Beware The Unruly Sun

The summer sun. It warms the sand and the soul. But as Kathleen Black will remind you, those brilliant rays can also ravage the body. Just weeks before her 35th birthday last fall, Black was told that the funny-looking spot on her left shin--no bigger than a pencil eraser--was a deadly form of skin cancer called malignant melanoma. "Boy, those two words will echo in your brain," she says. "I saw my life flashing in front of me."

In the United States, the incidence of melanoma is rising faster than almost any other cancer, striking Americans at twice the rate today as it did two decades ago. This year alone more than 44,000 people are expected to be diagnosed, and 7,300 could die. "The increase is absolutely astounding," says Dr. Martin Weinstock, chair of the American Cancer Society's (ACS) skin-cancer advisory group. "This is a major public-health problem."

But there's good news, too. Melanoma offers its victims an unusual grace period: diagnosed early--before it's had time to burrow beneath the skin--it's almost totally curable. New tools, including computer imaging, are helping dermatologists detect melanoma. And new treatments, such as therapeutic vaccines, are now being tested to fight against it. Most important, you can easily learn the warning signs--and possibly save your own life.

Melanocytes, the body's pigment cells, generally do good, not harm. They give our skin its natural color and, when struck by the sun, churn out additional pigment (or melanin) to darken and protect us. Melanocytes also cluster together to form moles. Most are innocuous. But in some people, ultraviolet radiation appears to help trigger melanocytes to multiply and turn cancerous, either in moles that already exist or in new skin lesions. More often than not, skin cancers turn out to be basal cell carcinoma or squamous cell carcinoma; both are "nonmelanomas" and are usually not fatal. "It's the melanomas that kill," says Dr. John DiGiovanna, a dermatologist at Brown University School of Medicine. Accounting for just 4 percent of skin cancers, they cause six out of seven skin-cancer deaths.

Although no one is immune to melanoma, people with fair skin and light eyes and hair are at greater risk. Other factors include having a large number of moles, a family history of melanoma and bad sunburns as a child--especially in the first 15 years of life. The best weapon against the disease is early detection. But don't rely on your GP: most have minimal training in skin cancer. Use the ABCD test to check yourself regularly (the Skin Cancer Foundation has visuals at www.skincancer.org): Is the mole asymmetrical? Is its border uneven or ragged? Is there more than one color present? Is the diameter greater than 6 millimeters? Also look for inflammation or bleeding. Check every inch of your body from your scalp down to the skin between your toes. Men are more likely to develop melanoma on their trunks (probably because they go shirtless in the sun), women on their legs.

If you see anything suspicious, call your doctor. The American Academy of Dermatology (www.aad.org or 888-462-DERM) can help you find a skin specialist in your area; the ACS (www.cancer.org or 800-ACS-2345) offers information about what to expect during an exam. A key factor in prognosis is how deeply the melanoma has invaded the skin. At less than three quarters of a millimeter, your chances are better than 95 percent. Beyond four millimeters, the odds plummet to less than 50 percent. Says AAD president Dr. Darrell Rigel: "That little difference is a big difference in survival."

If you do have a mole biopsied, request that it be read by a specialist called a dermatopathologist. "In less trained hands, there have been problems," says Rigel. Seek a second opinion if you have any concerns. Dorothy Shaffer, 42, was told in 1990 that the mole on her calf was "nothing to worry about." But the lab made a mistake. Now a disease that might have been licked is threatening her life. "If I see 45," she says, "I'll be lucky."

You may be able to help ward off melanoma. Start by using sunscreen with an SPF of at least 15. Dr. Mark Pittelkow of the Mayo Clinic recommends newer products containing zinc and avobenzone. Pay special attention to the kids, too. Last week the ACS reported that 72 percent of 11- to 18-year-olds surveyed got sunburned last summer--a potential precursor to cancer. One third were wearing sunscreen at the time. The FDA ruled last month that sunscreens can no longer be labeled "sunblocks" because they're incapable of absolute protection. Use them liberally (about a shot glass full) and repeatedly. Ditch products more than three years old. And try to avoid direct sun between 10 a.m. and 4 p.m.

The future of melanoma may be better for all of us soon. New digital imaging can take a magnified snapshot or Melanomagram, helping doctors see deeper into a lesion and track it over time. Computers may soon be able to "read" moles and help make diagnoses. A genetic test is on the horizon, too. Drugs derived from the body's own chemicals are now being used to boost the immune system to attack advanced melanoma, and therapeutic vaccines are being tested. "From 15 years ago until now, we've taken quantum leaps," says DiGiovanna.

Health officials, who are launching skin-cancer-awareness campaigns this summer, hope increased vigilance and new research will one day kill off melanoma for good. It all starts with people like Kathleen Black--her cancer turned out to be early stage. "I really feel like I've dodged a bullet," she says. Now it's your turn.

 

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