As we draw on the close of another summer I hope you have been faithful with sun protection. This is a skin cancer that is less common but the most dangerous of all types. It causes 75% of deaths related to skin cancer in the world. It can be a tiny black speck or the size of a pencil eraser. Melanocytes are found in skin, internally and in the eyes. In women it’s primarily on the legs and in men on the back. Its most common in white or light skin Caucasians living in sunny climates. There can be a familial tendency so more vigilance if there are relatives with known or past Melanomas.
In general cancers are caused from damaged to the cells internal DNA. UVB and UVA both are involved. Errors in DNA repair by the body cells, leads to deletions, insertions and translocations of inaccurate codings that lead to mutations. The stage is now set for cancer development.
Tanning beds-once believed to help prevent skin cancers, are recognised now to increase the incidence and particularly of Melanoma.
Early signs of Melanoma followed the Mnemonic ABCDE:
- Irregular borders
- Color- usually multi black brown mix
- Diameter changes
- Evolving over time
Existing moles need to be watched for changes. Hard to see areas can be observed by someone that becomes familiar with your skin or a physician.
The ABCED doesn’t apply to the most dangerous form of Melanoma-Nodular. It has its own classifications EFG. Often it has no color.
- Firm and non tender
There are all kinds of lumps and bumps that grow on the skin. Never feel it is a waste of time to seek a Dermatology opinion.
Less than 20% of early diagnosed tumors metastasize. So early is always better! It can spread to the liver, bones, abdomen to internal organs, brain and distance lymph nodes. Unfortunately Metastatic Melanoma requires drastic and often life saving measures from surgery to chemo therapy.
There is a type of Melanoma that runs in families. Much research work has gone into understanding how a preventable cancer develops, in the attempt to stop unnecessary deaths. Genetic testing can be used to determine if a person with familial melanoma carries a known mutation. People with red hair carry a mutated copy of gene MC1R have a 2-4 times increased risk for Melanoma.
THERE IS NO SAFE TAN WHETHER FROM NATURAL SOURCE OF A SUN BED. A tan ia a result of insult to body cells, as attractive as we may find a tanned skin to be. The use of tanning beds has increased the risk 75% of developing skin cancer for those using tanning devices before 30 years old. Recently the government has made it illegal to allow minors under 18 to use tanning beds. The International Agency for Research on Cancer states that tanning beds are “Carcinogenic to humans”.
A scoring system (Breslow and Clark) is used by pathologists to identify the treatment plan required and directly implicates the long term survival rate.
For early stage Melanomas’ surgical excision is the treatment of choice. Recently there has been a experimental use of an immune enhancement cream “Aldara” . Time will tell whether or not this reduces the incidence of reoccurrence. Close follow-up over a long period of time is required to watch for reoccurrence or other lesions developing. If lymph nodes are involved the game plan changes dramatically!
Chemotherapy and immune therapy is required for metastatic involvement. Various agents have been tried. So far results are limited except to increase the time in-between recurrences. NO CURE EXISTS Metastatic Melanoma can be detected by x rays, CT, MRI and Pet scanners.
The prognosis of this unique type of skin cancer depends on the depth (Breshow) and the depth relation to skin structures ( Clark level), the kind of Melanoma and whether there are any signs of regional (lymph nodes) or distance metastases (tumor in another organ of the body).
The deeper the lesion the darker the prognosis. This is even more serious than a less invasive lesion with a positive lymph node.
Once in the lymph nodes the number of nodes involved and how much abnormal tissue exists in the node dictates the prognosis.
The sun screen controversy:
Sunscreens are known to protect against sun burn and the two common skin cancers-squamous cell (SCC) and basil cell (BCC) The jury is out on Melanoma.
There is concern over many of the chemical ingredients in the over the counter sunscreens that are recognised as carcinogenic. Hence the change to physical blockers becoming more popular that contain Titanium and Zinc (See blog on The Confusing Story of Sunscreen and Sunblock)
Decreased exposure to UV light through sun and sun beds offers protection. The newer products with physical blockers allow for lower SPF numbers and effective UVA and UVB ray protection. There is controversy and concern that sunscreens provide a false sense of security for certain people that are sun seekers or because of work are exposed to higher life time rates of sun light thus increasing the risks of Melanoma. It is a cruel irony that sunscreens that we rely on to help prevent skin cancer may be creating an increased risk of skin cancer. What Dermatologists agree on is a healthier choice by selecting a physical sunblock over a chemical block(See blog) along with a healthy dose of common sense with sun exposure.