The next time you clip your toenails, take a closer look at your toes and the rest of your feet. That extra 60 seconds could save your life. It is widely speculated that Bob Marley, the charismatic, renowned Jamaican reggae music performer had melanoma of the right big toe which eventually spread to his brain and caused his untimely death at the age of 36.
Melanoma is the most serious type of skin cancer and it begins in the cells of the skin that make dark skin color (melanocytes). It is also called malignant melanoma because this type of cancer spreads to other parts of the body as it grows under the skin. Worldwide the number of melanoma is increasing faster than any other form of skin cancer among white and even fair skin dark people. Whites are 10 times more likely to develop melanoma than blacks. However, studies suggest more than half of melanoma cases in blacks involve the foot, where late diagnosis leads to higher death rates.
Melanoma in the foot
Melanoma is the most common malignant tumor of the foot. It often goes unnoticed until it is too late. Acral lentiginous melanoma (ALM) accounts for 70 percent of the melanoma in dark-skinned or Asian individuals. Half of the people who learn they have melanoma of the foot die within five years because the cancer had already spread throughout their body by the time it was diagnosed. It typically occurs on skin not exposed to the sun, on the soles of the feet and under or around the nails. It is characterized by a dark mole or spot that can turn into cancer.
Causes
Most cases of melanoma are caused by too much exposure to ultraviolet (UV) rays from the sun or tanning beds. Unlike other forms of melanoma, ALM does not appear to be linked to sun exposure. Anyone can get melanoma, but persons with fair skin, freckles or blond or red hair, blistering sunburns before the age of 18 and numerous moles increase the risk.
What to look for
Melanoma can occur anywhere on the skin, even on areas of the body not exposed to the sun. Melanoma usually looks like a mole or spot on the skin that may be brown, black, gray, blue or even red or white. Not all moles or areas of discoloration on the skin are melanoma. Often the first sign of melanoma is a change in the size, shape, color or feel of a mole. Look for the ABCDEs of melanoma when inspecting moles and other spots on your body. If a mole, freckle or spot starts to change over time and becomes asymmetrical (not perfectly round), outer edge or border changes, color change, diameter or size increases or elevation (gets higher on the skin), see your doctor immediately. If any of these signs are present on the foot or if there is discoloration of any size under the toe nail not caused by trauma, it is important to see a podiatrist right away.
Diagnosis
To diagnose melanoma, the podiatrist will get a history by asking a few questions, for example: How long has the mole been there? Have there been any changes in size or color of the mole? If so, how rapidly has this change occurred? The podiatrist will also examine the mole to decide if a biopsy is necessary. A biopsy is a test performed by cutting a piece of the affected skin and sending it to the lab to look for cancer cells under a microscope.
Treatment
If a biopsy is performed and it shows melanoma, the doctor will discuss a treatment plan that may include surgery -- cutting out the tumor or an amputation. It will also require seeing an oncologist (cancer doctor) for further treatment.
Prevention and early detection
Routine self-examinations of the feet are an important way to find skin cancer early, when it's easiest to cure. We recommend looking on the three most common areas of the foot - the soles, between the toes, and around or under the toenails. If a mole, freckle or spot starts to change over time, see a podiatrist immediately.
Everyone should practice strategies that can help prevent melanoma --or at least help in early detection, so that early treatment can be started. Following these precautions can help limit sun exposure and prevent melanoma of the foot and ankle.
o Wear water shoes or shoes and socks when on the beach, flip-flops do not provide any protection!
o Use adequate sunscreen in areas that are unprotected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of feet.
o Inspect all areas of the feet daily -- including the soles, underneath toenails, and between the toes.
o If you wear nail polish, remove it occasionally so that you can inspect the skin underneath the toenails.
o Avoid sun exposure during the peak hours (10 a.m. to 4 p.m.), and prevent sunburns. While sun exposure is harmful at any age, it is especially damaging to children and adolescents.
o Wear a wide-brimmed hat.
o For more information, email foothealth242@gmail.com or visit www.foothealth.org, apma.org or orthoinfo.aaos.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates on Albury Lane telephone 394-5820.

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