DEAR MAYO CLINIC: My 36-year-old sister recently noticed an unusual mole on her shoulder. She is scheduled for some tests. Her primary care physician believes it might be melanoma. What is melanoma? What treatment options are available, and is surgery necessary? Have there been recent advancements in treatments?  

ANSWER: While melanoma is much less common than other types of skin cancer, it is the most serious because it is more likely to metastasize, or spread, to other parts of the body. 

Melanoma starts in the melanocytes, which are cells that make the pigment that gives skin its color. The first signs of melanoma often are either a change in an existing mole or the development of a new pigmented or unusual-looking growth on the skin. 

The ABCDE guide helps you determine if a mole or a spot may indicate melanoma or another type of skin cancer:

• A is for asymmetrical shape. One half is unlike the other half.
• B is for border. Look for moles with irregular, notched or scalloped borders.
• C is for color. Look for growths that have changed color, have many colors or have uneven color.
• D is for diameter. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters, or the diameter of a pencil eraser).
• E is for evolving. Watch for moles that change in size, shape, color or height, especially if part or all of the mole turns black. Moles may also evolve to develop new signs and symptoms, such as itchiness or bleeding.

If you notice any of these signs, make an appointment with your primary care clinician or a healthcare professional.

A few types of tests are used to diagnose melanoma. The first is a punch biopsy performed with a circular blade pressed into the skin around the suspicious mole. Another technique is called an excisional biopsy, which uses a scalpel to remove the entire mole and a very tiny bit of normal skin around it. It’s also important to have a total skin exam at the initial diagnosis because some patients will have a second primary melanoma found at the same time.

Once melanoma is diagnosed, your care team will determine the extent of the cancer by measuring its thickness, identifying whether it has spread to the lymph nodes and looking for signs of cancer beyond the skin. If there's a chance the cancer could spread to nearby lymph nodes, you might need a sentinel node biopsy. During this procedure, dye is injected into the area where your melanoma was removed and flows to the closest lymph node or nodes. Those lymph nodes, called the sentinel lymph nodes, are removed and tested for cancer cells. 

Understanding the stage of melanoma will help your healthcare team create a treatment plan. Melanoma treatment often starts with surgery to remove the cancer. The treatment for thinner melanomas generally removes the melanoma with a margin of tissue, typically 1 to 2 centimeters of normal tissue. If the sentinel lymph node biopsy determines that the cancer has spread or your melanoma grows deeper into the skin, active surveillance with imaging, additional surgery and/or systemic treatment may be recommended.

Other treatments include radiation therapy and systemic therapy. Recent advancements have significantly improved the prognosis for patients diagnosed with melanoma. These include targeted therapies, an approach that uses medicine that attacks specific chemicals in cancer cells, and immunotherapies, which use medicines that help the body's immune system to kill cancer cells. Either option might be recommended for selected patients. Some patients also may benefit from systemic therapy before an operation.

Clinical trials have led to recent advancements in melanoma treatment because physician-scientists can test new and better approaches. Efforts are being made to enhance the accessibility and ease of patient participation in clinical trials. If you are interested in participating in a clinical trial, ask your care team about what options might be available.

While melanoma is a serious form of skin cancer, you can reduce your risk. Exposure to ultraviolet (UV) light is considered the leading cause of melanoma. UV light comes from the sun and tanning lamps and beds. You can reduce your risk by avoiding tanning beds, wearing broad-spectrum sunscreen with SPF 30 or higher, avoiding sun exposure during peak hours (10 a.m.–3 p.m.) and wearing sun protective gear outdoors. Use about 1 ounce of sunscreen and reapply every two hours, or more if you've been sweating or swimming. 

If you notice rapidly growing or changing skin lesions, it's important to notify your primary care physician or a care team member. The earlier melanoma is found, the better the chance of successful treatment. — Tina Hieken, M.D., Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota

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Editor’s note: The Union for International Cancer Control leads World Cancer Day every Feb. 4 to raise awareness about cancer, encourage its prevention and mobilize action to address the global pandemic

World Cancer Day's new campaign, "United by Unique," celebrates the stories of every person affected by cancer. "Every experience with cancer is unique, and it will take all of us, united, to create a world where we look beyond the disease and see the person before the patient. This World Cancer Day let's come together to rewrite the future of cancer care — one where the needs of people and communities come first," states the campaign website.

