Melanoma Risk — Incidence of the Most Serious Form of Skin Cancer Continues to Rise, and Affect More Patients in Their 20s

By Mary Powers

The beach season was shimmering on the horizon when she noticed the mole. It was dark, so black it was nearly blue, and about the size of a No. 2 pencil eraser.

When Colleen Smith made an appointment with her dermatologist to have it removed, her concerns were cosmetic, not medical. She was 24 years old and getting ready for a beach vacation. The dark mole near the middle of her back needed to go.

Smith, now 27 and a Memphis advertising account executive, was lucky.

The mole turned out to be melanoma, the most aggressive form of skin cancer. On April 20, 2004, Smith underwent surgery to remove a wide band of skin and tissue from the area surrounding where the mole had been removed earlier. Nearby lymph nodes were also checked for any evidence the cancer had spread.

With the diagnosis, Smith joined a small but growing

number of young patients diagnosed with the most serious form of skin cancer.

This year an estimated 62,480 Americans will be diagnosed with melanoma. The disease, which is cancer of the pigment that produces melanocyte cells, will kill about 8,420. While melanoma does sometimes arise in other areas of the body, including the eye, it usually begins in the skin.

The overwhelming number of melanoma patients are still closer to retirement than to college graduation, but Mid-South physicians said they are seeing more young patients like Smith.

Dr. Martin Fleming, a Memphis surgical oncologist, said the numbers started rising about 10 years ago. In the past month alone, he has treated four or five melanoma patients in their 20s.

“One hundred years ago, if you were affluent you wanted to be as fair as possible. Society has flipped that and now you want to be tan,” said Fleming, when asked what is driving the change.

Dr. Furhan Yunus agreed that increased exposure to ultraviolet (UV) light from the sun and tanning booths is one likely factor. Yunus is the chief medical officer of the University of Tennessee Cancer Center.

“I think we have not done a good job in this country to teach people about the risks of tanning and excessive sun exposure,” Yunus said.

Although he doesn’t advocate trying to avoid the sun completely, he counsels against sunbathing or using tanning salons.

“All spectrums of ultraviolet light cause some amount of damage,” Yunus said.

Damage comes from suntans as well as sunburns, said Dr. Rex Amonette, explaining: “Any tanning creates damage.” It is that damage to a cell’s genetic material that sometimes gives rise to the uncontrolled cell growth that characterizes cancer.

The Indoor Tanning Association, a trade group that represents equipment manufacturers and salon operators, disputes such statements.

On its Web site and in its literature, the association promotes the health benefits of UV light, particularly production of vitamin D. It argues that the link between indoor tanning and melanoma remains unproven.

Amonette said greater awareness is also likely playing a role in rising melanoma rates.

“We are finding them earlier,” said Amonette, a past president of the American Academy of Dermatology and co-chairman of the National Coalition for Sun Safety.

A 2005 study published in the British Medical Journal backs up Amonette’s observation. In it, researchers with the U.S. Department of Veterans Affairs linked the dramatic increase in U.S. melanoma cases in recent decades to more aggressive screening and diagnosis.

The incidence of melanoma in the U.S. has jumped sixfold since 1950, although the death rate remains stable. The American Cancer Society estimates 1 in 55 Americans will develop melanoma.

Melanoma rates among American men rose from 1975 to 2000. They fell slightly between 2000 and 2003, before climbing again in 2004 and 2005. The new cases included Sen. John McCain (R-Ariz.). McCain, who is 71 and the presumptive Republican presidential nominee, had a melanoma removed from his left temple in 2000.

Rates for women during that period just kept rising. Melanoma is the leading cancer killer among women ages 25 through 30.

With younger patients like Smith, Fleming worries about the long- term psychological impact of a cancer diagnosis. These are patients diagnosed before their cancer has spread and who are treated with surgery alone.

“The uncertainty begins to hang over people as a cloud that can really, if they aren’t objective about it, begin to impact their lives in a cancer phobia way,” he said.

He told Smith and his other patients to continue to enjoy the activities they always have, including golf, tennis or the beach, but just make sure to protect themselves. That means plenty of sunscreen, including keeping it on hand in the car, golf bag or gym locker. He also recommends wide-brimmed hats and a beach umbrella to create shade.

With her pale skin, blue eyes and blond hair, Smith could be a poster child for melanoma risk.

