Stages of Melanoma

Hello there! This is Sudhir Polisetty, welcoming you back to my dermatology blog.

As a General and Surgical Dermatologist practicing at The Dermatology Center in New Albany, Indiana, I see a large number of patients suffering from melanoma, a type of skin cancer that derives from certain types of skin cells.

Sudhir Polisetty explains the Stages of Melanoma

Sudhir Polisetty explains the stages of Melanoma

Doctors like myself diagnose nearly 160,000 cases of melanoma annually. As an expert in the field, I have found that early detection can drastically increase a persons chances of survival. After a melanoma diagnosis, several tests are done to find out if the cancer has spread. This process, called staging, determines the stage of the disease, which will help you and your doctor devise a proper treatment plan. Some tests used in the process include:

  • Physical exam and history
  • Lymph node mapping/sentinel lymph node biopsy
  • CT scan
  • PET scan
  • MRI with gadolinium
  • Blood chemistry studies

More information on these procedures can be found here. Melanoma stages range from stage 0 to stage IV and include the following:

  • Stage 0- In this stage, also called melanoma in situ, abnormal melanocytes are found in the epidermis, which can become cancerous and spread to nearby tissue.
  • Stage I- Stage one is broken down into two substages, IA and IB. In stage IA, the tumor has no ulceration and is less than 1mm thick. In IB, the tumor either has an ulceration, or is more than 1mm thick.
  • Stage II- This stage is divided into stages IIA, IIB, and IIC. In IIA, the tumor is either between 1-2mm thick with an ulceration, or it is more than 2mm without an ulceration. In stage IIB, the tumor is between 2-4mm thick with an ulceration, or greater than 4mm thick without an ulceration. Lastly, in stage IIC, the tumor is more than 4mm thick and includes an ulceration.
  • Stage III- In stage III, the tumor may have any thickness but has either spread to lymph nodes, has matted lymph nodes, is in a lymph vessel, or very small tumors can be found on or under the skin near the cancer site.
  • Stage IV- If a patient is diagnosed with stage IV melanoma, this means the cancer has spread to places in the body far from where it first started, such as the lungs, brain, liver, bone, and soft tissue.

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Thanks for reading!

Sudhir Polisetty

Cellulitis and When to Seek Help

Greetings and welcome back to my blog. My name is Sudhir Polisetty and my credentials and experience in the field of dermatology have landed me a job at The Dermatology Center in New Albany, Indiana. In addition, I write this blog in order to inform others of dermatology research, skin conditions, and updates in treatment. One condition we see frequently at our clinic is cellulitis.

Cellulitis is a bacterial infection that spreads through the skin to deeper tissues. It causes red patchy areas of skin, commonly affecting the legs and face. The infection is often painful, swollen, and is paired with a fever and tiredness. Occasionally, the lymphatic vessels also become involved. Although the legs and face are the most commonly affected area, cellulitis can occur on any part of the body. While most cases are mild, it can sometimes progress to a serious infection, potentially affecting the whole body.

Patients can become infected with cellulitis after an event where the skin is broken. This can include surgery, cuts, bites, tattoos, piercings, eczema, psoriasis, or fungal infections. According to Wikipedia, the risk factors for this skin condition include obesity, old age, and leg swelling.

The bacteria typically involved with this infection are streptococci and Staphylococcus aureus. While cellulitis resulted in 27,000 deaths worldwide in 2010, it can be easily treated with antibiotics. Cephalexin, amoxicillin, or cloxacillin is the usual method of treatment, but doxycycline or trimethoprim/sulfamethoxazole might be recommended if your dermatologist has concerns about methicillin-resistant Staphylococcus aureus (MRSA). Nearly 95% of people see improvements after a week of treatment. In severe cases, patients may need to be treated in a hospital in order to get IV antibiotics directly into their bloodstream.

Thanks for reading!

Sudhir Polisetty

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Sunscreen Values

Sunscreen Values

Sudhir Polisetty explains the difference between sunscreen values and UVB Ray protection.

Sudhir Polisetty is a skilled General and Surgical Dermatologist practicing at The Dermatology Center in New Albany, Indiana. During his career, he has seen many cases of melanoma, caused by the damaging effects of the sun. According to the Huffington Post, Melanoma is the most common form of cancer in young people. In fact, in the United States, one person is diagnosed with melanoma every eight minutes.

Exposure to ultraviolet (UV) rays is the leading risk factor for developing melanoma, but it is something that can be easily controlled and reduced. A number of skin care tips can be found on his Pinterest page, but the preventative measure that Sudhir Polisetty recommends most is the use of sunscreen.

