About the Expert
Dr. Valle, board-certified through the American Board of Surgery (ABS) and a Fellow of the American College of Surgeons (FACS), specializes in oncologic surgery with specific expertise in melanoma treatment. Dr. Valle joined University Surgical Associates in 1996.
May is Skin Cancer and Melanoma Awareness Month, and skin cancer is both the most common and most preventable type of cancer. In this first installment of a new series hosted by University Surgical Associates, we spoke with Dr. Alvaro Valle, MD, FACS — surgical oncologist specializing in melanoma — about some important issues to consider when it comes to skin cancer.
Dr. Valle shares some insights into this surprisingly complicated disease.
Q: Do all melanomas look the same?
Dr. Valle: No. Identifying a potential skin cancer isn’t easy, making it important to have any skin changes evaluated by a dermatologist early, when there’s a greater likelihood of effective treatment. Many people have heard of the ABCDE melanoma assessment model, which describes the characteristics of skin damage that doctors look for when evaluating and diagnosing suspicious skin lesions. It’s a good start because it gives people a framework to evaluate changes in their skin. However, it can potentially be misleading because it’s often assumed that all the features described must be present for it to be a melanoma. In reality, variations aren’t always obvious, and a new or changing lesion warrants dermatological evaluation.
Q: If I’ve had a mole or birthmark my entire life, can it become dangerous?
Dr. Valle: Yes. Any skin lesions can be benign or pre-cancerous, but they still have the potential to develop into cancer. While moles and birthmarks often remain stable for years, sometimes they change because of factors beyond a person’s control, a combination of genetics, personal or environmental factors. So, birthmarks should not be taken for granted that they will remain benign. They should be monitored appropriately because they can change. I tell everyone, especially people with many moles, to take advantage of the technology in your pocket and take routine skin selfies to monitor skin lesions over time. This time stamp can be very helpful to dermatologists who can evaluate how these lesions have changed and make decisions about which lesions to biopsy.
Q: How can I make sure I never get a melanoma?
Dr. Valle: You can’t completely avoid the risk, but you can reduce it. It can occur anywhere on the body, and often shows up on a person’s back, face, arms and legs. Some lesions can also occur in non-sun exposed areas like the bottoms of the feet, the lower abdomen, under the fingernails, eyes and mucosal areas. The best prevention is to limit exposure to the sun’s UVA and UVB rays — think wearing SPF daily on your face and any exposed areas, wearing hats, sunglasses and protective clothing, and staying out of the sun during the middle of the day (from about 10 am to 3 pm) when the sun is at its hottest. Removal of a premalignant lesion is an effective means of prevention.
Q: Do I really need an annual checkup?
Dr. Valle: Absolutely — an annual checkup from your dermatologist is essential. Seeing your dermatologist will help ensure you catch any suspected issues early. Schedule these visits annually and immediately report any skin changes between visits. If your dermatologist finds an abnormal or suspicious mole during a skin cancer screening exam, they may recommend it be removed. They have the appropriate education, expertise and sophisticated tools. Removal of precancerous moles is one of the best ways to prevent melanoma.
Q: When is surgery needed for melanoma?
Dr. Valle: The mainstay of melanoma treatment is surgical removal of the skin cancer — it’s the gold standard. Early melanomas are commonly treated by the dermatological surgery team. The role for surgical oncology is for advanced melanomas or when the procedure requires a hospital setting, general anesthesia and/or removal or sampling of the lymph nodes as well as internal organ lesions. When the melanoma has spread beyond the primary site, there is an indication for drug or systemic therapy in the form of immunotherapy, targeted therapy and in some cases, radiation therapy, which requires the participation of a medical and radiation oncologist. I’ve seen a lot of melanomas over the last 35 years. It’s a challenging disease with multiple clinical presentations, often unpredictable. It can potentially metastasize or spread to every part of the body. Expertise matters when tailoring the appropriate surgical procedure and modality.
For more information or to schedule an evaluation with
Dr. Valle at University Surgical Associates, call (423) 267-0466.