trial. Clinical trials are research studies designed to improve treatment for cancer patients. Some trials investigate new cancer drugs and treatments, while others compare standard treatments with new treatments.

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.