good evening and thank you for watching PBS Fort Wayne.

>> This is going to be an interesting show for you.

This is called Life Head and what we do on this show is to try to provide you with education and information that will help you and decisions that you have to make in your LIFE Ahead.

Well, obviously your health is one of the biggest things you have to be concerned with.

And our topic this evening is going to be on melanoma.

If you have some questions or some comments, please give us a call.

The number is there at the bottom of the screen (969) 27 twenty and we have a doctor a surgeon actually of melanoma that's here with me this evening on the set that will take your phone calls and give you some good medical advice.

>> I'd like for you to meet Dr. Kevin Lo, Dr. Love, thank you for coming this evening as well.

>> This is a man with a great experience and he's a surgeon as well as a diagnostic physician.

So you know all there is that we're going to be able to talk about tonight with melanoma.

>> I hope I hope hopefully I can answer all the questions that yeah.

Well let's start Dr. Lowe with defining what melanoma is.

>> You know, people have different ideas of what it is I'm sure.

>> So there are really three three main types of skin cancer.

There's basal cell skin cancer ,squamous cell skin skin cancer and melanoma.

None of those melanoma is the most dangerous.

It evolves from the melanocytes, the pigment producing cells of the skin and we all have that.

>> We do we do it now, OK?

We all do.

And and occasionally some of those will begin to grow abnormally and turn into a melanoma cancer name those others again squamous cell and with that it's another kind of skin cancer that grows from the squamous cells of the of the skin that is most often not aggressive and can be treated OK relatively easily.

>> OK, all right.

But it's a melanoma if we hear our physician say that word that's when we better be paying attention to yeah absolutely.

>> And making sure you follow up and and make sure that gets diagnosed appropriately and treated well.

>> You know people have been saying more recently I think in the last several years but it's sun too much sun people to get sun burns.

>> Is that true?

>> Absolutely.

Or tanning beds or extreme or more exposure to ultraviolet light.

So people that tan and tanning beds are laid out in the sun quite a bit or had multiple sunburns especially when young are at an increased risk of having melanoma when they're when they're older now did you hear the doctor say that tanning beds and that's something that a lot of people that used to do tanning beds, you know, it was promoted as the safe way you're not laying out in the direct sun but that's not true.

>> Unfortunately, no.

And I was sharing with the doctor that I can remember as a kid or teenager whatever we wanted to get a sunburn so that we could end up with the tan.

>> We wanted tan lines and we actually even used to mix iodine in baby oil and smear that on to to get a sunburn actually.

>> And I remember getting it so bad you'd actually peel the skin that was done wasn't that well probably not the best for the future of your skin and certainly probably increases our risk and many of us you know, had that had that in our lives today on the Sun quite a bit without protection but now we have such good options for right for protecting ourselves and I love that SPF is promoted so widely now and I think that kids are more conscious of it and mothers I see you know, at the beach or the pool or whatever first thing they're doing is you know, they're in their kids down with sunscreen so they're growing up with that.

>> Yeah, absolutely.

And also there's some protective clothing for kids.

You know this is comfortable.

True.

And they can swim in yeah, that's true.

Swimsuits with the sunscreen and whatever.

>> OK now kind of an unusual question but uh, you've been practicing for how many years?

>> Twelve years since twelve years.

>> So you've seen a lot of patients and you've done a lot of surgeries.

Is there any common thread in terms of age or um genetics male female who seems to be the most common recipient of melanoma?

>> Well, there are there are a few genetic syndromes that have an increased risk of skin cancer but that's not the majority of the cases that we see.

Most of the cases we see are spontaneous or just related to sun exposure and and typically are there on the parts of the body that are sun exposed most often.

>> Oh yeah.

I thought that was interesting and I as I was reading about it before the show, we think that it's parts of the body that are exposed and I had some on the back my neck were probably from those years I laid out the sun too much but you can also get melanoma on other parts of the body you can and so it's not always related to sun exposure that you can develop melanoma even under under nails or really even in the mucosa of the skin of the mouth or even sometimes in the eye when those are likely not sun related but still can be very dangerous.

