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Living in Northern Nevada offers a lot of great opportunities to outdoor enthusiasts, as well as art lovers, festival goers, foodies, and music fans. All these outdoor opportunities make our community special, but when it comes to the health of our skin, this time spent outdoors requires that we be aware of the dangers of skin cancer, including melanoma. Dr. Michael Zumwalt, Fellowship-Trained Mohs Surgeon and Board-Certified Dermatologist with Skin Cancer & Dermatology Institute, answers our questions about this dangerous type of skin cancer.


What is melanoma, and why is it so important for Northern Nevadans to know about it?

Melanoma, one of the most dangerous forms of skin cancer, is derived from the pigment-producing cells of our skin called melanocytes. A collection of melanocytes is known as a nevus or mole, so melanoma is also known as a “cancerous mole.” How dangerous a melanoma is depends on how deep the cancer invades into the skin. The most superficial form of melanoma, called melanoma in situ, has nearly no risk of life-threatening complications, whereas a thick melanoma (>4mm in depth) only has a 50% survival rate. Luckily, majority of melanomas are diagnosed at an early stage and only require localized surgery for treatment. This is why the early diagnosis of melanoma is so incredibly important.

It is estimated there are approximately 200,000 new cases of melanoma in the US every year. Nationwide, 1 in 38 Caucasians will develop melanoma in their lifetime. Northern Nevadans have a much higher incidence of melanoma due to enjoying 300 days of sunshine per year, living at a high elevation where the UV rays are more intense, and enjoying all the world-class outdoor recreation we have in our backyard. Due to these factors, cancer surveillance data shows we have nearly a 50% increased risk of developing melanoma compared to the average American.


What other factors increase the risk of developing melanoma? 


The risk of developing melanoma is strongly associated with the number of lifetime sunburns an individual receives, especially in childhood. According to the Skin Cancer Foundation, a single blistering sunburn in childhood or a lifetime history of 5+ sunburns doubles your risk of melanoma. Individuals with higher education have the highest risk of melanoma as they are more apt to work indoors during the week and then get burned during weekend outdoor reaction activities. It is never too late to practice sun protection, even later in life, as getting a sunburn just once every two years can triple one’s risk of developing melanoma.

Other risk factors include a family history of melanoma, having red hair, freckled-prone skin, indoor tanning, and a weakened immune system.


What things should readers look for as warning signs for melanoma?

Self-skin checks on a routine basis are an essential part of diagnosing melanoma early. The American Academy of Dermatology has a guide on the best way to perform a self-skin check. From my clinical experience, I find these two factors are the most helpful in diagnosing melanoma:

  1. The “ugly duckling” rule: For any single mole you have on your body, you can find a similar-looking one elsewhere. Melanomas typically stand out from other moles and appear distinctly different from any other mole on your body.
  2. New/changing/evolving moles: Adults typically stop developing new moles on their bodies, and normal moles typically change very slowly over time. Any new/changing/evolving mole on an adult should be evaluated carefully to ensure it is not a melanoma. A limitation of this rule is that other common types of benign (noncancerous) brown age spots, such as seborrheic keratoses and solar lentigines, are expected to develop/change over time.

Another way to remember the typical characteristics of melanoma is the ABCDEs of melanoma. Although the ABCDEs of melanoma are helpful, many benign (non-cancerous) moles can have one or two atypical features. If a mole has multiple ABCDE features, it needs to be evaluated by a board-certified dermatologist.

ASYMMETRY: One half of a mole is unlike the other half.

BORDER: The mole has an irregular, scalloped, or poorly defined border.

COLOR: The mole has varying colors from one area to the next, such as shades of tan, brown, or black or areas of white, red, or blue.

DIAMETER: While melanomas are usually greater than 6 mm or about the size of a pencil eraser when diagnosed, they can be smaller.

EVOLVING: The mole is actively changing in size, shape, or color, which is typically not normal in adults.

Are melanomas typically easy or hard to diagnose? 

They can be both! From my clinical experience, about half of melanomas are pretty obvious; some can even be spotted across the room or instantly stand out when performing a skin exam. On the other hand, some melanomas can be quite subtle. An early melanoma in situ, the earliest form of melanoma, commonly presents as a slightly atypical sunspot that can easily blend into sun-damaged skin. I have seen large melanoma in situs the size of a person’s entire cheek go unnoticed as the light brown skin lesion was not overtly concerning for skin cancer at first glance to an untrained eye.

  • It is a common form of skin cancer that can be deadly if diagnosed late but easily treatable when diagnosed early.
  • Northern Nevadans develop melanoma at a much higher rate compared to the rest of the country.
  • A history of recurrent sunburns dramatically increases your risk of developing melanoma.
  • Any new or changing mole that stands out from the rest of your moles should be evaluated promptly by a dermatologist.

If you are interested in having a dermatologist do a full-skin exam to check for moles, irregularities, or any areas of concern, you can book an appointment at Skin Cancer & Dermatology Institute’s Carson City location here.

About the Dermatology Provider


Michael Zumwalt, M.D. is a Board-Certified Dermatologist and Fellowship-Trained Mohs Surgeon who specializes in diagnosing and treating all skin cancers. Dr. Zumwalt is passionate about patient care and strives to deliver a “whole person” care approach in his practice. When he is not working, he enjoys spending time with his family and participating in outdoor activities.




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