The Mayo Clinic Comprehensive Cancer Center celebrates World Cancer Day and recognizes the unique experiences of each person under its care. Here are some of their stories:

Pokémon party at Mayo Clinic Children's Center brings joy, lasting memories

Five-year-old Arthur Heyer has been battling neuroblastoma since he was 2½ years old. His love for Pokémon has been his superpower, lifting his spirits as he battles what no child should ever have to face. With the help of Make-A-Wish Minnesota, Arthur was able to celebrate life and his passion for Pokémon with a party for his friends.

Innovative therapy helps one man with cancer pay it forward

After putting off a colonoscopy for decades, Brian Principe was diagnosed with colon cancer that had spread to his liver. After standard chemotherapy and hepatic artery infusion pump chemotherapy, his tumors have shrunk, and he is helping others get the screening they need to prevent the disease.

Focus on hope: Brescia's story

Hodgkin lymphoma derailed 20-year-old Brescia Dover's plans to become a professional photographer. Mayo Clinic's Adolescent and Young Adult Cancer Program helped her get her plans back on track. She is now cancer-free and owns her own marketing agency.

Kirk Mathers found a lasting way to thank his care team: He got inked

After learning that an egg-sized growth on his foot was sarcoma, Kirk Mathers sought care at Mayo Clinic. He later decided to honor his cancer experience and his care team with a series of tattoos that continue to spark conversations.

Teamwork and a new nickname inspire patient through pancreatic cancer treatment

After a pancreatic cancer diagnosis and multiple cardiac arrests during treatment, Walter "Dick" Whetstone was told he had just months to live. At Mayo Clinic, he found help, hope and a new nickname based on his love for Clemson University in South Carolina.

Sally Blackwell 'no longer on the sidelines' after life-changing surgery for rectal cancer

Sally Blackwell experienced constipation and lack of weight gain while she was pregnant with her second child. After her child's birth, her symptoms worsened but were dismissed as hemorrhoids. Then, at 33, she was diagnosed with rectal cancer at Mayo Clinic. The lifesaving care she received inspired her to become a social worker at Mayo Clinic.

Father of five on life after cancer: 'Everything feels so good and rich and valuable'

A swollen lymph node led Gary McCracken to Mayo Clinic to find the source of his cancer. The Head and Neck Surgery team in Rochester used exploratory robotic surgery to find the source — his tonsil — and removed the tumor and surrounding lymph nodes. After chemotherapy and radiation, he's now fully recovered and traveling the country with his wife. 

A version of this article originally appeared on the Mayo Clinic Comprehensive Cancer Center blog.

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The advisory has recommendations to increase awareness, including updating the existing Surgeon General's health warning label on alcohol-containing beverages.

According to Dr. Donald Hensrud, a Mayo Clinic physician specializing in preventive medicine and nutrition, the number of cancer cases caused by drinking alcohol may surprise you.

Watch: The Mayo Clinic Minute

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"About 100,000 cases of cancer each year in the United States are due to alcohol consumption — and about 20,000 deaths. So this isn't a small problem," says Dr. Hensrud.

He says alcohol is the third-leading preventable cause of cancer in the U.S., behind tobacco use and obesity.

"The risk starts with actually relatively low intakes of alcohol over a long period of time," says Dr. Hensrud. "Consuming it once in a while probably isn't going to increase the risk that much. But there are many people who consume it regularly, and there are many people who assume that there are health benefits on the heart. And these benefits probably aren't as strong as what we used to believe."

He says when drinking alcohol is combined with tobacco use, the risk of cancer increases significantly.

"Some studies have suggested the optimal amount of alcohol for people less than 50 is zero. So we need to dial back, I think, a little bit on our alcohol consumption. Be aware of it. An occasional drink of alcohol is not going to increase long-term risk, but we need to be aware of it and keep a lid on our consumption over time," says Dr. Hensrud.

