With knowledge about melanoma, it’s possible to protect yourself from the life-threatening consequences.
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Kristin’s midwife, examining her after the birth of her second child, first noticed the suspicious growth on Kristin’s back that was later diagnosed as melanoma.
Red-haired and fair of skin, Kristin had always been careful about protecting herself from the sun, but her aunt had died of melanoma and her sister was recently diagnosed, so she knew her risk was high. She heeded the midwife’s warning, and her doctor removed the melanoma before it had become invasive.
The incidence of melanoma in the United States has been increasing over the past several decades. In 1973, there were 5.7 cases diagnosed each year per 100,000 people; in 2002, there were 14.3 per 100,000. Even with knowledge about the cancer–what causes it, who is at risk and what it looks like–Kristin was unable to prevent the disease, but she was able to protect herself from the life-threatening consequences.
A cancer of the pigment-producing cells, melanoma is the least common of skin cancers but the most deadly. Since it’s on the skin, it’s possible to spot it while successful treatment is possible, but too many Americans fail to do so: more than 50,000 persons are diagnosed with malignant melanoma every year and about 7,500 die.
Don’t Fight the Sun
As with all skin cancers, melanoma is clearly more prevalent among fair-skinned individuals living in sunny areas. Australia, which leads the world in skin cancers, has a rate of melanoma three times that of Los Angeles and 50 times that of most black and Asian populations.
With an aggressive campaign initiated in the 1980s to educate the public about sun safety, Australians today are much more inclined to use sun screen and wide-brimmed hats when venturing outside and to avoid recreational sun “baking” and use of tanning parlors. As a result, the incidence of all skin cancers has been declining, and 90 percent of melanomas are detected early and successfully treated.
With melanoma, the association with ultraviolet radiation is more complex. While melanomas are more common after age 40, they also occur frequently in much younger individuals, even adolescents. And the risk is higher for a person working indoors. Cumulative sun exposure is clearly not a factor and may even be somewhat protective by providing a base tan to protect the skin from the most traumatic damage.
In addition, melanomas often develop on the sole of the foot, the buttocks or even genital areas that are seldom exposed to the sun.
It’s believed that the greatest danger comes from intense sun exposure or one or more severe sunburns before age 18, followed perhaps by intermittent intense exposures in later life. It’s a pattern that’s familiar to most Americans.
Perhaps even more important than sun exposure is the genetic component. Certain individuals have a risk 10 times that of the general population. These include:
· anyone who has had a previous melanoma;
· a person with two family members who have had melanoma and
· anyone with a large number of pigmented moles, some of which are atypical–larger than normal or with slightly irregular borders and pigmentation.
The greatest danger comes from one or more severe sunburns in childhood followed by intermittent exposures later in life.
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An even higher-risk group–with a risk more than 100 times that of the general population–includes:
· anyone born with a pigmented, hairy mole larger than two centimeters in diameter;
· a person with three or more close relatives who have been diagnosed with melanoma and
· anyone with two family members who have had melanoma, one of whom had atypical moles.
Knowing she had strong genetic risks, Kristin was wise to protect herself from ultraviolet radiation. And she was also right in realizing that she was still vulnerable.
A melanoma can occur anywhere on the body, although the most common sites are on the trunk for a man and the legs for a woman.
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If you have genetic risks or spent a great deal of time in the sun as a child, you should schedule regular skin examinations with your family doctor or a dermatologist.
But even if you have no known risks, it’s important to examine your own skin regularly and to enlist the help of a family member or friend in monitoring hard-to-see areas on your back and the soles of your feet. Become familiar with all of the little irregularities in your skin, and be sure to note any changes.
A melanoma can occur anywhere on the body, although the most common sites are on the trunk for a man and the legs for a woman.
A simple guide to identifying suspicious growths uses the ABCDE mnemonic:
· Asymmetry: one half is not the same as the other.
· Border: the border is irregular, with notches or a blurred, ragged edge.
