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Glenn D. Braunstein, M.D. Headshot

The ABCDEs of Melanoma: Don't Let Sun Worship Turn Fatal

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Southern Californians carry on a love-hate relationship with sunshine: we love that bountiful sunny days mean plenty of time at the beach and outdoors, but we're wary of the damage it can do to our skin. This makes most of us experts already on slathering on sunscreen, slapping on hats and seeking out shade as necessary.

But these precautions alone aren't enough to defend us against the deadliest of skin cancers: melanoma. That requires the extra steps of knowing well our skin and all its blemishes -- and knowing a good dermatologist.

Skin cancer is the most common form of cancer in the United States, with more than 3.5 million diagnoses in more than two million people each year. There were 114,900 new cases of melanoma diagnosed nationwide last year, with almost 8,700 of those fatal, reports the Skin Cancer Foundation. Melanoma begins in cells, melanocytes, which generate the pigment melanin. This cancer often starts in moles but also can be found in other pigmented tissues, including the eye or intestines.

When the disease is caught in its earliest stages (Stage IA), the outlook is good, with 97 percent or so of patients surviving after five years and 95 percent surviving after 10 years. Advanced melanoma (Stage IV) that has spread through the body leaves far fewer survivors, with less than 20 percent surviving after five years and 15 percent after 10 years.

Melanoma Therapy

Recent scientific advances offer hope for patients with advanced melanoma. In late March, the Food and Drug Administration approved a new drug therapy for melanoma -- the first new treatment approved in 13 years. The drug, ipilimumab (brand name Yervoy), works by stimulating the immune system, signaling it that cancer cells are invaders for attack. The drug works for a segment of patients, only about 20 percent; a study in the New England Journal of Medicine shows those patients lived 32 percent longer and had a 20 percent greater chance of surviving for one year than those who received a melanoma vaccine instead.

Another potential treatment, also described in the New England Journal of Medicine, is still in the research phase. But patients in a study whose melanoma had a specific gene mutation orally took a drug twice daily to inhibit that mutation. Phase I trials showed a majority of patients had complete or partial tumor regression -- good news but still years away from being an FDA-approved treatment.

While scientists seek better treatments or a cure for the disease, those under the sun must take steps to protect their hides and minimize skin cancer risk. Know the warning signs of melanoma, which can be described in a mnemonic. If you see or find any of these symptoms with a mole or other skin feature, consider the red flag raised, and see your doctor or dermatologist immediately.

Making a Mountain out of a Mole

Here are the ABCDEs and a link to photographs that show them. [Warning: Click here with care; as with all medical images, this selection from the American Academy of Dermatologists isn't easy for many people to look at.]

Asymmetry: If two halves of a mole don't match, that mark is suspicious.

Border: An early sign of melanoma is a mole with an uneven edge -- scalloped or notched.

Color: Any mark on the skin that is in a rainbow of browns, tans, blacks -- or even red, blue, pink, white or gray -- should be examined by a physician.

Diameter: Melanomas may start smaller but tend to be larger in diameter than a pencil eraser.

Evolving: Moles or lesions that change size, shape or color can be trouble. Be wary of new symptoms with skin features, such as itching, bleeding, crusting or pain.

Scientists are unsure what causes melanoma, but 65 percent of cases can be attributed to UV exposure. Melanoma risk doubles if you suffer even a single blistering sunburn in childhood or adolescence; five or more sunburns at any age also double risk. This increases the importance of good habits to protect not only against sunburns but also skin cancer: apply and re-apply broad-spectrum, water-resistant sunscreen; wear protective clothing; seek shade; and avoid tanning beds. (For the young, especially, tanning beds and salons are a bad idea, no matter what vanity and peer-pressure may argue otherwise. Lawmakers across the country, especially those in California who want to bar minors from tanning beds or restrict their use, have my backing.)

Equally key -- especially for those of us who live in spots like Southern California where sun exposure is inevitable -- is to examine your skin regularly. It's easy. Stand in front of a full-length mirror, take a good hard look and search for any changes in moles, new moles or marks and any lesions not healing well. Use a hand mirror to check your backside or other hard-to-see areas.

Although melanoma can strike anyone, certain individuals are at an increased risk, including those with more than 50 moles, large moles or unusual moles. Other risk factors: having blood relatives with melanoma; fair skin; red or blond hair; and blue or green eyes. Those who have undergone a previous brush with melanoma or other skin cancers also are at heightened risk. I encourage these higher-risk people to schedule regular check-ups with a dermatologist or other health professional.

In the meantime, until medical science advances to the point of eliminating this scary cancer, an ounce of lifestyle prevention -- in this case a healthy slathering of sunscreen and a dab of thoughtful self-examination -- could outweigh a pound of later care. So don't be vain, ignorant or stubborn: if you see changes in your skin, get them checked out. Not just your appearance, but also your life, could be at risk.