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Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery

Written by Dr. Ringpfeil

Melanoma

Melanoma is the most serious type of skin cancer due to its potential to metastasize to other body organs. People can die from melanoma but melanoma can also be cured by surgery alone if caught early. The incidence of melanoma in the United States has been increasing. Melanoma results from changes within the pigment-producing cells called melanocytes. It can occur on its own or within a pre-existing mole. Melanoma can develop on any part of the skin even those areas not commonly exposed to the sun. It can also develop within the eye.

The risk of developing melanoma increases with age but it is also the most common cancer in women aged 25 to 29. It is rare before puberty. There are different types of melanoma: superficial spreading, nodular, lentigo maligna, and acral lentiginous. Up to 70% of melanomas fall into the category of superficial spreading melanoma. It is commonly found on the backs of men and on the legs of women. It appears as a flat to slightly raised irregularly shaped and colored spot.

It is slow-growing often over a period of years. Nodular melanomas are the next most common. They represent 15% to 30% of melanomas and involve deeper layers of the skin. They are rapidly growing over a period of months and occur as a brown, black, blue, or non-pigmented raised lesion. Lentigo maligna melanoma represents 4% to 10% of melanomas. Lentigo maligna occurs on sun-exposed areas, particularly the face, of older individuals.

It is characterized by an irregularly shaped and irregularly colored flat spot. The least common type of melanoma is the acral lentiginous variety, which represents 2% to 8% of melanomas. This type occurs on the palms and soles and is most commonly seen in black individuals. Acral melanomas can also occur on the bed of the fingernail or toenail and are characterized by a dark streak within the nail.

Diagnosis

Melanomas are diagnosed with a skin biopsy. Melanomas are staged based on the size of the tumor, whether or not lymph nodes are involved and whether or not the cancer has metastasized. The thickness of the lesion and whether or not ulceration is present are also important factors in determining the severity of the melanoma and prognosis. During skin exams, a trained professional will employ the ABCDs of melanoma when evaluating a lesion.

These include "A" for asymmetry, "B" for borders (looking for jagged or irregular borders), and "C" for color (looking for a mixture of brown, black, red, or a lesion that looks significantly different in color than a patient's other moles) and "D" for diameter (anything 6 mm or larger will draw attention but may not indicate concern if none of the other features are present). If a lesion has any suspicious features a biopsy should be performed. After microscopic evaluation by a pathologist, the diagnosis can be made.

Treatment

Melanoma is treated through surgery. The entire lesion needs to be excised with a margin of normal tissue to ensure definitive removal. The width of the safety margin needed is determined by the depth of the melanoma. For thicker melanomas, a sentinel lymph node biopsy (SLNB) may be done to check to see if cancer has spread to the lymphatic system.

Management

It is recommended that an individual who has been diagnosed with melanoma have a complete skin exam every 3 months for the first 1-3 years. After this period skin exams should be performed every 6 months. During these exams, the entire skin surface should be evaluated because melanomas can occur in non-sun-exposed areas. The exam will look for evidence of recurrent or metastatic lesions as well as precursor lesions. All immediate family members should also have an annual complete skin examination.

Coping

Patients who have received a diagnosis of melanoma can receive support through organizations such as the American Melanoma Foundation (www.melanomafoundation.org). They should also check their skin periodically for new or changing lesions and comply with recommendations for a professional skin check.

Prevention

Prevention of melanoma and skin cancers, in general, can be facilitated by strict sun protection through the daily appropriate use of sunscreen and sun-protective clothing. Regular skin checks by a trained professional will also help identify skin cancers and potential precursor lesions.

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SKIN

# of surveys: 4187
Last updated: 1/02/2024 11:10 AM

PATIENT RATINGS

Would you recommend us?

definitely
93.1%
probably
6.16%
maybe
0.58%
not likely
0.08%
no
0.02%

Compare our service to other similar practices

excellent
87.9%
very good
10.1%
good
1.8%
poor
0.06%
very poor
0%

Overall doctor performance

excellent
94.2%
very good
4.89%
good
0.80%
poor
0.03%
very poor
0%

The doctor listened to you attentively

excellent
93.9%
very good
4.97%
good
1.05%
poor
0.05%
very poor
0%

The doctor took time to answer your questions

excellent
94.0%
very good
4.66%
good
1.27%
poor
0.02%
very poor
0%

The doctor explained treatment options

excellent
94.3%
very good
4.16%
good
1.25%
poor
0.14%
very poor
0.02%

The doctor explained treatment options

excellent
92.0%
very good
5.69%
good
2.18%
poor
0.11%
very poor
0.0%

Front desk performance

excellent
85.6%
very good
10.2%
good
3.66%
poor
0.31%
very poor
0.08%

Aesthetician performance

excellent
88.6%
very good
7.61%
good
3.39%
poor
0.24%
very poor
0.08%

Office comfort

excellent
90.9%
very good
6.93%
good
2.08%
poor
0.05%
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Parking

excellent
66.4%
very good
14.4%
good
15.7%
poor
2.49%
very poor
0.9%

Friendliness of the staff during appointment

excellent
90.9%
very good
7.23%
good
1.85%
poor
0.05%
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What WE DID WELL

(Answers:674)

very comfortable, pleasant office setting

#12024-12-02

I was scared that I had something on my face after my laser treatment. As it turns out Jill took a second look and told me it was normal and it will resolve. The reason why I tell you this is because Lisa at the front desk was instrumental on making sure I was followed up and that my fears were elevated. Lisa was outstanding! From my experiences in the past, I find most people at the front desk don't really care about the patients. However, I did not get that from Lisa. She kept in contact with me until I was completely satisfied with my care. She really is a professional and deserves recognition. Her job is the most important one in the office. I have left other offices in the past because I didn't care for the staff. That won't happen here! Hats of to LISA!!!! P.S. The computer in the waiting room is AWESOME too!!!

#22012-12-06 11:38:48

Having Alana accompany me from start to finish of the appt. It was comforting.

#32011-04-28 17:24:05

The doctor is exceptionalyy easy to talk to. Excellent people skills!

#42024-10-27

All was excellent

#52011-05-03 10:51:30

Dr Ringfell was very attentive to my problem. She reviewed my medical history throughly unlike any other physician that I have met before. I felt that she aswered to all my questions with extreme knowledge and confidence. I am leaving my appointment today reasured that she will find the right diagnosis to my problem.

#62025-01-07

best waiting room decor ever enjoyed talking to doctor

#72011-01-12 08:19:57

The doctor and her Medical Assistant are very thorough and they take time to explain everything that you need to understand.

#82025-07-21

welll...besides the freeezing sensation applied to my paipai, i loved the paintings...for sure

#92025-05-05

Everyone was extremely welcoming, pleasant and professional. I felt very secure with the knowledge and professional, caring treatment by both the doctor and her assistant.

#102024-09-13

What can we do better?

(answers:373)

Parking was a little tight.

#12011-06-09 15:52:46

my visit was great

#22025-04-11

smile more

#32010-09-09 10:34:11

Please send out paperwork in advance for pediatric patients

#42025-01-11

REDUCE WAIT TIME TO SEE DOCTOR

#52011-01-10 12:20:58

WINE AND CHEESE WOULD BE NICE IN THE WAITING AREA

#62011-02-09 12:32:20

No room for improvement

#72025-02-12

coffee in waiting room

#82011-12-14 11:20:21

n/a

#92025-01-23

Can't think of anything staff were very helpful

#102024-12-27

Customer Rating : 4.7

Based on 637 ratings