>> How can you identify those so it depends where they are so so if they're wherever they are they will show up as as dark typically darker darker spots and and sometimes the the eye melanomas will affect vision.

>> Oh really your physician be able to see those with a with a by looking inside the eye what would a optometrist or an ophthalmologist certainly identify that certainly and maybe they would think oh it's just probably cataracts or something and well I think it has a different yeah I think it has a pretty typical appearance that they watch out for .

>> OK have you ever had to do surgery in an unusual place or do what I tell?

>> Yeah, I don't know you want to hear about that but yeah certainly they they occur and really if you're in practice long enough you'll see them kind of everywhere I go.

>> Somebody told me once when we were talking about melanoma I can't remember who it was.

>> It was some famous rock singer that got melanoma between his toes.

>> Do you know that story?

Well, I've heard of people getting certainly on their feet and that's that can be difficult to treat.

>> Yeah.

And didn't get to it early enough and it became very serious.

Jeff has just called in Doctor.

>> Let's see what his question is.

And again I want to encourage all of you to call with your questions.

Geoff, thank you so much for watching us on LIFE Ahead tonight.

And Geoff says this doctor he said is it just the appearance of a new mark or does the color matter?

>> Good question.

And you have a wonderful slide.

Let's take a look at that.

A photo of a melanoma and you can explain to us, Doctor, what it is you're looking at and if the color as Jeff said his question is is it just the appearance of a new mark or does the color matter?

And there several colors in this.

>> Yeah.

So the color certainly does matter and for the for what we think of what we see most commonly in what we think of as the typical melanoma, the color is often not consistent through the entirety of the lesion.

So as you can see in this when there's some brown there's some black or some red you can even see some dark blue sometimes or even a pale pale area.

And so that that is one of the things we'll talk about tonight is one of the characteristics of a different to the appearance of the melanoma from other types of skin lesions.

>> Would these be typical colors of melanoma?

>> What would you call it a spot or marker lesion is usually OK but that you're that you're here the doctor I have to think of these new terms lesion OK, so where the lesion typically have those colors then it would I think that's the most most common sort of there's a brown to black OK transition within the color of the lesion.

>> OK. All right Jeff, I hope that answers your question and the rest of you give us a call here at (969) 27 twenty .

>> Meanwhile Doctor, let's talk about how you can identify them if you know I think everybody's probably got a mirror at home and I think you'll probably want to go to your mirror before the show is over before you go to bed tonight so you might look for a lesion that or a mole.

What we say is the mole that that like we just showed up that has different colors.

>> What else would we look for ?

So first I'll say that that some of the places can be very difficult.

They on the back of your your neck like like you I can be difficult to see.

So it's important to have somebody give you give you a look over every every now and especially if you've had if you have fair skin you've had a lot of sun exposure in your life and you're getting older very important that someone looks at the places that you can't you can't see readily the things we look for are aided by knowing the memory ed abcde abcde ok and A is a is asymmetry.

So if you were to draw a line through the center of the lesion do the two halves have the same shape or are they different?

Typically a melanoma will not have the same shape on both sides of a bisected lesion.

>> So if you're looking at this lesion or what you might think is a mole the top and the bottom might have a different border is that what you're saying exactly.

>> To me the top half looks like a bi lobed maybe area in the bottom half just has one one circle or something like that whereas a mole or a large freckle or something like that would typically have a roughly circular shape.

>> OK, all right.

That's the age what else in terms of the ABCDs is what we're going to look for when we look at our body.

>> What's B B is for border so a mole or a freckle typically has a well defined border so you can see where the skin stops and where the lesion starts.

OK, where the where the dark area starts.

>> Melanomas often lead often they have a border that sort of bleeds into the surrounding tissue or is scalloped or rough shaped.

>> Would it be flat to your skin because a lot of times stick up a little bit?

>> It depends.