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Dr. Andrew Keaveny, a Mayo Clinic transplant hepatologist, says heavy drinking also can lead to alcoholic hepatitis, which is becoming more common in younger people.

Watch: The Mayo Clinic Minute

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"Alcohol can cause liver damage. And in some individuals who drink excessively, it can result in significant complications," says Dr. Keaveny.

Sustained alcohol use can result in alcohol-related liver disease.

"There is a condition called acute alcoholic hepatitis, where the alcohol triggers an acute inflammatory process in the liver, and patients can become really quite sick, quite quickly," he says.

And it's rising among young people.

"Some of the more tragic cases of liver disease related to alcohol received now are due to young individuals who consume excessively, or binge alcohol," says Dr. Keaveny.

Alcoholic hepatitis can develop quickly. Symptoms can include jaundice, confusion, nausea and vomiting.

"They can present with multiple complications of their liver disease, which requires really a multidisciplinary approach to address and manage their issues," he says.

Treating alcoholic hepatitis requires an assessment of liver damage and complications, and addressing the patient's alcohol use disorder. Dr. Keaveny says corticosteroids may be used, but they have limited effectiveness and risks. The next step may be transplant.

"We consider patients for liver transplantation who have acute alcoholic hepatitis. This requires a very careful assessment of multiple factors, their medical, social and psychological factors, to determine whether they may be eligible for liver transplantation," Dr. Keaveny says.

Living with alcoholic hepatitis?

Connect with others like you for support and answers to your questions in the Transplants Support Group on Mayo Clinic Connect, an online patient community.

The post Mayo Clinic Minute: How alcohol affects your liver appeared first on Mayo Clinic News Network.

Editor's note: January is Cervical Cancer Awareness Month.

When it comes to healthcare screening, different healthcare guideline organizations may have different recommendations. The same is true for cervical cancer screening.

Cervical cancer is almost always caused by a persistent infection with high-risk strains of HPV. Routine screening has dramatically reduced cervical cancer deaths, and regular screenings are essential because early detection makes precancer treatment more effective.

Dr. Kathy MacLaughlin, a Mayo Clinic family physician specializing in cervical cancer prevention, says Mayo Clinic follows U.S. Preventive Services Task Force recommendations.

"They recommend screening for 21- to 65-year-olds, either with a Pap smear every three years or, starting at age 30, the Pap/HPV co-test, or the primary HPV test every five years," she says.

Starting February 5, Mayo Clinic practices in the Midwest will offer a FDA-approved self-collection HPV test to help reduce barriers to screening. This service will later expand to Mayo Clinic in Arizona and Mayo Clinic in Florida. 

Watch: Dr. Kathy MacLaughlin talks about screening for cervical cancer

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For women ages 21–65, the U.S. Preventive Services Task Force recommendations are:

• Screening for cervical cancer every three years with cervical cytology alone in women aged 21 to 29 years.
• For women aged 30 to 65, screening every three years with cervical cytology alone, every five years with high-risk HPV (hrHPV) testing alone, or every five years with hrHPV testing combined with cytology (co-testing).
  

Dr. MacLaughlin says the current guidelines suggest that after age 65, if you've had past negative/normal screening, particularly important in the prior 10 years, it's OK for most people to stop screening, but that might not always be the case.

"People who have previously had precancers (CIN-2 or CIN-3) treated with a procedure called LEEP (loop electrosurgical excision procedure) should not stop screening. If someone is immunocompromised or has had cervical cancer, they should not stop screening. Or if they've had in utero DES (diethylstilbestrol) exposure, they should not stop screening. To exit screening after age 65, there should be none of those risk factors. And then you also need 10 years of either three negative Paps or two negative HPV tests to say, yes, you are done," she says.

If you're unsure if you should be screened, consult your healthcare team to determine what's best for you.