When choosing a sunscreen it is important to know what to look for. WebMD dictates that a higher sun protection factor (SPF) is not necessarily better. SPF refers to the ability of a sunscreen to block ultraviolet B rays, which cause sunburns. Unfortunately, Florida dermatologist James M. Spencer, MD, claims “SPF is not a consumer-friendly number. It is logical for someone to think that a SPF of 30 is twice as good as a SPF of 15 and so on, but that is not how it works.”

In actuality, the SPF rating measures the time it would take to get a sunburn without sunscreen against the time it would take with sunscreen on. A sunscreen with a SPF of 15 blocks around 94% of UVB rays, while SPF 30 and SPF 45 block 97% and 98% of rays. The higher SPF ratings do block slightly more UVB rays, however, the difference is miniscule. Kids require the most attention, as it is much easier for them to get sunburned. No sunscreens offer 100% protection; therefore, whatever product you choose should be applied liberally and often.

Melanoma Symptoms

ABCDE's of Melanoma

Sudhir Polisetty describes the ABCDE’s of Melanoma as: Asymmetrical, Border, Color, Diameter, and Evolving.

Hello! Sudhir Polisetty here, welcoming you back to my blog dedicated to all things dermatology.

Melanoma is a type of skin cancer that originates from specified types of skin cells. While Melanoma accounts for less than 2% of skin cancer cases, it is the leading cause of death from skin disease. Doctors like myself diagnose nearly 160,000 cases of melanoma annually, and while it is deadly, early detection drastically increases the chances of survival.

Normally, moles are evenly colored. These black, brown, or tan spots on the skin can be flat or raised, round or oval. After a mole has developed, its characteristics should stay the same for years, as changes to the size, color, or shape, can suggest the possibility of melanoma. Doctors advise individuals to seek medical attention immediately if he or she is showing any of the features outlined by the

ABCDE rule:

  • Asymmetry- One half of the birthmark is different from the other half.
  • Border- Edges of the birthmark are ragged, blurred, or irregular.
  • Color- Patches of pink, white, red, or blue exist, or the color is not the same all over.
  • Diameter- The size of the spot is greater than 6 millimeters across.
  • Evolving- The birthmark or mole is changing in color, shape, or size.

Some melanomas may not fit into any of these categories. Other warning signs may include: a sore that will not heal; itchiness, tenderness, or pain; redness or swelling beyond the border, spreading of the pigment; or scaliness, bleeding, or oozing on the surface of a mole.

It can be difficult to tell the difference between a normal mole and melanoma, so it is important to contact your dermatologist about anything you are unsure of. In addition, schedule a routine cancer-related checkup by a qualified professional. Remember, early detection is key!

Thanks for reading,

Sudhir Polisetty


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Study Finds Link Between Melanoma and ED Drugs


As Sudhir Polisetty explains, new research suggests that sildenafil and other erectile dysfunction medications could increase a man’s risk of melanoma.

Hello, Sudhir Polisetty here with another melanoma blog post. In recent years, troubling findings have been uncovered linking melanoma to erectile dysfunction drugs. PDE5A inhibitors, including sildenafil, Viagra, and other erectile dysfunction drugs could potentially increase the risk of melanoma, but thus far, the study is unable to demonstrate a thorough cause-and-effect relationship.

The study, published in JAMA Internal Medicine, analyzed 25,848 men who enrolled in a Health Professionals’ Follow-up Study. After adjusting for other known risk factors, such as number of moles, natural hair color, family history, and number of sunburns in a lifetime, the study showed that men who had recently used sildenafil were twice as likely to develop melanoma. Those who had used sildenafil in the past, but not recently, showed a slight increased risk. Erectile dysfunction alone, however, didn’t appear to have any significant association to the disease.

The study focused exclusively on the sildenafil contained drug, Viagra, as other erectile dysfunction drugs containing PDE5A inhibitors were unavailable at the start of the study. Investigators assume that tadalafil (Cialis) and vardenafil (Levitra) would produce similar results. In fact, investigators pointed out that because these drugs are longer-acting, the risk for melanoma may even be greater than that from Viagra.

June Robinson, author of an accompanying editorial, believes that a prospective study is necessary before any clinical recommendations are changed. Since the study was retrospective, interpret this information cautiously.

Although melanoma is currently incurable, early detection is key. In 2014 alone, 76,100 cases of melanoma will be diagnosed and 9,710 patients will die from the disease. This being said, in spite of the study’s insufficient findings, a continued investigation should be supported. Physicians may consider performing melanoma screenings before writing prescriptions for erectile dysfunction drugs.


You can find more information about the study here:


Thanks for reading!

Sudhir Polisetty

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Durable Melanoma Remission Seen With Bristol Immunotherapy Drug


This diagram shows how Nivolumab works to improve melanoma survival rates.

