Saturday, April 30, 2011

Malignant Melanoma

What is melanoma?  Melanoma is the deadliest skin cancer. The incidence of melanoma has more than tripled in the white population in the past twenty years and with this increase, the number of deaths. This truly can be a deadly disease and great diligence is needed to avoid it as well as to discover it early. The good news is that melanoma is uncommon in children ( but it does exist!)


Who is at risk of getting it?  The risk factors for developing melanoma are both environmental as well as genetic. There is an interplay between these two factors. Males are more at risk; lower extremity lesions (skin abnormalities found on the legs and/or feet) were more common in non-white groups. There is overwhelming evidence of the association between melanoma rates and UV exposure (mainly associated with being in the sun). This is more true for exposed areas of the skin to the sun (sorry sun lovers!). The bad news is that bad sunburns even in childhood or adolescence increase the risk of melanoma. The data leans more toward intermittent intense sun exposure, in other words the occasional weekend sunburn from all day at the beach.  Also, geography plays a role. The farther from the equator and the farther south increases the risk. If one has had a diagnosis of melanoma already, reducing the sun exposure recreationally really does help decrease the odds of getting a second melanoma. 

As noted, it is interesting that the pattern of sun exposure is unique to the risk of getting melanoma. This tends to be associated with intense, intermittent sun exposure and frequently occur in areas exposed only sporadically such as the back in men or the legs in women. Melanomas of the head and neck are more common in outdoor workers. Parents, it is REALLY important to know that five or more severe sunburns in childhood give an estimated twofold greater risk of developing melanoma. 

Most sunscreens with sun protective factor( SPF) will protect against UV-B and far less against UV-A. Unfortunately, there is no good data to prove sunscreens really protect against getting melanoma or any other skin cancer.

What about tanning beds?  The hot topic is tanning beds. Technically, melanoma is more highly associated with UV-B but there is also strong data linking this cancer to UV-A  which means patients using tanning beds and those treated with puva light therapy for psoriasis at an increased risk. The risk seems worse with the newer high speed, high intensity units.  So, like a good doctor, I discourage the use of tanning beds, no matter what! If you want a tan, perhaps the best idea is the self-tanning lotions with DHA. It will help you look brown without the UV damage to your DNA.

What about moles?  There are studies from Australia showing that the number of moles(or nevi) may be associated with increased risk. Someone with 50-100 moles is more strongly associated with melanoma risk ( up to 5% increase). It is very important to understand that if you’ve had a melanoma, you are greater risk of getting a second one. Thus, get your skin checked!
Be on the outlook for atypical moles. What is atypical?  These are larger than the common mole(4-12MM); different colors( shades of tan or brown and pink or dark); some notched borders. Atypical moles have a higher risk of developing melanoma.  If you have a funny looking mole, a dark mole, a new mole, a mole that has changed in its appearance, a lot of moles, or a family history of skin cancer, get a skin check up.
Even if these risk factors don’t apply, it is still a good idea just to get a skin check, period.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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