Risk and prevention for cervical cancer

"Persistent high-risk human papillomavirus infection, or HPV, is the cause of the majority of cervical cancers. Anyone with a cervix who is sexually active is at risk, particularly if they haven't had the HPV vaccine series," says Dr. MacLaughlin.

Along with HPV, other risk factors for cervical cancer include:

• Smoking tobacco
• Lack of screening
• Multiple sexual partners

Preventing cervical cancer involves three steps:

• HPV vaccination is most effective if given to preteens/teens (females and males), but it is routinely recommended for all 9-26-year-olds and available through a shared decision-making discussion with your clinician for 27-45-year-olds (females and males). 
• Get screened at recommended intervals. 
• Appropriate management of abnormal screening results.  

What happens with your HPV self-collection results?

Dr. MacLaughlin says about 85%-90% of people will test negative or not have HPV. They will be advised to have repeat testing in three years — though that could change with future guideline updates to five-year interval screening. 

However, for those with positive HPV test results, further testing will be needed. 

Different types of high-risk HPV are being screened for, she says.

"HPV 16 and HPV 18 are the highest of the high risk. They cause 70% of cervical cancers. If either of those is found on the HPV self-collection test, the patient will need a referral to colposcopy, which is an outpatient procedure where the cervix is looked at under a microscope," says Dr. MacLaughlin. "Some small biopsies might be taken from the cervical tissue to ensure that there's not precancer."

Dr. MacLaughlin explains that if other types of HPV are found on the self-collection test (not HPV 16, not HPV 18), the patient will need to return to the clinic for a Pap test to complete their cervical cancer screening, as that information is necessary to guide the next steps. She says there is a difference from a clinician-collected cervical sample for HPV testing because the lab can add a Pap test to the sample of cervical cells but cannot run a Pap test on vaginal samples. This is expected to happen about 10% of the time. 

The U.S. Preventive Services Task Force is updating its recommendations. In its draft recommendation statement, it endorses the HPV self-collection option for people aged 30 to 65.

Related resources:

• Improving cervical cancer screening with HPV self-collection tests
• Mayo Clinic Q&A: What to know about cervical cancer
• Mayo Clinic Minute: Why Black women need to be screened for cervical cancer
  
  

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Dr. Kathy MacLaughlin, a Mayo Clinic family physician specializing in cervical cancer prevention, says screening for HPV is important, but there are barriers for some patients to screening tests that require a speculum exam — and that leads to lower screening rates in those populations. 

A new option will be offered soon to help with these healthcare disparities. Mayo Clinic is one of a few medical organizations in the U.S. that will provide eligible patients with the option of an FDA-approved self-collection HPV test. The alternative screening is expected to become available at Mayo Clinic practices in the Midwest beginning February 5 and then later expand to Mayo Clinic in Arizona and Mayo Clinic in Florida. 

Watch: Improving cervical cancer screening with HPV self-collection tests

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Traditional cancer screening involves a clinician-collected cervical sample for a Pap and/or HPV test. A new option will hopefully get more people screened.

"We're calling it the HPV self-collection test. The difference is that instead of your clinician putting in a speculum and doing a swab of the cervix, the patient would use a self-collection device to get a vaginal sample to test for HPV," says Dr. MacLaughlin.

The HPV self-collection test is done in a healthcare setting

She says the test is quick and painless. It's aimed at people facing barriers to having a speculum exam. For example, those with disabilities, mobility issues, cultural or religious reasons, or a history of trauma. The test is done privately in a healthcare setting, such as an exam room.

How the self-collection test works

"The device is inserted, just like a tampon into the vagina, and the little plastic wings on the side of the device control the insertion depth, so people don't have to worry about pushing it in too far. And then they would take the plunger and push that in, and that extends the sampling brush. This is a very soft, dry bristle brush. And then the handle needs to be rotated five times, and it clicks. You can hear the click. You can feel the clicks, so you know you've done enough turns. Once that has been done, the patient would remove the entire device and just retract the brush and cap it, and this will get sent to the lab for the testing," Dr. MacLaughlin explains.

Talk with your healthcare team to determine which test is best for you. The most important thing is to get screened.

