Idaho has the highest per capita rate of death from skin cancer in the nation and the seventh highest incidence. As a dermatologist, this makes the fight against melanoma very personal. In dermatology, melanoma is public enemy No. 1. If your doctor just told you that you have melanoma, it doesn't necessarily mean that the first order of business is to make sure your life insurance is up to date. Fortunately, even though more melanomas are being diagnosed than ever before, most are discovered early.

The deeper a melanoma is, the more likely it is to have spread by the time that it is diagnosed. There is something called a Breslow's depth and generally melanomas less than 1mm in depth are considered early and the survival rates are in the high 90 percentile. Most of the melanomas diagnosed in North Idaho are in situ melanomas. In situ means that the melanoma is still in the upper part of the skin known as the epidermis.

The next step beyond an in situ melanoma is a melanoma with a Breslow's depth of 0.1 or 0.2 mm. There are all kinds of terms bantered about concerning melanoma, but the Breslow's depth is the most useful information concerning survivability of melanoma.

An in situ melanoma has no Breslow's depth and is basically 100 percent curable. All of this information is obtained from a biopsy reading by a dermatopathologist. Though many medical providers have experience with melanoma, a board-certified dermatologist working in concert with a trained dermatopathologist can provide the best assurance that a suspicious lesion will be diagnosed and handled correctly.

The most important treatment for a melanoma is surgical excision. Sometimes this is combined with a technique called a sentinel node biopsy, in which tissue from a lymph node is removed for examination. If a melanoma is deeper than 1mm a sentinel biopsy can help determine prognosis more accurately.

Unfortunately, some individuals want to do "everything possible" and want to get a sentinel node biopsy whatever the depth of their melanoma. There is no firm evidence that removing a lymph node or having a sentinel node biopsy is a cure.

The best cure is early detection and excision of a melanoma. The sentinel node biopsy is useful information that helps the patient receive the appropriate treatment for a deeper melanoma, particularly greater than 1mm in Breslow's depth.

Melanoma has generated the following myths:

MYTH: If a melanoma is biopsied, the cells can break off and spread the cancer all over the body.

FACT: Research has shown that biopsying a melanoma is the best way to diagnose. If cancerous cells are going to migrate, they do so in a complex process of metastasis; a biopsy isn't the catalyst for spread of melanoma

MYTH: Sun exposure doesn't cause melanoma

FACT: Melanoma has many risk factors, but decades of research and experience show that sun and other UV exposure is one of the greatest risk factors, and can exacerbate other risk factors. People with the following characteristics have the highest risk for melanoma:

• Fair complexions that burn or blister easily

• Blond or red hair

• Excessive sun exposure during childhood and teen years, blistering and sunburns before age 18

• Family history of melanoma

• More than 100 moles or more than 50 if you are under 20 years of age.

However, anyone can be diagnosed with melanoma.

Dr. Stephen D. Craig is a board-certified dermatologist and the owner of North Idaho Dermatology in Coeur d'Alene.