Michael Hunter, MD on Medika Life

Hockey Fan Spots Melanoma

Melanoma is much less common than other types of skin cancers...but melanoma is more dangerous

NOT JUST ANOTHER NIGHT AT a hockey game. The Canucks faced off against my Seattle Kraken. Sitting behind the arena glass, a young woman spies a mole on the back of assistant equipment manager Brian “Red” Hamilton’s neck as she watches the Canucks play the Seattle Kraken on October 23.

The skin lesion appears irregular in shape and color. Brown, black, and purple. The abnormality seems slightly raised above the surrounding normal-appearing skin.

Does he know about the skin lesion? Nadia Popovici, a young premedical student, types a message on her phone and knocks on the glass window to get his attention. He looks at the message, nods, smiles, and continues to work.

Only later does he get the news. Cancer. More specifically, skin melanoma.

Melanoma Basics

The American Cancer Society (ACS) explains that “melanoma is a skin cancer type that develops when melanocytes (the cells that give the skin its tan or brown color) begin to grow out of control.”

Melanoma is much less common than some other types of skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught and treated early.

A risk factor raises your risk of getting a disease such as cancer. The ACS explains that several risk factors can make a person more likely to develop melanoma.

Ultraviolet light

Sunlight is the primary source of UV rays. Others included tanning beds and sun lamps. The pattern and timing of the exposure may play roles; for example, frequent sunburns (especially in childhood) can lead to melanoma on the chest and back.


Most moles never cause cancer, but those with many moles are more likely to develop melanoma.

Family history

Got a first-degree relative (parent, sister, brother, or child) with melanoma? Your risk is high of getting this skin cancer. Approximately ten percent of those with melanoma have a family history of the disease. Your risk of melanoma is also higher if you have a personal history of skin cancer (of any type). You should have regular skin exams by a dermatologist, examine your skin monthly, and be diligent about sun protection and avoiding tanning beds.


Other risk factors for melanoma include race — Whites have a significantly higher risk than African Americans. Those with blond or red, blue or green eyes, or fair skin that freckles or burns quickly have a higher risk. Males have a higher risk of melanoma, as do older people (please note that it happens in young people, too).

Finally, the inherited condition Xeroderma Pigmentosum (XP) is a rare, inherited condition that affects skin cells’ ability to repair DNA damage. Individuals with XP have a high risk of getting melanoma and other skin cancers when they are young, especially in skin areas exposed to the sun.

Fast forward to this: Popovici and Hamilton in an emotional meeting. Our premedical student hero asks Hamilton, as both wear face masks if he is okay with shaking hands or hugging. An embrace soon follows, as does $10,000 (for medical school expenses) from the two hockey teams. Yes, this suicide crisis line worker just received several offers of admission to schools of medicine.

I want to end with some melanoma warning signs. Look for any new skin lesions, changing or unusual. Melanomas can arise anywhere, even where the sun does not shine. Fortunately, most moles, growths, and brown spots are harmless, but not always.

Melanoma symptoms and cancer detection

Use the ABCDEs and the Ugly Duckling sign to help yourself detect melanoma. The Skin Care Foundation reminds us of the warning signs of melanoma:

A is for Asymmetry. Most melanomas are asymmetrical. If you draw a line through the middle of the lesion, the two halves don’t match, so it looks different from a round to oval and symmetrical common mole.

B is for Border. Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.

C is for Color. Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan, or black. As it grows, red, white, or blue may also appear.

D is for Diameter or Dark. While it’s ideal to detect a melanoma when it is small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 mm, or ¼ inch in diameter) or larger. Some experts say it is also essential to look for any lesion, no matter what size, that is darker than others. Rare, amelanotic melanomas are colorless.

E is for Evolving. Any change in size, shape, color, or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching, or crusting, may be a warning sign of melanoma.

Other warning signs include

  • A non-healing sore
  • Pigment spread from the border of a spot into the surrounding skin
  • Redness or a new swelling beyond a mole’s border
  • Change in sensation (for example, itchiness or tenderness)
  • Change in a mole’s surface of a mole — scaliness, oozing, bleeding, or the appearance of a lump or bump

If you notice these warning signs or anything changing, new, or unusual on your skin, please promptly see a skin doctor (dermatologist).

The five-year survival rate for patients in the United States whose melanoma is detected early.

The survival rate drops to 66 percent if the disease reaches the lymph nodes and 27 percent if it spreads to distant organs. Immunotherapy is markedly improving the last number, but more on that later.

Melanoma pictures


My message today is: Look. And have someone check your back. If you have concerns, see a skin doctor soon. I am pleased that early-stage melanoma is associated with such an excellent prognosis. Recent immunotherapy advances have dramatically improved long-term survival odds on the other end of the spectrum.

Thank you for joining me today. Oh, Vancouver won 5 to 2 over my Seattle Kraken, but you and I both know the real winner.


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Michael Hunter, MD
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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