Sunburned Again! Melanoma

Melanoma is a skin cancer that involves cells called melanocytes. These cells produce the pigment of our skin. These cells are also found in our bowel, eyes and other pigmented areas.  Melanoma is the most deadly form of skin cancer.

Fortunately it is the least common but the number of incidences are growing. They are expected to double every 10 to 20 years. The most common site for melanoma in women is the legs and in men it is the back.  It can occur anywhere on the body including places not exposed to sun.

It most commonly occurs in fair skinned people living in sunny climates such as North America, Europe, Southern Africa and Latin America. One in about 33 Americans is affected by some form of Melanoma. Risk factors are genetics and of course exposure to ultra violet light. This includes tanning beds ladies. The World Health Agency Research on Cancer has categorized them as a human carcinogen.

“Monroe County, according to the Florida Department of Health, experienced almost twice as many deaths from melanoma than statewide averages between 2009 and 2011.”

Those of us that are at risk are: people who sunburn easily, people with chronic sun exposure or intermittent intense sun exposure even without sunburn, fair skinned people, tanning bed use especially before age 35, people with multiple moles of 60 or more, and if you are on chronic steroid use or are immunosuppressed for some reason. Of course if you have had a melanoma before, or an atypical mole, or suffer from other skin cancers you are at a greater risk too. Some studies suggest that if your child is sunburned she or he has a greater chance of developing melanoma later in life.

What to look for:
The ABCDE of a mole

Asymmetry: Self-explanatory, if it does not look the same on the right side as it does on the left it is asymmetrical.

Border: if it is scalloped, irregular, paisley like, or vague it is a concern. Smooth borders are ok.

Color:  If the mole has several different shades of brown or has black or red or blue or has a blood vessel in it that’s a concern. Normal moles are the same color throughout.

Diameter: It doesn’t really matter if it’s small. If it has the above characteristics it should be examined by a professional. Usually they say 6mm or larger, about the size of a #2 pencil eraser. But again, don’t wait until then.

Evolution: a fairly new one but everyone knows that a mole that is changing or growing is not good. Any change in size, elevation, color or shape is a concern. Generally you are looking for the “ugly duckling” lesion.

If you are at risk, or just live here in the Keys, it’s important to examine your skin once a month. Examine all of yourself under arms, back, legs even the backs of your legs, your genitals, yes, even non sun exposed areas, including buttocks and the bottoms of your feet. With fair skinned people, ugly ducklings can be hard to detect. You will need to see a provider with a dermatoscope, which is basically a lighted magnifying glass.  She or he may want to send a small piece to the lab for a definite diagnosis. This procedure is not too painful but can be lifesaving.

Everyone knows by now to use sunscreen. It should be 30 spf or more and should protect against UVA and UVB rays. Look for ingredients such as zinc, avobenzone or titanium.

Some clothes are made to block damaging sun rays. Columbia makes nice breathable long sleeve shirts and dresses. A wide brimmed hat is an excellent choice.

Remember, melanoma doesn’t just stay on the skin, it spreads to organs as well.  My friend’s friend had a lesion on his back that went ignored. Eventually that lesion went away, but it had spread to his brain and he died.  Err on the side of safety, if it looks weird to you, it may very well be.

The point is to screen yourself often, once a month. Ask your partner to check you where you can’t see and take advantage of free screenings around your neighborhood. The Lower Keys Health System has a health fair coming up in October and Zonta will have a skin screening booth staffed with professionals.

Carolyn has lived in the Florida Keys since 1992, presently practicing at Womankind in Key West and has taught nursing and practiced as a Nurse practitioner since 1979.