· Color: shades of tan, brown, black with possible dashes of red, white or blue.
· Diameter: greater than seven millimeters or about the size of a pencil eraser.
· Elevation: elevated above the skin surface.
Even one of these characteristics is cause for concern, and some melanomas may not meet any of the criteria. Probably the most important sign is a change in size, shape or color of any existing skin lesion. If a mole is inflamed, crusted, bleeding, itchy, painful or seven millimeters or more in diameter, it may require biopsy.
Melanomas come in four types:
A lentigo maligna is a flat, pigmented area–an overgrown freckle–that is most often seen on older persons. The freckle itself may be harmless, but it can become invasive when it thickens and forms nodules.
A superficial spreading melanoma, the most common type, also grows horizontally at first with variable pigment that may include brown, purple or even the absence of pigment. Vertical or downward growth is a sign that the lesion has become more invasive and dangerous.
A nodular melanoma, grows downward very early and, as a result, is the most malignant and the most dangerous.
An acral melanoma, typically develops on the palms, the soles of the feet or under the nails. These are more common among black-skinned individuals.
Once a doctor has confirmed a suspected melanoma, the patient should be seen by a hospital specialist–a dermatologist, plastic surgeon or general surgeon–within two weeks for removal. When the cancer is detected early enough, as Kristin’s was, surgical removal is usually curative, and further treatment depends on the depth of the lesion at the time of diagnosis. Careful monitoring is necessary to spot any recurrence.
Once the cancer has metastasized, it’s difficult to treat, and the five-year survival rate is less than 10 percent. Some cancers can grow very slowly over a number of years, then metastasize quickly. If you have any question at all about a suspicious mole or other growth, don’t delay in having your family doctor or dermatologist check it out.
REFERENCES:
R.E. Achenbach, “Melanoma and Melanocytic Neoplasia II: A Different Point of View,” Journal of Drugs in Dermatology, December, 2003.
“Britain Has Higher Mortality than Australia,” Cancer Weekly, April 15, 2003.
Jeff Evans, “ABCD Checklist May Miss Certain Types of Melanoma: Criteria Lack Sensitivity,” Skin & Allergy News, August, 2003.
Diana Gorgos, “Intensity of Lifetime Sun Exposure Tied to Melanoma Risk,” Dermatology Nursing, June, 2003.
Timothy F. Kirn, “New Data Shed Light on Melanoma in Children,” Family Practice News, May 1, 2003.
Peter L. Reynolds and Scott M. Strayer, “Treatment of Skin Malignancies,” Journal of Family Practice, June, 2003.
Arthur R. Rhodes, “Melanoma’s Public Message,” Skin & Allergy News, April, 2003.
“Shedding Light on Melanoma,” Harvard Women’s Health Watch, September, 2001.
“Skin Cancer Prevention and Detection Practices among Siblings of Patients with Melanoma,” Clinical Oncology Alert, January 2004.
Nigel Stollery, “Top Tips: Melanomas,” Pulse, August 18, 2003.
Scott M. Strayer and Peter Reynolds, “Diagnosing Skin Malignancy: Assessment of Predictive Clinical Criteria and Risk Factors,” Journal of Family Practice, March, 2003.
H. Tsao et al, “What Are the Chances That a Mole Will Turn to the Dark Side?” Internal Medicine Alert, May 29, 2003.
Nancy Walsh, “Malignant Melanoma: Look for Enlargement,” Family Practice News, April 15, 2003.
Mike Wyndham, “Pharmacy Update: Malignant Melanoma,” Chemist & Druggist, February 14, 2004.
Mitchel L. Zoler, “Intermittent, Intense Sun Triggers Nevi Formation,” Skin & Allergy News, July, 2003.
Mitchel L. Zoler, “Lifetime Risk of Melanoma in U.S. Increased to 1 in 67: incidence Rates Soar,” Family Practice News, August 1, 2003.
