Recently, a family member went though quite a trying experience after being diagnosed with “a melanoma.” The label itself creates an immediate sense of fear and anxiety in most individuals who hear those words directed at them. My intent with this article is to shed some light on the facts about the frequency, causes, risk factors, and things that can be done to prevent it from becoming a concern for you and your loved ones.
WHAT IS MELANOMA?
Malignant melanoma is a form of cancer that occurs in the melanocytes. Melanocytes are cells in the skin that produce a pigment called melanin. The more melanin that you have present in your skin the darker your skin tone. The American Cancer Society estimates that in 2022, nearly 100,000 new cases of melanoma will be diagnosed, and unfortunately about 7,500 people will die from the condition.
Melanoma is approximately 20 times more common in white Americans than in black. Statistically, the lifetime risk for melanoma is approximately 2.6% (1 in 38) for white, 0.6% (1 in 167) for Hispanic, and 0.1% (1 in 1000) for black persons.
When melanoma is diagnosed early (it is localized and has not spread), the 5-year survival rate is close to 100%.
Unfortunately, melanoma is a very aggressive form of cancer which can metastasize to other regions of the body relatively rapidly. Once this occurs. the survival rate reduces to 16%. Therefore, early detection and treatment is imperative, and recognizing it early is critical for improving survival rates.
As many are aware the exposure to ultra-violet light (sun exposure) is truly the most vitally important risk factor to consider. What this form of light rays cause are genetic alterations in the melanocytes in the skin. This in turn causes malignant transformation of the cells. In other words, the UV light causes the DNA to change or mutate, and the cells then begin to replicate at an accelerated rate and spread to other areas if not removed. This increase in the number of malignant cells is actually due to fact that the normal genetically controlled cell death rate is shut off, and cells continue to live when they should be dying. This causes an increase in the number of cells in an area and the potential spread to other areas.
Those who are fair skinned with light hair color are at the greatest risk, however melanoma can affect darker skinned individuals. Other risk factors include sunburns, those who already have large moles with irregular borders called “dysplastic nevi,” and those with a personal or family history of “cutaneous melanoma,” which is the most common form of melanoma. Due to some of these genetic factors, melanoma can occur on areas that are shielded from the sun.
PREVENTION
The good news is that melanoma is one of the most preventable forms of cancer. Simple preventative measures such as reducing “intentional tanning” can reduce your potential incidence. I know, many folks want that year-round tan, but you must weigh out the upside (not much in my opinion) with the downside (potentially increased risk of all forms of skin cancer particularly melanoma). Reducing skin exposure to the sun’s rays is most important in fair skinned individuals in the 10–24-year age range. An added benefit to reducing sun exposure is that chronic exposure to UV irradiation also accelerates normal skin aging. This is what gives areas of the body that are frequently exposed to the sun, such as the face, neck, forearms, and back of the hands, visible signs of aging more rapidly than other areas of the body.
Some simple things that you can do to reduce your risk (and stay younger looking longer) are to avoid prolonged exposure to midday sun, wear a wide brimmed hat, wear tightly woven clothing that covers the arms and legs, wearing sun glasses (yes, you can get melanoma in the eye), avoiding indoor tanning, and wearing a sun screen (which I will discuss later in this article).
Visual screening is one of the most important things that you can do to reduce your incidence of something small getting larger, or worse yet, spreading to other areas of the body. Keep in mind however that what we commonly refer to as moles, or “pigmented nevi,” are benign accumulations of melanocytes in the skin. These typically do not change much in size or disappear in time. However, it is important to keep a check on them because approximately 33% of these benign moles will become melanomas. A visual scan of these areas and the entire body on about a monthly basis will give you a baseline to use in order to detect any changes in these benign moles. Looking for changes in size, color, and borders (irregularly shaped borders) will help you identify any potential melanoma early when it can be addressed and thereby reduce the potential for further spread.
The ABCDE’s of melanoma to keep in mind are (A) Asymmetry; (B) Border Irregularity; (C) Color Variation; (D) Diameter (greater than 6 mm.), and (E) Evolving or Changing Appearance.
A dermatologist may use a “dermatoscope” which is a handheld instrument to magnify and illuminate the skin. This aids in identifying any skin abnormality suggestive of a melanoma.
In most instances a biopsy will be used to definitively identify a melanoma. This is simply a tissue sample of the area of concern on the skin, which is then sent to a pathology lab to be studied by a pathologist who can identify cellular characteristics of a melanoma. This is the best way to determine definitively whether or not you are dealing with a melanoma or not.
If it is determined to be a melanoma, then it will be “staged” to determine how aggressive it actually is at that point. Staging is a process that was developed by the American Joint Committee on Cancer (AJCC). The stages include T0 or Stage 0 in which the melanoma is found only in that site and only in the outer layer of the skin (the epidermis). In this case, the 5-year survival rate is 100%. In stages I-II the survival rate is 97.6%. In stage III, where there has been some regional spread only, the survival rate reduces to 60.3%. Finally in stage IV, where there has been spread to other distant areas of the body, the survival rate drops sharply to 16.2%.
Therefore, early detection and treatment, or better yet prevention is the key to avoiding the condition and, if it is identified, surviving with an early diagnosis.
A WORD ABOUT SUNSCREEN
Sunscreens can be a controversial issue for most. We want the wonderful benefits of the sun without the detrimental effects. Many of us realize that in order generate sufficient vitamin D we need sufficient sun exposure. But how much is too much? A general rule for sufficient generation of vitamin D is to have a full body exposure to the sun’s UV rays for 30 minutes (15 minutes on one side then flip for 15 minutes) every day. Most of us will not accomplish this task year-round and therefore, if your intention with your sun exposure is to generate vitamin D, I would suggest supplementation with a high-quality vitamin D supplement instead. However, since most will be exposed to the sun’s rays on specific areas of their body for more extended time frames, then sunscreen can be the answer. However, what is the “cleanest” form of sunscreen? Well, that is something you will have to do a little research on in order to determine which one is right for you. Here is a link to the Environmental Working Group’s site for not only rating your current sunscreen but perhaps finding a better, safer, “cleaner” one to use in the future. (https://www.ewg.org/sunscreen/about-the-sunscreens/?category=beach+%26+sport+sunscreen)
Fortunately, my family member underwent several surgeries to excise the melanoma and now has been given a clean bill of health. Meanwhile, I trust that this information will be helpful in your quest to take proactive steps to avoid this potentially devastating form of cancer in the first place.