So I've seen both I've seen ones that you can can sort of feel the difference in texture only but you also especially as they get larger they can they can mount up a bit.

>> Oh OK. All right OK so that's borders that's the A and the B and C is C is color which we talked about with Geoff's question it's a it's a variety of color within the same lesion whereas typically a mole will have a consistent color throughout.

>> OK and is we're looking at on the screen here as far color normal moles are usually a single shade of brown having a variety of colors and a single mole or mole that changes colors is a warning sign and this can include different shades of brown or black or colors like red, white or blue like you mentioned when we looked at let's look at that picture once again and show all of you once again the irregular shapes and the colors.

>> Anything else to point out here in terms of a symmetry border or color, Doctor?

Yeah, so I think in this if you if you were to imagine a line through the middle of that lesion left to right there you can see that the top half would not be of a similar shape to the bottom.

>> Yeah, yeah.

Very different obviously as opposed to I guess I think of moles mostly as is round roughly sort of most different sizes but you know roughly round.

>> All right, let's talk about diameter that's the D d so so typically melanomas are a bit larger than you think of with with the mole.

>> Oh yeah.

And usually over about a quarter of an inch is what we think is kind of large.

>> It is and so so so when they're they're not always that size but certainly when you see something that's that large maybe has one or two of these other characteristics we're talking about that's something that needs to be evaluated and pay attention to melanoma as are often larger than six millimeters and diameter which is about the size of a pencil eraser.

>> However, they can be smaller when they first develop.

>> OK, so it could start out as what almost pinpoint size and grow to the size of an eraser?

>> It is and that's a good point.

So if you notice that something is changing fast enough for you to to appreciate the difference in size, that's that's also a worrisome sign.

>> And again that as the doctor mentioned, you don't have somebody else look on your back or places where you can't see Ravelli and have them look periodically and notice any of those types of changes.

Sarah, just call Dr Low and this is her question.

>> She says How quickly do they grow once they appear?

Does it take years or months?

>> So it's a great question.

The answer is yes to both of those.

So sometimes it does take years for them to evolve typically I think more in the time span of a year or two maximum for these for these to grow from something you you've very first notice to to really notice that there's been a change in the side but they also can be very fast and over and grow over a period of months.

>> Wow.

When do you get alarmed?

I mean you know let's say you've noticed something on your body and and you've you've looked at some of these signs either they are regular borders or the colors or or the diameter when when should you get alarmed?

>> So I think I think if it's worrying if you if you know these signs and it's worrying to you it is worth getting evaluated.

>> OK, absolutely.

So if you particularly if you notice a change in some of the other changes, we'll talk about our itchiness or or if the lesion bleeds easily if it when it's barely bumped or if it if it grows or if it tends to you know, it starts to mound up or it's been flat before those are ah you said if it bleeds would this be a spontaneous thing or would this be if it itches and you scratch it bleeds too easily so if you barely bump it maybe if you barely have any kind of trauma to it typically they won't bleed spontaneously but maybe just a light a light OK well cosmetically so that's the E we're talking about the ease now the balding.

>> So this is a some sort of a a lesion or a spot that does start to evolve.

Let's take a look at that slide again involving is any change in size, shape, color or elevation you talked about perhaps getting thicker or any new symptoms such as bleeding, itching or crusting talk about crusting.

>> So it's just it's a change in the way that the surface looks such that there's a maybe a covering a light covering on the lesion that can you come off and regrow come off and regrow.

>> That happens with a lot of a lot of different kinds of lesions.

But that's one thing that can be an indication that is there don't regular moles do that sometimes they'll just be distant in Geelong.

>> Yeah, absolutely.

>> And I think that's why we have to consider the whole picture.

OK, all right.

Now we've talked about the ABCDs and and E's let's talk a little bit about diagnosis again.

You know, we're talking we've been talking about just how to identify it on your body at surface level.

>> But it's not just on the surface.

You as a surgeon see this literally see this.

So how deep would it be if it's melanoma?

