Most people wouldn’t really think of a melanoma on the feet and legs, but they do present there, especially if the skin has been exposed to the sun’s rays.
Suzanne and Lindsey have been trained to use a Dermatoscope in clinic as they see lots of feet and legs on a daily basis and are best are placed to observe, document and photograph anything unusual that may be seen in clinic. The results are recorded in medical notes, which can then be sent on to the GP for a further referral to dermatology for more investigations.
A Dermatascope is a hand held device that magnifies and illuminates any lesion on the skin that may need further investigations (see main image above).
Melanoma is a serious form of skin cancer that begins in cells known as melanocytes, it is less common than the other skin cancers but it is more dangerous because of its ability to spread to the other organs if not treated quickly.
Only 20- 30% of melanomas are found in existing moles but 70-80% arise on normal looking skin!
Melanocytes are skin cells found in the upper layer of the skin, when the skin is exposed to UV radiation from the sun, that damage triggers the melanocytes to produce more melanin. So burning or tanning triggers changes or mutations within the melanocyte which then results in uncontrolled growth in the cells.
Darker skinned people have more `eumelanin`- which protects the skin, whereas lighter skinned people have more `pheomelanin`- this type of melanin does not have the ability to protect the skin and is more susceptible to sun damage, burning and skin cancer.
Melanomas are not so easy to spot initially, especially when they are located on the back and out of sight. The ABCDE checklist provided gives a short but comprehensive list of warning signs.
Melanomas are very curable when detected and treated early, once the melanoma has spread deeper into the skin it then becomes more difficult to treat and can have a fatal outcome.
There are four main types of melanoma on the skin.
This is the most common melanoma; it can arise from an existing mole or appear as a new lesion; it grows on the surface of the skin for some time before penetrating more deeply. It is most likely to appear on the torso in men, the legs in women and the upper back in both.
usually present in older people and is typically present on sun-damaged skin on the face, ears, arms or upper torso. It is superficial initially before it too spreads deeper in the tissues. It may look flat and blotchy with uneven borders
These are the melanomas that we as podiatrists may see more of as they are located under the nails or on the soles of the feet or palms of the hands. They can be commonly found in people of colour, especially of African origins. An example of this type is Bob Marley whose death was caused by a melanoma under his toe nail.
These are the most aggressive melanomas; they grow deeper into the skin more rapidly than the others and are most frequently found on the torso. legs, arms and scalps in older men. Usually appearing as a blue- black bump on the skin.
Skin Cancer Foundation, DermnetNZ and Primary Care Dermatology Society. Photo credits- PCDS and Servello skincare
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