"The beauty of screening is that we're catching things before it is cancer, when it's still treatable as a precancer," she says.

Dr. MacLaughlin says that, for now, the self-collection screening must be done in a healthcare setting and is not for at-home use. However, this is anticipated to change in upcoming years, and eventually, home-based self-collection should be approved. 

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Dr. Richard Sharpe Jr., a Mayo Clinic radiologist, says it's crucial to talk with your healthcare team to find the screening method that is right for you. An MRI is one option.

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"The first thing to know if you get notified is that dense breast tissue is completely normal. 

Half of all women will have dense tissue," says Dr. Sharpe.

He says dense breasts are identified through a mammogram. Additional testing is the next step.

"The most widely available supplemental screening test for women with dense tissues is probably an ultrasound of the breast or an MRI," says Dr. Sharpe. "There have been lots of studies showing that MRI is the most sensitive test for finding breast cancer."

An MRI is meant to be used along with a mammogram, not instead.

"MRI is the most sensitive test we have for finding breast cancer. It can see through density. It can find hard-to-see, small cancers," says Dr. Sharpe.

But it's not for everyone. You'll lie face down on a table and then guided into the MRI machine."Some patients that have challenges with claustrophobia might struggle to be comfortable in the smaller space of the MRI scanner," explains Dr. Sharpe.

The benefit is clear, he says.

"Women with dense tissue or high risk for breast cancer that undergo breast MRI, we are able to see cancers that would be hiding from the mammogram."

Supplemental screening options

Other supplemental screening options include molecular breast imaging (MBI), ultrasound and contrast-enhanced mammography. 

Dr. Sharpe says choosing what screening method works for you is an individual decision that should be made with your healthcare team, but he says it's important to start with your annual screening.

"The most important thing for women to know is that you should get your annual mammogram, starting at age 40. Also, if you have dense tissue, consider a supplemental screening, another imaging test looking at the breast tissues in a different way — and you should get that exam regularly as well," he says.

"The most important thing for women to know is that you should get your annual mammogram, starting at age 40. Also, if you have dense tissue, consider a supplemental screening, another imaging test looking at the breast tissues in a different way — and you should get that exam regularly as well," he says.

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Dr. Keith Knutson, a cancer vaccine researcher at Mayo Clinic, explains how the development of personalized lung cancer vaccines is giving hope to patients.

Watch: The Mayo Clinic Minute

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It may sound like something out of a science fiction movie, but it is reality. Mayo Clinic researchers are developing personalized lung cancer vaccines.

"We actually make a vaccine that's specific for each individual's cancers," says Dr. Knutson.

The process involves analyzing cancer cells to create a one-of-a-kind vaccine.

"We can take a small part of that cancer and sequence that cancer and get the information that we need to design the vaccine," he explains.

The vaccine uses the immune system to identify and combat cancer.

"We can use that vaccine to hopefully prevent the disease from coming back, or we can use it to help shrink a tumor when given with other types of therapies," Dr. Knutson says.

You can reduce your risk of lung cancer by quitting smoking and avoiding exposure to secondhand smoke.

Read more about Dr. Knutson's work on the Mayo Clinic Comprehensive Cancer Center blog.

Related posts:

• Innovation in lung cancer screening, treatment
• Tomorrow's Cure podcast: How personalized vaccines combat cancer

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ROCHESTER, Minn., and PALO ALTO, Calif. — Mayo Clinic Laboratories, a global leader in advanced laboratory testing, and Lucence, a pioneering molecular diagnostics company, announced a strategic collaboration today to expand international access to cutting-edge cancer testing services. This collaboration aims to leverage the strengths of both organizations to drive better outcomes for patients worldwide.

Lucence, with its CLIA-licensed and CAP-accredited laboratories in California and Singapore, will provide access to its innovative LiquidHALLMARK® technology through Mayo Clinic Laboratories. LiquidHALLMARK® is an ultra-sensitive, next-generation sequencing liquid biopsy that analyzes circulating tumor DNA (ctDNA) and circulating tumor RNA (ctRNA) for clinically relevant biomarkers across various cancers.