Light hair, light eyes and a tendency to burn or freckle are all associated with an increased risk of melanoma. But Mid-South physicians warn that African-American or Hispanic descent doesn’t completely eliminate the risk.

For Smith, there is also a family history of the disease. She lost a grandfather to melanoma. She was in the eighth grade when, at the request of her parents, doctors removed her first mole.

Earlier this month Smith was back in surgery. Fleming removed a second melanoma that developed just inches from the first. It was so small, he opted not to check lymph nodes for evidence of spread.

“It was the better end of bad news,” Smith said, speaking the day after she learned one of the four moles Fleming removed during her routine six-month check was a melanoma. “This (melanoma) is something I’ll deal with the rest of my life.

“I wasn’t a hard-core tanner,” Smith said. “I never went to tanning beds in high school. I did a little bit in college.”

Over the years, she got her share of deep tans and the occasional bad sunburn.

For melanoma patients in their 20s, Yunus said genetics likely plays a role.

At least three genes have been implicated in the disease, and genetic testing is now available for those with a strong family history of melanoma.

But unlike individuals who inherit an increased susceptibility to breast or ovarian cancers, Yunus said there is little to offer those who inherit melanoma-associated genes.

“There is not a whole lot we can do other than monitor these patients more aggressively,” he said. Yunus said he’s only had one or two patients opt for genetic testing.

Instead, Smith and others at high risk for the disease come several times a year for a head-to-toe skin check.

Unlike basal and squamous cell cancers, the slow-growing and more common forms of skin cancer, melanoma can spread rapidly and fatally.

“If melanoma spreads, it is a very deadly disease,” said Dr. Brad Somer, a Mid-South oncologist. “In other areas of cancer treatment there have been major breakthroughs in terms of life-prolonging therapies. In melanomas, there haven’t been the same kind of breakthroughs.”

Smith looked coolly pale early on a recent spring morning.

“I use tons of sunscreen, wear hats and watch the hours I spend outside,” she said. “After an hour outside, I’ll start feeling, ‘Oh, I don’t need to be out here.’”

As her friends move into their late 20s and early 30s, they make fewer trips to the tanning beds. But they are more worried about wrinkles than cancer.

It is a lesson not lost on dermatologists. Amonette said the American Academy of Dermatology public education campaign now focuses on linking sun exposure to wrinkles and age spots.

“There is a greater fear of aging than skin cancer,” he said.

– Contact Mary Powers at 529-2383. To read more stories by this reporter, go to commercialappeal.com, click on Contact Us at the top of the home page and then click on the reporter’s name.

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INSTANT FEEDBACK

What readers are saying on commercialappeal.com:

nativememphian13: When I was in my 20s, I went to the tanning bed for a few months – that was when we thought it was “safer.” When I went to see the dermatologist about a mole, he read me the riot act and told me I should never be in the sun without the highest level of sunscreen due to my fair complexion. Fortunately, I did not have cancer. But I try to reinforce the danger to my teen girls today. It’s so HARD because of the still prevalent image that a tan is good- looking and healthy.

woodendoor: My mother had a melanoma removed successfully and without incident or complications. It was caught very early on.

Tips: If you feel like your skin is burning, skin damage has already been done. Stay out of the sun once you reach that point, and try to avoid the circumstances that got you there in the future.

Pippin: For little ones, (or anyone else for that matter), Blue Lizard sunscreen from Australia is great.

I don’t sell it or anything, just have (finally) found a sunscreen that works well on all family members, regardless of their ages.

Some people (educated folks that I know), think that tanning beds are OK, please understand that they are not.

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ONLINE

For more information about melanoma, try these Web sites:

American Academy of Dermatology, aad.org . Look under “Featured Items,” to check for free skin cancer screenings;

National Cancer Institute, cancer.gov/cancertopics/ types/ melanoma ;

Indoor Tanning Association, theita.com .

On the Blog

Wondering about your moles? Go to our Healthy Memphis blog at commercialappeal- web.com/health to see examples of moles that should prompt a doctor’s visit. Also find links to the National Weather Services’ daily ultraviolet rating for Memphis and other U.S. cities.

“I think we have not done a good job in this country to teach people about the risks of tanning and excessive sun exposure.”

Dr. Furhan Yunus, chief medical officer of the University of Tennessee Cancer Center

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Originally published by Mary Powers / powers@commercialappeal.com .

(c) 2008 Commercial Appeal, The. Provided by ProQuest Information and Learning. All rights Reserved.