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Melanoma is serious, but often curable

Leigh Ann Laube • May 20, 2009 at 12:00 AM

Although melanoma is the most serious form of skin cancer, if it’s recognized and treated early, it is nearly 100 percent curable.

The incidence rate for invasive melanoma is highest in Caucasians, who are almost 30 times more likely to develop melanoma than African Americans. Men 65 or older are more than twice as likely to develop melanoma as women in the same age group.

Everyone is at some risk for melanoma, but increased risk depends on several factors, including sun exposure, number of moles on the skin, skin type, family history, personal history and weakened immune system.

“Melanoma is the most genetically determined of the skin cancers. People are not immune even if they have paid attention to sun exposure,” said Dr. Joni Sago, with Dermatology Associates of Kingsport.

According to the National Cancer Institute, there will be an estimated 68,720 new cases of melanoma in the United States this year, with an estimated 8,650 deaths.

Between 1998 and 2008, Dermatology Associates treated 1,166 patients with melanoma. Of those, 226 were men and women between the ages of 50 and 59; 304 were between the ages of 60 to 69; and 275 were between 70 and 79. The majority of melanomas were found on patient’s arms, back, and head and neck.

The warning signs of melanoma — known as the ABCDs — have been updated to include an “E,” Sago said, and the “E” is the most important.

Added to asymmetry, border, color and diameter is “evolving.” According to the Skin Cancer Foundation, “Any change in size, shape, color, elevation or another trait, or any new symptom such as bleeding, itching or crusting points to danger.”

Sago has seen melanoma in women of all ages, particularly on their backs and legs. In younger men, it’s common on their trunks as well. In older men, it’s found on their heads and necks.

There are different types of melanoma, and the melanomas are classified

Once the type of melanoma has been established, the next step is to classify the disease as to its degree of severity. Early melanomas are localized, and more advanced melanomas have spread to other parts of the body.

“We like to detect it early because it’s quite treatable. Early means it’s in the skin. Late means it’s in the node,” Sago said.

Most people with thin, localized melanomas are cured by appropriate surgery, she said.

“Sometimes we do lymph node biopsy or dissection. The depth really matters. We want to catch them before they’re a millimeter.”

And if it’s caught too late?

“We treat with chemotherapy, usually unsuccessfully.”

Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. Most sunscreens absorb the high energy ultraviolet light — the part of the sun’s rays that are harmful — and transform it to less damaging energy.

The U.S. Food and Drug Administration has changed sunscreen labeling to include a four-star rating system that informs consumers how well the product protects them against ultraviolet A light.

UVB light is primarily responsible for sunburn. UVA light penetrates the skin more than UVB light does, and causes tanning. Both types of UV light contribute to premature skin aging, skin cancer and other types of skin damage. Currently, sunscreen labels are required to carry a sunburn protection factor (SPF) value that informs potential users how well the product protects against UVB light.

Under the new regulations, a UVA star rating is displayed on sunscreen labels, near the SPF rating.

With the new UVA rating system, one star will represent low UVA protection; two stars, medium protection; three stars, high protection; and four stars, the highest UVA protection available in an over-the-counter sunscreen product.

“There’s not many that are going to be four-star,” Sago said.

As for the SPF value, Sago recommends purchasing the highest value simply because people tend to spread on sunscreen too thin, especially at the beach.

“A family of four should go through a bottle of sunscreen a day, so if you have any left from last summer you’re using too little,” she said.

Sago cautions when using combination sunscreen and repellents on children. If you reapply the sunscreen as needed for the sunscreen component, you are potentially exposing your child to too much DEET.

Other ways to protect against sunburn include using Rit Sun Guard Laundry Treatment, which provides UV protection to your clothes, and wearing rash guard clothing that has a UPF (ultraviolet protection factor) rating.

While the American Academy Of Pediatrics doubled its vitamin D recommendation for kids in 2008 — and while our bodies need vitamin D to build and maintain strong and healthy bones — the AAP doesn’t recommend more sun exposure. The American Academy of Dermatology doesn’t recommend getting vitamin D from sun exposure or indoor tanning.

Because we’re a “stay indoor society,” Sago said, 40 percent of residents in this area are vitamin D deficient.

The AAD recommends getting vitamin D from a healthy diet, which includes naturally enriched vitamin D foods, fortified foods and beverages and/or vitamin supplements.

“There’s no harm taking supplements,” Sago said. “It’s infinitely easier and more precise.”

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