Melanoma: Deadly skin cancer


It is a common misconception that skin cancer is nothing to worry about because it is curable. Not so, not for any of the 3 types of skin cancers. All of them would ultimately spread all over the body and kill the patient, if not diagnosed early and surgically removed on time.

The most notorious is melanoma, the deadly skin cancer that kills about 12 percent of its victims. In 2014 alone, 76,100 cases (43,890 in men, 32,210 in women) of this invasive skin cancer are expected to be diagnosed in the United States alone and more than 9,700 of them (6,470 males and 3,240 females) are expected to die from the disease. This accounts for more than 75 percent of all deaths from the 3 types of skin cancers.

What are the types    of skin cancers?

The three are, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Basal cell cancer, which rarely spreads, unless neglected, usually affects the face, the part most exposed to the sun, and the most common skin cancer among persons with fair (light) complexion. BCC is the commonest skin cancer among Filipinos. Squamous cell cancer, on the other hand, affects those with dark complexion, like Filipinos, and usually parts that are NOT exposed to the sun, like legs and feet. Among those with fair complexion, SCC also affects parts exposed to the sun, like the face, neck and ears. Spread is more likely compared to BCC.  But melanoma, which accounts for less than 2 percent of skin cancers, is the most aggressive and deadliest of those three. Around 3.5 million cases of BCC and SCC are discovered annually in the United States. The rare forms of skin cancers, which are also non-melanomas include: keratoacanthomas, Merkel cell carcinoma, skin lymphoma, Kaposi sarcoma, skin adnexal tumors, and sarcomas.

What is melanoma?

Melanoma is a skin cancer that starts in the melanocytes, the cells that produce skin pigment called melanin, which helps shelters the deeper layers of the skin from the destructive effects of the sun on the DNA. While it frequently affects the skin (head, neck, between the shoulders and the hips, and also under the nails), this fast-spreading cancer can also start in the mouth, eyes, anal and genital areas. Melanoma is rarer in persons with dark skin, but when it occurs among them, the usual sites are the palms, soles of feet, under fingernails, and toenails. It is the least common of the skin cancers but the one with highest fatality rate.

What is the racial distribution?

The past 3 decades, the incidence of melanoma has been rising. Whether it is due to some destruction in the ozone layer caused by the abuse humans have done to our environment and to ecology as a whole, which reduces our protection from the harmful higher dose of the rays of the sun, is an issue the experts are grappling with. Whites are 20 percent more commonly affected than African Americans. The lifetime risks of getting melanoma are estimated as follows: 2 percent (1 in 50) for Caucasians; 0.1 percent (1 in 1000) for blacks; and 0.5 percent (1 in 200) for Hispanics. There are many risk factors involved but exposure to sun is a major one. The risk increases with age and the average age where it is found most is 61, although victims younger than 30 are not rare, especially among white women, who are very fond of sun-bathing.

Are tanning salons safe?

Tanning salons, like non-prescription skin whitening cream or drug, are safe, as long as you do not use them. Use of artificial tanning has been linked to increased risk of skin cancers. Lightening complexion reduces melanin pigments and lowers the skin protection, thus elevating the risk for skin malignancy and the still unknown adverse effects to the body system of long term use of non-prescription whitening agents, such as glutathione. There is a legal move to ban tanning salons and use of tanning beds and booths.

What are the risk factors?

The following are factors for the development of skin cancers in general: excessive sun (ultra violet –UV- radiation exposure, natural or from tanning booths or lamps), unprotected skin; individuals with pale skin that easily gets sun burned or does not tan much or at all; those with blond or natural red hair; those exposed to arsenic compounds, coal tar, creosote, pitch or radium; those with multiple or unusual moles and/or severe sunburns in the past. A strong family history of melanoma is also a risk.

What are the signs to watch for?

The following should be of concern: any change on the skin, especially in the size and color of a mole, its growth or a new growth; bleeding, oozing, growing scales on any bump or nodule on the skin; a non-healing sore; change in the sensation, like pain, tenderness or itchiness; and spread in the color or pigmentation beyond the border or edge of a mole. Vigilance, paying attention to, and checking, your body often, and early medical consultation, concerning any and all diseases, including skin cancers, could save your life.

What is the prognosis for Melanoma?

Basal cell and squamous cell carcinomas have excellent prognosis, when treated early, almost 100 percent. About 84 percent of melanomas are detected while they are at a localized stage among health conscious individuals, and the 5-year survival rate is 98 percent. For those with regional spread and distant spread, the survival goes down to 62 percent and 16 percent, respectively. Over-all, the 5-year survival rate for melanoma is about 91 percent.

What are the prevention measures?

Since exposure to UV radiation is the major culprit in skin cancers, it is best to avoid long exposure to the sun and avoid tanning salons or tanning booths or lamps, and the use of skin whitening agents. Sun and UV rays are highest between 10 AM and 4 PM. Where your shadow is shorter than you are, that’s when the radiation is the strongest and most harmful. Stay in the shade and if you have to go out, use an umbrella and sunscreen (SPF 85+ and higher are now available for the face) and highly recommended by dermatologists. SPF 15 confers about 93 percent protection; SPF 30, about 97 percent; and SPF 50, about 98 percent. The use of at least SPF 30 or higher is preferred, applied generously about 30 minutes before outdoor activities, and every two hours thereafter especially after swimming or sweating a lot. No sunscreen today provides 100 percent protection against UV radiation. Donning on a long sleeve shirt (which is not see-through) and use of a wide rim hat for women or baseball cap with neck cover to protect neck and ears helps greatly. Although cloudy, about 80 percent of the UV rays still pass through the clouds. Any surface, including land, water and snow, reflects UV rays, even when one is under a shade. The basic principle is to stay away UV radiation.

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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA,  a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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