Reprinted from the Health District's quarterly publication mailed to district residents (Summer 2009)


TOPIC: Not a Superficial Matter
Risk from melanoma more than skin deep
by chryss cada

I'm not a dermatologist, but in the past year I’ve had a lot of complete strangers show me their "funny-looking" moles.

I blame the scar. The 6-inch "S" on the back
of my left calf gets people’s attention. When I tell them that’s where I found my own funny-looking mole about a year ago, they want to show me theirs.

I’m not just trying to get out of looking at strangers’ moles when I tell them to get it checked out by a professional (though it’s a nice side benefit). Having a dermatologist biopsy a questionable mole can save your life — it did mine.

When the dermatologist’s office called with the results of my biopsy, I don’t remember hearing much after the word "melanoma." They said something about not knowing how deep it was and needing to cut it out and test the skin around it, but I wasn’t listening. I was watching my 1-year-old and 3-year-old daughters playing in the backyard and considering the possibility of not being there to watch them grow up.

Melanoma accounts for about 3 percent of skin cancer cases, but it causes more than 75
percent of skin cancer deaths. The American Cancer Society estimates that in 2008 there were 62,480 new cases of invasive melanomas diagnosed, and 8,420 of those cases ended as fatalities.

I hung up the phone and, even though it was a cloudy day in April, went to get the girls’ hats and sunscreen.

"It’s only in the last 10 to 15 years that sun protection has become a
big issue," says Fort Collins–based
dermatologist Brad Baack. "We’re seeing the effects of lifetimes of exposure to the sun."

The incidence of many common cancers is falling, but the incidence of melanoma continues to rise significantly. One blistering sunburn in childhood or adolescence more than doubles a person’s chances of developing melanoma later in life, according to a 1983 study.

My diagnosis brought back a childhood memory of blisters covering my body after I fell asleep in a metal canoe in the middle of a lake, in the middle of the day, in the middle of July.

I don’t miss the burns, but I still like feeling sunshine on my skin.

"You don’t have to stop doing things that you like to do — you just have to do it earlier or later [in the day] and wear protective clothing and sunscreen," Baack says. "You have to change your habits, not your life."

I was lucky. My melanoma was shallow, less than a millimeter deep. When you catch melanoma that early, it’s 99 percent curable, according to the American Cancer Society. Baack says it’s closer to 100 percent. In its later stages, when the cancer has spread to other parts of your body, the likelihood of survival drops to 15 percent.

The good news is melanoma doesn’t strike without warning. "Melanomas grow sideways first, then down," Baack says. "So you can catch them and get them out early. You know how your body makes moles — if something looks out of the ordinary, get it checked out."

Make an appointment. The worst thing that can happen is you spent some time finding out, as I did, just how lucky you are.

The skin color factor

While melanoma is uncommon in African Americans, Latinos and Asians, it is frequently fatal for these populations.

The average annual melanoma rate among Caucasians is about 22 cases per 100,000 people. In comparison, African Americans have an incidence of one case per 100,000 people. However, the overall melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.

Melanomas in African Americans, Asians, Filipinos, Indonesians and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60 to 75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.

Source: The Skin Cancer Foundation, www.skincancer.org

What to look for

The back of the leg is the most common place for women to get melanoma, perhaps because it’s difficult to reach with sunscreen. For men, the back is the most common location for the disease to appear.

Use the "ABCDE’s" to assess your moles. Consult your dermatologist immediately if any of your moles or pigmented spots exhibit:

  • Asymmetry: one half unlike the other half.
  • Border: irregular, scalloped or poorly defined border.
  • Color: varied from one area to another: shades of tan and brown, black: sometimes white, red or blue.
  • Diameter: while melanomas are usually greater than 6 millimeters (the size of a pencil eraser) when diagnosed, they can be smaller.
  • Evolving: a mole or skin lesion that looks different from the rest or is changing in size, shape or color.