Welcome back to my melanoma blog. My name is Sudhir Polisetty, and as a General and Surgical Dermatologist I pride myself in keeping up with melanoma breakthroughs. My first blog post focused on Nivolumab, a potential breakthrough melanoma treatment. Recently, I read a follow-up article on this treatment, which has produced lasting remissions in patients with metastatic melanoma.

Typically, melanoma is caused by melanin- forming cells that grow into a malignant tumor. Ultimately, it spreads throughout the body, including the liver, lungs, brain, bones, and lymph nodes.   Bristol-Myers Squibb’s ‘Nivolumab’ works by forcing the body’s own immune system to attack cancer cells.  As part of a greater experiment, Nivolumab and other immunotherapies disable PD-1, which is a protein that stops the immune system from attacking cancer cells. By disabling this protein, also known as the Programmed Death receptor, Nivolumb can continually force the body’s immune system to kill harmful cells.

Dr. F. Stephen Hodi, who heads the study, claims, “the durability of clinical benefit, now with long-term follow-up is fairly remarkable.”  The results of the trial have been published in the Journal of Clinical Oncology, adding that the drug’s effectiveness may be greater in patients whose cases are not so advanced. Bristol Meyers is taking further measures to find a cure by conducting trials using a combination of drugs, as well as testing Nivolumab on other types of cancer such as kidney and lung cancer.

Once diagnosed with melanoma, a patient’s life expectancy plummets to around a year. Thus far, results have shown that 62% of patients were still alive after a year of treatment and 43% after two years of treatment with this drug.  During my residency I witnessed many patients suffering from melanoma, thus my excitement about the potential of Nivolumab. I will be interested to see the data from later-stage trials, as well as if the results can be sustained over a greater length of time.

Learn more in the new report from Reuters:


Thanks for reading,

Sudhir Polisetty

I also write a blog about breakthroughs related to psoriasis. Read my psoriasis blog to learn more, or follow me on Tumblr to find out when I update that blog:‎

GSK Reports Results of Late Stage Study

GSK Logo

GlaxoSmithKline recently announced the results of a Phase III study into combining trametinib and dabrafenib. Sudhir Polisetty shares those findings in this blog post.

In my last blog post, I discussed recent studies by GlaxoSmithKline (GSK) into the effectiveness of combining two drugs, Mekinist (trametinib) and Tafinlar (dabrafenib), for treating metastatic or unresectable melanoma. The Food and Drug Administration (FDA) gave accelerated approval for the new drug combination after it showed promise in a Phase I/II study. This approval, however, was dependent on the results of an ongoing late stage (Phase III) trial to assess the drug combination’s clinical benefit in a patient population. Today GSK reported the results of that ongoing study.

GSK announced that its Phase II study, the first of its late stage studies, met its primary endpoint goal of Progression Free Survival. The company added in its release that the observed progression free survival, response rate, and interim overall survival rates were all in line with the values observed in the Phase I/II study that showed so much promise. More specifically, the progression free survival observed among patients using only dabrafenib was greater than the rate seen in previous single agent dabrafenib studies. This led to a more modest difference in the progression free survival between each treatment arm compared to what researchers observed in the Phase I/II study. Among the cohort treated with a combination of trametinib and dabrafenib, the most commonly reported adverse effects were arthralgia (joint pain), pyrexia (fever), chills, diarrhea, fatigue, headache, hypertension, nausea, and vomiting. These are the effects seen in more than 20% of patients in the study.

GSK hopes these initial results, as well as further data to be collected from the study, will increase the body of evidence regarding the efficacy and safety of combining trametinib and dabrafenib for treating melanoma. The combined treatment is approved only for use in the United States in patients with BRAF V600E or K metastatic melanoma.

For more information on this combination of drugs, speak to your dermatologist or read more about GSK’s findings on Reuters:

Thanks for reading,

Sudhir Polisetty

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GlaxoSmithKline Melanoma Drug Receives Accelerated Approval


In this blog post, Sudhir Polisetty shares news about a new melanoma treatment option from GlaxoSmithKline that received accelerated FDA approval.

Welcome back to my melanoma blog, my name is Sudhir Polisetty and I am a dermatologist practicing in New Albany, Indiana. Early this morning, GlaxoSmithKline made headlines with its announcement that a new drug combination for treating melanoma received accelerated approval from United States regulators.

The Food and Drug Administration (FDA) approved two of the company’s drugs, Tafinlar (dabrafenib) and Mekinist (trametinib) to combined use in treating patients with unresectable melanoma or metastatic melanoma with BRAF inhibitors. Unresectable melanoma refers to legions that cannot be surgically removed while metastatic melanoma refers to melanoma that has spread to other parts of the body. BRAF inhibitors, where are mutations of a gene, have proven effective in shrinking melanoma tumors but patients eventually develop resistance to them. While Tafinlar and Mekinist have already been FDA-approved for separate use, GlaxoSmithKline believes melanoma will be held at bay longer by combining the two drugs.

