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There has never been a generation more aware of their bodies than the baby-boomers. Early detection is our mantra; we scrutinize every bump, blotch and bowel movement as if we expect to find the Holy Grail spelled out in a rash on our abdomens. This would make one think that melanoma, one of the more treatable cancers if detected early, hasn’t got a chance to kill anyone.
Unfortunately, we also spent long summer days cultivating what was erroneously called a “healthy tan”. That notion has proven difficult to displace. We know now that any darkening of the skin is a sign of damage, but, strangely, we still think we look healthier with a tan. And, of course, we forget our sun screen or think it should hold up after twelve hours at the beach, ten of which were spent in the water. So we’re absolutely fried, and then develop melanoma as the ultraviolet radiation of sunlight affects the DNA in the skin cells. It also may act to suppress the immune system.
First, we need to understand how human skin is constructed. It has two layers, the epidermis, which is what we can see, and the lower layer, the dermis. It’s in the epidermis that skin cancers develop. Melanocytes in the epidermis produce a dark pigment called melanin that is fed to the cells above it, keratinocytes. Melanoma is
melanocytes, affected by ultraviolet radiation and some other things, that have run amok, growing wildly in one place.
The common skin cancers are squamous cell or basal cell. These are also caused by exposure to the sun, but are rarely life-threatening. Melanoma has the tendency to spread to other parts of the body (metastasis) through the lymph system and the blood, sometimes very quickly. Favorite destinations are the lungs, liver, and brain. That is what makes it a dangerous cancer. But its early signs are right out there to see, which makes it easier to catch at an earlier, treatable stage with an excellent prognosis. Everyone, check your moles!
Moles (nevi or in the singular, nevus) the size of a pinhead most frequently appear in childhood as a reaction to sun exposure. Most are benign and insignificant, but all
have the potential to become melanoma. They can be removed surgically, or you can just keep a weather eye on them throughout your life. According to Marianne Berwick and associates in the Journal of the National Cancer Institute, as of 1996, those maintaining vigilance are 44% less likely to die of melanoma than are those who aren’t. If you’re in a high risk group, such as those with a family history of melanoma, people that have had basal or squamous cell cancers, those who live near the equator where ultraviolet rays are strongest, or work outdoors, check yourself monthly. Use the ABCDE’s of melanoma...Asymmetry (the growth has an irregular shape), Border irregularity (the border is irregular or notched, not a smooth or oval shape), Color variation (different tones of tan, brown, black, blue, pink or white), Diameter (larger than 6 millimeters or one that is clearly growing), and Elevation (some melanomas are slightly elevated or develop a bump). A previously unbothersome mole may start to sting or itch, and some melanomas are just plain ugly. If something doesn’t seem right, show it to your regular physician. If they’re not alarmed, but you still are, get a second opinion from a dermatologist.
To obtain an accurate diagnosis, a biopsy of the suspicious-looking mole will be done. It will either be removed in its entirety surgically, after a local anesthetic is injected, or after it has been quick-frozen. If it’s a large mole, a “punch” biopsy of the most worrying area is done; a “shave’ biopsy can be done in the area of the face. The material will be sent to a pathologist; the diagnosis should be ready within a week. If it is melanoma, this report will indicate its biological growth state. Is it still just growing outward from center (radial growth) or has it begun to penetrate the skin? The level to which it has penetrated determines its “Clark” level, named for Dr. Wallace Clark, who in 1969 categorized all melanomas by level, thus distinguishing those which were most likely to spread to other places in the body.
The severity of melanoma is broken down into stages, 0 through IV. Stage 0 means that the abnormal cells are found only on the surface of the skin, with no penetration of deeper tissues. Stage I means that cancer has been found in the outer layer of the epidermis, and may
have invaded the upper part of the dermis, but shows no signs of having spread to the lymph nodes. Stage II, it’s in the lower part of the dermis, but, again, not the lymphatic system, Stage III, it may have satellite tumors near the original tumor, it may have spread to the lower layers of the skin, the lymph nodes and possibly to other parts of the body. In Stage IV, the tumor has spread to other organs or is found in lymph nodes far from the original site. Recurrent disease means it went away after treatment, but has come back.
Melanoma metastases that are close to the original tumor are called regional metastases; ones that have traveled to other areas of the body are distant metastases. The regional ones are first removed surgically, then adjuvant therapy is used to eliminate any disease that may crop up in other parts of the body. Adjuvant treatment may consist of radiation or chemotherapy. If there are many metastases on an arm or leg, a tourniquet is applied to isolate the blood supply and drugs are injected into the artery supplying that limb (regional perfusion). This avoids affecting the whole body with the toxic chemicals. Distant metastases may be difficult to locate and treat effectively; prognosis can be poor for those patients.
Radiation therapy uses high energy x-rays to kill cancer cells, or involves the injection of radioisotopes in the areas where cancer has been found. The use of Alpha-Interferon to bolster the immune system has been tried with about a 10% success rate, as of 1996.
A new treatment has shown some promise for those whose cancer has spread; clinical studies are still being done by Amgen Pharmaceuticals of CancerVax, a BRM (biological response modifier) that may enable the body’s immune system to fight the disease. Other BRN’s are being studied intensely as well. Ask your doctor about clinical studies being conducted in your area, or contact the American Cancer Society at 1-800-227-2345, The National Cancer Research Institute at 1-877-226-2373, or the
American Association for Cancer Research, Philadelphia, PA. There are many informative websites, message boards and chat rooms where you can find answers to your questions- keyword, melanoma.
Stay informed, keep an eye on yourself, get your tan from a bottle, and be well.
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