>> So that's that is really the crux of what we do after we are suspicious of that a lesion on the skin is a melanoma as we go about determining how deep that lesion is is a first step.

So really these signs ABCDE or signs that increase our present increase our suspicion enough that we then move to a biopsy and that biopsy importantly should be done in a way that the entire thickness of the lesion is sampled.

Typically we do that with a tiny circular scalpel so it takes a very small circle of of tissue out of the lesion but all the way down through the skin like how deep so a millimeter or two .

>> Mm.

Something like that.

OK so if you saw a spot on me you would take this circular sample if you will about a millimeter deep is that what you said.

>> Yeah well it depends where it is so if it's on the very thin skin of the hand it would be maybe a millimeter but on back it could be several several millimeters and then what do you do?

>> Do you have a biopsy or so?

So that's that you take the sample, you send it to the pathologist and they look at it deep to deep to shallow and cross section he'd say Oh OK and tell us exactly they they measure it and tell us exactly how deep from top to where the lesion stops in the skin and how deep that is and then what.

>> So that's that's the important part.

We know that as these lesions get deeper than a a millimeter that they have a tendency to spread then to four cells in relation to move out.

>> And so so when we when we biopsy, if we get if we get the deeper deeper lesion, then that prompts us to begin to look at the lymph nodes in the area of the lesion.

>> I understand there are some changes medically in lymph nodes that it used to be you know, that you take out any nearby lymph nodes but that's not necessarily true now it isn't so medications have been developed in the last five or ten years which mean for many people who have a deeper melanoma lesion they don't have to go through that rather complicated post-operative period recovery of having all of the lymph nodes in a lymph node base and taken out what's the largest you've ever seen in terms of a lesion on see I'm learning the word yeah.

>> Yeah.

So a couple of a couple of inches.

Oh really they can be that big.

Yeah.

>> Or even even larger than that sometimes though of course the larger they get the more difficult the surgery is.

What happens when they get to a point where they begin to affect other parts of your body, other organs.

>> Yeah so there's what we do with the treatment and how do you determine that and so the sequence of diagnosis and treatment as we biopsy the lesion that we see determine the depth of that depth is over about a point one millimeters then that indicates that we need to look at the the lymph nodes and in the region those are identified with what's called a sentinel lymph node biopsy.

>> So we label the lymph nodes that would see cancer Sentinel Sentinel lymph biopsy.

>> All right.

Explain what that is.

So we inject a couple of different types of dye around the lesion and then follow that dye with imaging and with our eyes to the lymph nodes that would see cancer if cancer had spread.

And so for example, if there's a lesion on the hand or on the arm that typically the lymph nodes we see labeled with this dye or in the R in the armpit and you'll see that you see it both with a with a probe we have and one of the dyes we use is blue.

>> OK, you see that dye and then you know that that's where there might be where the melanoma might be spreading exactly exactly.

And then we sample those few nodes and send those because we know from the history of treatment of melanoma those if those if the cancer spread those are likely the ones that will have cancer in them.

>> Wow.

This is a disturbing conversation but a very needed one.

>> And we have another question here.

This is Carla and she says At what point when I was going to ask I guess at what point can you not treat the lesion?

>> So that is that's a good question.

And in some of the the unfortunate cases that we see that cancer is spread beyond the lymph nodes and to to other organs and it can still be treated.

But typically those situations are not treated at least initially with surgery.

>> So typically those are treated with different medications, medication like are their names or we don't see a solution.

>> So so so the newer very effective versus what we've had in the past medications are immunotherapy therapy.

>> No therapies that work particularly well for melanoma.

What is immunotherapy?

So it is a type of medication.

There's a number of classes that leverage our own immune system to better identify or attack the cancer.

>> Oh, OK. All right.

That makes sense and I'm sure that this other areas of medicine there are continually new revelations and new discoveries as there is research.

>> What's the most significant change in your years as a surgeon and physician?

>> Have you seen change since you started?

Well, for melanoma really is these new medications that's been a that's been a huge change in what patients have to go through and how well patients do after they have a diagnosis of melanoma.