“We look forward to making LiquidHALLMARK available so physicians and their patients have access to important insights that can inform treatment decisions,” said William Morice, M.D., Ph.D., president and CEO of Mayo Clinic Laboratories. “Incorporating this test into our catalog supports our goal of offering comprehensive testing options for serious or complex cases.”

The Medicare-covered LiquidHALLMARK® test provides actionable findings by offering targeted therapies based on genomic results, including detailed descriptions of each finding and associated clinical trials. The test reports include graphical maps for understanding cancer genomic profiles and tracking tumor changes over time, while delivering comprehensive information on each genomic finding, highlighting its role in the patient’s cancer type and existing functional evidence.

"Working with Mayo Clinic Laboratories will advance our shared goal of making innovative cancer tests available to benefit everyone globally," said Min-Han, M.B.B.S., F.R.C.P., Ph.D., founding CEO and medical director of Lucence. "Combining Lucence's liquid biopsy testing with Mayo Clinic Laboratories' broad reach and expertise means that healthcare providers everywhere can be empowered with important information to improve personalized cancer care."

The collaboration between Mayo Clinic Laboratories and Lucence represents a significant step forward in the field of oncology diagnostics. By integrating their respective strengths, the two organizations aim to provide healthcare providers with the tools they need to make informed decisions and deliver personalized treatment plans for their patients.

Mayo Clinic Laboratories is a for-profit, wholly-owned subsidiary of Mayo Clinic. Therefore, Mayo Clinic has an indirect financial interest in the technology referenced in this press release. Mayo Clinic will use any revenue it receives to support its not-for-profit mission in patient care, education and research.

###

About Mayo Clinic Laboratories 
Mayo Clinic Laboratories, the global leader in turning test results into clinical answers, provides advanced testing and pathology services for 3,400 healthcare organizations in partnership with Mayo Clinic's Department of Laboratory Medicine and Pathology. Mayo Clinic Laboratories offers more than 4,400 tests and pathology services and performs more than 26 million tests annually.

About Lucence 
Lucence is a precision oncology company committed to improving cancer care through innovative testing solutions. With CLIA-licensed and CAP-accredited laboratories in California and Singapore, Lucence offers advanced liquid biopsy technologies that provide critical insights into cancer biology. The company's flagship product, LiquidHALLMARK®, is designed to detect clinically relevant biomarkers in ctDNA and ctRNA, enabling precise and personalized cancer treatment.

Media contact:

• Mayo Clinic Laboratories: newsbureau@mayo.edu
• Lucence: inquiry@lucence.com

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Dr. Kristin Robinson, a breast radiologist at Mayo Clinic, says there are several options when it comes to these screening tests. She recommends working closely with your healthcare team to determine what is the best supplemental screening available and right for you. 

One option is molecular breast imaging (MBI). A Mayo Clinic study shows that MBI is more effective than mammography alone for women with dense breasts.

Watch: The Mayo Clinic Minute

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Why supplemental breast screening is recommended

"Breast density is important for really two separate reasons. One, the dense tissue on a mammogram looks white, and cancer looks white, so you can imagine if we're trying to find a small breast cancer in a sea of white breast tissue, it can be very difficult," says Dr. Robinson.

And second, those with dense breasts have a slightly higher risk of developing breast cancer.

"For those reasons, we encourage women who have dense breast tissue to consider supplemental screening," says Dr. Robinson.

One screening you may hear about is MBI, a test developed by the Mayo Clinic. It's done in addition to a mammogram. It uses a radioactive tracer that can identify cancer cells.

"And since breast cancer is growing quickly, it's recruiting blood flow, it has more energy than the surrounding breast tissue, it will uptake that radiotracer more so than the normal tissue," she explains.

And by doing so, it lights up and becomes clearer to see for a radiologist compared to the normal surrounding tissue. 

To find out if MBI or other screening options are best for you, talk with your healthcare team.

"If you have dense breast tissue, really consider supplemental screening because we know that detects a significant number more breast cancers than mammograms alone," Dr. Robinson says.

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