Q. My dad had melanoma when he was in his early 40’s and required an operation that removed a large piece of skin from his shoulder.  I am now in my late 20’s and would like to know if I am at greater risk for developing melanoma because my dad had it?

A. Most malignant melanomas occur sporadically and are not due to a genetic predisposition.  People who have fair complexion, blond hair, and blue eyes, are at greater risk than people with darker complexion.  So if you fit that complexion type, you are at a higher risk than others.  However, there is a rare condition called familial melanoma which accounts for about 8% of melanomas.  Familial melanoma is defined as a melanoma that occurs in someone who has a first degree relative (mother, father, sister, or brother) who has also had melanoma.  So, with that definition in mind, if you were to develop a malignant melanoma, then you would be diagnosed with familial melanoma.  There are at least two gene mutations that have been identified that when present carries a higher risk for developing melanoma.  Genetic testing is available for at least one of these genes.  At present, most people are not routinely tested unless there are more than three first degree relatives in the family with melanoma.  The reason testing is not commonly performed is that having the gene or not having the gene does not really change what needs to be done, which is close surveillance of your skin by a dermatologist and application of sunscreen at all times while you are outdoors.  My suggestion to you is that you see a dermatologist for an initial screening of your entire body.  You will be advised by the dermatologist on important protective measures that can be taken to reduce your risk of developing this rare but dangerous form of skin cancer.  Melanoma is generally a preventable skin cancer if exposure to UVA or UVB sunlight is limited, especially in people with fair complexion.

Q. I would like to have a breast enlargement, but have heard that breast implants will ultimately break and have to be replaced.  Are there any implants that last forever?

A. No!  All breast implants will eventually fail.  There are two types of implants, saline and silicone gel.  A fair estimation of how long these implants will last is around 15 years in most patients.  What I tell my patients is that saline implants will last between 15 and 20 years in about 80% of patients, and less than that in 20%.  When saline implants break, the saline is absorbed by the body and then excreted via the kidneys, and so the saline is gone from the body.  Of course, the breast on the side that the implant has failed is now small, so it will be necessary to change the implants.

Silicone implants probably last about the same amount of time as saline implants, but I advise my patients who have silicone implants to proactively change their silicone implants about 12-14 years after placement, in order to minimize the possibility of the gel leaking into the breast tissue.  When a silicone implant leaks, the breast will not change size because the silicone is not absorbed to any great degree by the body, and so any silicone that may have leaked out of the shell, is still in the breast and therefore the breast does not change.  Therefore it is very difficult to tell when a silicone gel implant has leaked.  It is important if you have silicone gel implants that you stay in contact with a plastic surgeon and that you consider changing your implants if they are more than 15 years old.