Surgeon general there there have been so many particularly minimally invasive surgeries where we can do rather complex surgeries with small incisions.

You don't have to make a big ism's anymore and the advent of robotic platforms to perform those minimally invasive surgery has really a huge change for me and my practice.

>> Oh, that's that's wonderful.

I have to tell you that I was having a conversation with Dr Lowe before the show started and and I you know, I'm happy to hear that he's the father of five children.

>> What advice do you give them?

Do any of them dare even come in with a sunburn?

>> Yeah, well unfortunately they do occasionally slip by us without sufficient sunscreen but we do use it we do use sunscreen liberally and try keep them out of the way of direct sun exposure when when it's reasonable.

OK, what do you have boys and girls?

>> I have four boys.

One girl.

Oh my goodness four boys.

OK so they're out probably doing sports and not thinking about sunscreen as much as girls might we do we do have to think about that for them especially our younger yeah yeah.

>> OK all right you have just a couple of minutes left if any of you want to give us a call here at (969) 27 twenty doctor if we've gone through this list and let's let's let's go through those A B, C, D and E sure to remember the alphabet just name those again and very quickly.

>> Sure I know sure.

Asymmetry is that let's look at that slide again if we could imagine.

>> There we go.

All right.

So we so symmetry asymmetry is just one if you bisect the lesion the two halves are not similar border means the border is not well defined but rather scalloped or or bleeds into the surrounding tissue color is a variety of colors.

So if you see something a lesion that's just has multiple colors not just brown, not just a darker color in it diameter the larger a lesion gets the more likely it is a melanoma and then evolving is really any change that you can notice with your eyes over time evolving into something that than it was when it started.

>> Exactly OK. And I think as you said, it could start off as just a tiny little freckle and then if you see it starting to change in color or borders see I'm learning a lot from you too good.

>> Or a regular structure and colors may be determined within that lesion.

>> If we see that change then you want to make sure you get that checked.

How often should somebody have a let's say a full body check, you know, whether they've ever had any melanoma before or not?

>> People should get a body check.

How often?

Absolutely.

So first of all, first I'll say these these ABCDs are really the way by which we go about determining whether we should see our doctor or not.

And so you want to er on the side if you have any if you have any any questions about those you want to go see your doctor.

So some societies recommend that that anybody had significant sun exposure in their youth particularly if you have fair skin should get checked over the age of forty or fifty and that that that really involves just a physician someone who's used to seeing who knows what melanoma looks like checking you head to toe for four lesions that are worrisome.

So that's what you do.

You'd look at the whole body picture.

Would you notice other things like you mentioned you could even get it in your eye or in your mouth.

>> Would that be something you'd look for ?

Only if they're seeming to have a problem.

>> You know, certainly look for that also.

Yeah, absolutely.

OK, any last minute recommendations?

>> We have one minute left here so you can give us the wisest words.

You know, as a doctor and a surgeon of melanoma and I want our audience which is fabulous by the way to get as much out of this as they can.

>> What would you share with them, Doctor?

So there are a few things a few cancers we really have excellent screening for one of those is melanoma and that's just what we've talked about tonight is getting somebody that knows what they're looking at to look at your your skin.

The other is is colon cancer and how effective colonoscopy can be at preventing it at preventing advancement of polyps to colon cancer, even diagnosing colon cancer earlier when it exists and it really makes a huge difference in outcomes and I understand colon cancer even now with at home screenings and kids that you can get make it easier for people.

Absolutely.

It's not not appropriate for everybody but for those that don't have a strong family history or personal history, those kids can be effective.

OK, good advice obviously.

Well, we appreciate not only you, Dr Kevin Lowe for being with us and answering our viewers calls tonight but the rest of you I'm so happy that you were here and watching us tonight on LIFE Ahead next Wednesday night.

>> We'll be right back here again with a new topic and and new guests.

Meanwhile tonight stay safe and stay healthy.

Good night