FDA approval came after the drug combination showed promise in a Phase I/II study. Accelerated approval is dependent on the results of the ongoing Phase III trial, which will assess the clinical benefit of this drug combination in a patient population. The randomized Phase I/II open-label study evaluated single-agent dabrafenib (150mg) and the combination of the two drugs as the recommended dose (150/2mg).

Observed overall response rates were 76% for patients treated with the drug combination and just 54% for patients treated with only dabrafenib. The median duration of the response, or how long the results lasted, was 10.5 months for the drug combination and 5.6 months in patients treated with dabrafenib only. These results were supported by analyses conducted by the blinded independent radiologic review committee.

For more on this potential new treatment, take a look at the full press release on Market Watch:

Thanks for reading,

Sudhir Polisetty

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Late Stage Melanoma Patients at Risk for Further Melanoma


According to a new study, Stage III & IV melanoma patients could be at greater risk of developing new primary melanomas.

Welcome back to my melanoma news and research blog. My name is Sudhir Polisetty and I am a dermatologist with The Dermatology Center in New Albany. A recent article appearing in the Journal of Clinical Oncology caught my eye. This study, from Lisa Zimmer, MD, of the University Duisburg-Essen’s Department of Dermatology, investigated the incidence of new primary melanomas after diagnosis of Stage III and IV melanoma.

The authors of this study decided to investigate the effects of BRAF inhibitors such as Vemurafenib after clinical trials for such drugs have shown evidence for increased tumor progression and even development of new primary melanomas. Researchers analyzed a total of 7,778 patients diagnosed with Stage III or IV melanoma at Melanoma Institute Australia between 1983 and 2008.

They found that 5% of the 4,215 patients with Stage III Melanoma (295 patients) and 1% of the 3,562 patients with Stage IV Melanoma (43 patients) developed at least one new primary melanoma after the initial diagnosis. Researchers also measured the cumulative incidence rates at six months, one year, and ten years after the initial diagnosis. Incidence rates for Stage III melanoma patients were 1.2%, 1.8%, and 5.9% respectively, while incidence rates for Stage IV melanoma patients were 0.2%, 0.3%, and 0.4%. Male patients and melanoma patients with a history of multiple primaries were especially vulnerable to developing new primary melanomas.

After assessing these results, the researchers concluded that Stage III and IV melanoma patients remain at risk of developing new primary melanomas. Incidence rates were lower than those reported in patients receiving BRAF inhibitors, but since dermatologic assessment is more frequent in BRAF inhibitor trials, we must use caution before comparing these results. Additional studies are needed to get a better idea of the effects of BRAF inhibitors.

You can view the full journal article here:

Thanks for reading,

Sudhir Polisetty

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Melanoma of the Oral Cavity

Welcome back to my melanoma blog. Melanoma is primarily known as a type of skin cancer appearing on a patient’s body, which is what most of my posts on this blog have focused on. The New England Journal of Medicine recently detailed the story of a 45-year old Chinese patient who developed a rare type of melanoma in his upper gums.

According to Wei Guo, M.D. and Xin Wang, M.D. of Shanghai and Jiangsu respectively, an otherwise healthy 45-year old man presented with non-painful discoloration of the maxillary gingival. He had no previous history of pigmented skin lesions and said the discoloration had been present for four weeks. Upon further intraoral examination, the lesion was identified as a pigmented macule, 1.5 cm x 4 cm, with asymmetry, multiple colors, and irregular borders. You will hopefully recognize many of these traits from the ABCDE Detection Criteria I introduced in an earlier blog post. Doctors completed a partial removal (maxillectomy) with 2-cm margins but the patient declined radiotherapy and chemotherapy. In a follow-up consultation six months after the partial maxillectomy, doctors reported no signs of tumor recurrence.

In an article appearing on, Emory University Professor of Pathology Dr. Susan Muller provided additional background on melanoma in the mouth. She completed a study in 2008 investigating the number of melanoma patients treated at Emory University and affiliated hospitals, finding that just eight patients presented with melanoma in the mouth over a 20-year period.

Muller explained that melanoma attacks melanocytes, the cells that produce pigments that influence skin color. She added, “at this point, we don’t know, first, why there are melanocytes in the mouth, and second, what makes those cells go bad and become malignant,” before concluding that patients don’t necessarily have to examine their mouth for possible melanoma, as the risk of oral cancer is much higher. Still, the case serves as a good reminder that melanoma can also occur in the oral cavity.

To view the full article from Live Science, click here:

Thanks for reading,

Sudhir Polisetty

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