The statistics are striking: skin cancer is the most common form of cancer in the U.S. Fortunately, in most cases, it is basal cell or squamous cell carcinoma. Once the lesion is removed or topical cream is prescribed, the patient sees their dermatologist on a regular schedule. Then there is melanoma, which represents less than 5 percent of all skin cancers diagnosed but results in approximately 71 percent of skin cancer deaths. There is no ignoring the seriousness of melanoma.
“We know that genetics — family history — can predispose someone to develop malignant melanoma, but in the majority of cases, sun exposure plays a role,” says Kathleen Joyce, MD, an Emerson dermatologist. “While it is still more prevalent in older individuals, we are diagnosing melanoma quite often in young people these days, especially women. Many tell me they frequented indoor tanning salons. We are fortunate that Massachusetts passed cutting-edge legislation last year that bans individuals younger than age 18 from using tanning beds.”
Some people find the sun irresistible. “There is a psychological aspect to spending time in the sun,” Dr. Joyce notes. “The sun stimulates the release of dopamine, so patients often say they feel better when they’ve been in the sun. Other patients insist that they are careful to not get a sunburn; they only tan. The fact is, if you’re getting a tan, you’re causing skin damage.” When someone says they need the sun as a source of vitamin D, Dr. Joyce suggests they take a supplement instead — a much safer solution.
Home skin checks prove important
Jennifer Fyfe, who was diagnosed with melanoma at age 41, looks back at her sunbathing days and makes no excuses. “As a teenager and in my early 20s, I wanted to be tanned,” she says. “I used to visit tanning beds and wasn’t diligent about using sunscreen. But I learned my lesson.”
She is a good example of how to care for oneself after a history of baking in the sun. “I’ve been going for skin checks my whole adult life,” says Ms. Fyfe, who works as a retail buyer. At her first appointment, Caroline Levine, MD, an Emerson dermatologist, photographed Ms. Fyfe’s skin so that she could monitor any changes.
Ms. Fyfe monitored herself at home. “I have a lot of moles, so I check my skin regularly,” she says. “One day I noticed a red spot on my back, near my shoulder. It looked like a scratch, but it didn’t go away.” She already had an appointment scheduled with Dr. Levine.
“This is how things should go — patients check their own skin and, if they detect a change, they get to the office soon,” says Dr. Levine, who performed a biopsy and called Ms. Fyfe with the results.
“It was a melanoma,” says Ms. Fyfe. “Dr. Levine told me we caught it early, it was not very deep, but it needed to be removed. Within a week, I was back at her office to have the procedure, which was fairly easy. First she numbed the area, and I went home with stitches and a large bandage. Dr. Levine is an amazing doctor. She always makes you feel comfortable.”
Dr. Levine removed the lesion itself, which was less than 1 millimeter in depth, as well as a margin of adjacent tissue. Ms. Fyfe returned every three months the first year, then every six months the following year.
“During those checkups, I inspect the procedure site to look for a possible recurrence and examine the patient’s lymph nodes to make sure they are not enlarged, which could imply that the melanoma had metastasized,” says Dr. Levine. “I also instruct patients on how to check their lymph nodes themselves.”
After a melanoma diagnosis, time to adjust behavior
Those who are diagnosed with melanoma are encouraged to inform their first-degree relatives. “There can be a genetic link, so the patient’s children, parents and siblings also need to be checked,” says Dr. Levine.
She informed Ms. Fyfe that she should tell her other physicians, including her ophthalmologist, dentist and gynecologist, that she was diagnosed with a melanoma. “People don’t realize that melanoma can develop in areas not exposed to the sun. That includes in the eye, inside the mouth and in the genital area.”
Having a relationship with a trusted dermatologist is important, but after being diagnosed with a melanoma, one has to adjust behavior. “Dr. Levine told me to make sure I use sunscreen everywhere, including on my feet and hands, and she told me to wear a hat because I need to protect my scalp,” says Ms. Fyfe. “I wear 50 SPF sunscreen myself, and my husband, Dan, and I put it on our sons, who are five and seven. Melanoma runs in families, so we need to protect them.”
She also spreads the word about prevention. “I work with a lot of young women who, after summer weekends, come to the office bright red. I definitely mention to them that I was diagnosed with melanoma. If that doesn’t get their attention, I tell them there are other good reasons to protect themselves from the sun — like wrinkles.
“When I was younger, I was naïve about the long-term effects of the sun. Now I’m not so naïve.”