Melanoma - Cancer's Best Kept Secret
When my 21 year old daughter was diagnosed with melanoma, the leading cause of skin disease deaths, we were often greeted with remarks like, ‘Oh yeah, my uncle had that – they just have to remove it.” More likely than not, the uncle had one of the less serious forms of skin cancer, certainly nothing to fool around with, but of the slow growing, rarely invasive variety. Malignant melanoma is a serious, sometimes deadly form of cancer, yet its causes, preventions, and treatments are clouded by misinformation and risk factor denial.
Melanoma is a cancer of the melanocytes, which are the cells that produce melanin, the pigment that gives us hair and skin color. It occurs when the DNA is damaged, usually, but not always, by overexposure to UV radiation from the sun or tanning beds. These cells start to grow out of control, causing malignant tumors. Melanoma can form in moles that have been present for years, or develop in new areas. It can occur anywhere on the body, including scalp, bottom of feet, mouth, eyes and genital areas. When a biopsy is done on a suspicious lesion, and melanoma has been diagnosed, the immediate treatment is excision. The surgeon will remove the affected area as well as a good portion of surrounding non-affected skin to ensure what they call “clean margins” around the lesion. Depending on the depth of the cancer, they may or may not remove lymph nodes to see if the cancer has spread.Because my daughter's spot was on her ear, the surgeon took a large wedge out of her ear, and then sewed it back together. The result? A perfectly shaped ear, although quite a bit smaller than the other! That's okay, we'll take it as a badge of honor!
ABCDE SIGNS OF MELANOMA
The ABCDE system was developed to aid people in recognizing potential skin cancer. These are the signs to look for:
A – Asymmetry - If you visually divide the questionable spot in half, the two halves
are different, or not symmetrical.
B – Borders – If the edges of the abnormal spot are irregular or jagged.
C – Color – If the spot has different shades of tan, brown and black in it, or even
red or blue. Also, if there appears to be a color change over time.
D – Diameter – If the spot is over 6 mm, about the size of a pencil eraser.
E – Evolution – If the mole or spot keeps changing appearance.
Other telltale signs are sores that don’t heal, bleed frequently, or are very black. Some rarer forms look like clear nodules, which don’t go away and become quite itchy. What has become frustrating for us is that we now look at all skin abnormalities with a very biased eye, and upon examination and/or biopsy by a dermatologist, none of the subsequent spots have been cancerous. However, we will continue to be diligent with our body checks, and question anything that concerns us.
It is estimated that close to 9000 people die annually from malignant melanoma in the United States, with 120,000 new cases being diagnosed. About half of these cases will be invasive, meaning the cancer has spread to other parts of the body. Unfortunately, the usual treatments of chemotherapy and radiation are not very effective against invasive melanoma, leaving the patient few options other than experimental procedures. One of the most promising is immunotherapy, or experimental vaccines which boost the body’s own immune system to fight off the cancer cells. Gene therapy also has become increasingly effective in altering the body’s white blood cells to become more aggressive in eliminating malignant cells. Many of the country’s top universities and cancer centers run clinical trials, which are completely experimental but have shown promise in lab studies. Patients diagnosed with late stage melanoma should definitely consult with their physician to see if they would qualify to participate in one of these. While there are risks involved in trials, conventional cancer treatments are basically ineffective in treating advanced cases.
Risk factors and Prevention
So what are the risk factors involved in contracting malignant melanoma? As with all skin cancer, people with fair skin are at greater risk. Exposure to UV light, whether from the sun or tanning beds, especially when accompanied with bad sunburns, are also causes. There is a genetic factor involved, and people with a close relative who has had melanoma have a 50% greater chance of contracting it as well. Finally, the more moles you have, the higher chance one of them will become abnormal or malignant.
There are many precautions one can take to lessen the chance of developing this skin disease. The main way is to decrease exposure to harmful rays. Choosing shady locations during the hottest time of the day, applying sunscreen with an SPF of 30 or greater at all times when outside, reapplying after swimming, wearing UV-blocking sunglasses, and avoiding tanning beds are all effective preventative measures. Everyone should do a head to toe skin check once a month, with help if needed. This includes a scalp check and use of a mirror to reach hard to see locations. Yearly examination by a private physician or dermatologist is also recommended.
The number of cases of melanoma diagnosed in the United States is steadily increasing, especially among young adults. It is vital that organizations, schools and communities raise awareness of this deadly disease, educate the populace about means of prevention, and continually support research to improve treatments and find a cure.