Foot Health

Melanoma of the foot

The next time you clip your toenails, take a minute to look closer at your toes and the rest of your feet. Those extra 60 seconds could save your life!

Melanoma is the most serious type of skin cancer. It begins in the cells of the skin that make the 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. Worldwide, the number of melanoma is increasing faster than any other form of skin cancer among white and light-skinned dark people. Whites are 10 times more likely to develop melanoma than Blacks. However, studies suggest more than half of all melanoma cases in Blacks involve the foot, and because of late diagnosis, can lead 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) is a type of melanoma which accounts for 70 percent of all the melanoma in dark-skinned or Asian people. 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. Melanoma 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. Everyone needs to check their feet for signs of melanoma. People of all races and colors can get melanoma on their feet. In fact, about the same number of African Americans and Caucasians develop melanoma on a foot. For people of African or Asian ethnicity, the feet and hands are the most common places for melanoma to appear.


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 is not linked to sun exposure. Anyone can get melanoma, but people with fair skin, freckles or blond or red hair, blistering sunburns before the age of 18 and numerous moles are at increased risk.

What to look for

Everyone needs to check every part of their feet for signs of melanoma. By thoroughly checking your feet, you can find melanoma early.

Pay close attention to places on your feet that have been injured. Even if the injury was years ago, examine the area carefully.

Research has shown that a foot injury may increase your risk of developing melanoma. Bob Marley, the legendary reggae artist, developed melanoma on his foot. It is believed that the melanoma began where he had injured his foot while playing soccer. He later died of melanoma.


Look for the signs
of melanoma

When this skin cancer develops on a foot, you may see the ABCDEs of melanoma, but it’s also possible for a melanoma to have different features. Aside from looking like a changing mole, a melanoma on the foot can appear as a:

• Brown or black vertical line under a toenail.

• Pinkish-red spot or growth.

• New spot or growth where you injured your foot.

• Rapidly growing mass on your foot, especially where you once injured your foot.

• Non-healing sore on your foot (or a sore that heals and returns).

• Sore that looks like a diabetic ulcer.

• Sometimes, melanoma on the foot feels painful, bleeds, or itches, but not always. The bleeding tends to stop and start.

Melanoma can occur anywhere on the skin, even in 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 toenail without 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 skin and sending it to the lab to look for cancer cells under a microscope.


Treatment

If a biopsy shows melanoma, the doctor will discuss a treatment plan which may include surgery – cutting out the tumor or a part of the toe or foot (an amputation). It will also require seeing an oncologist (cancer doctor) for further treatment.

Prevention and early detection

Routine foot inspection is 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 where melanoma occurs – the soles, between the toes, and around or under the toenails. If a mole, freckle or spot starts to change in size, shape or color, see a podiatrist immediately.

Following these precautions can also help limit sun exposure and prevent melanoma of the foot and ankle:

• Wear water shoes or shoes and socks when on the beach, flip flops do not provide any sun protection.

• Use adequate sunscreen in areas that are not protected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of feet.

• Inspect all areas of the feet daily – including the soles, around the toenails, and between the toes.

• If you wear nail polish, remove it occasionally, so that you can inspect the skin underneath the toenails.

• Avoid sun exposure during the peak hours (10 a.m. to 4 p.m.), and prevent sun burns. While sun exposure is harmful at any age, it is especially damaging to children and adolescents.

• Know your family history, especially if there is a history of melanoma or other skin cancer.

 
• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at foothealth242@gmail.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.

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