August 23, 2014 | by Kim Proescholdt
With Labor Day just around the corner, summer is on its way out. But just because summertime is ending doesn't mean we can skip sunscreen. Protection from ultraviolet (UV) radiation is needed all year round. Exposure to UV radiation — whether from the sun or from artificial sources such as sunlamps used in tanning beds — increases the risk of melanoma, the deadliest form of skin cancer.
Here, Jae Jung, M.D., Ph.D., assistant professor in dermatology at City of Hope, shares simple prevention tips to lower the risk of melanoma. She also explains that the disease is almost always curable if detected and treated in its earliest stages.
What is melanoma and what causes it?
Melanoma is a type of skin cancer. It arises from melanocytes, the cells that produce pigment in our skin. They are most common in sun-exposed areas of the skin, but can arise anywhere including under the fingernails, oral or genital mucosa, and eyes.
Melanoma is usually caused by too much UV exposure, either from natural sun or in tanning booths. Use of tanning beds can increase your risk of melanoma by 75 percent. Patients with fair skin, light hair and eyes, have a propensity to sunburn and are at higher risk of developing melanoma. Patients with many moles (greater than 50), atypical moles, and a family history of melanoma are also at increased risk.
How can one reduce their risk of getting melanoma?
For most patients, protecting your skin from UV radiation is the best way to reduce your risk. Use sunscreen and reapply frequently, typically every one to two hours if you are in the sun. Sunscreen labeling can be confusing. I generally recommend using sunscreen with an SPF (sun protection factor) of at least 30 with broad spectrum coverage (blocks both UVA and UVB). In actual daily use, patients tend to under apply sunscreen, and studies have shown some benefit of the higher SPF lotions in these situations.
Use of protective clothing is also a great way to reduce UV exposure and is critical for those people who enjoy outdoor hobbies where it is not practical to continuously reapply sunscreen. The amount of visible light that you can see through the fabric does not necessarily correlate with the amount of UV that passes through to your skin. UPF (ultraviolet protection factor) 50 is the highest rating for sun protective clothing (UPF ratings are similar to SPF ratings for sunscreen).
How can one tell the difference between a regular mole and melanoma?
Melanomas generally have five features distinguishing them from benign moles and can be remembered easily as the “ABCDE” of melanoma. “A” is for asymmetry. Melanomas tend to be asymmetrical rather than round or elliptical. “B” is for border. The borders of melanomas are often scalloped, irregular or blurred. “C” is for color. Melanomas have different shades of tan, brown or black. They can have unusual colors like red, white or blue. “D” is diameter. The majority of melanomas are greater than 6 mm, about the size of a pencil eraser. “E” is evolving. Melanomas change in size, shape and color.
Is melanoma hereditary?
Only a small percentage, about 10 percent, of melanomas are familial. But the development of melanoma is associated with many heritable traits such as fair skin, red or very blonde hair, blue or green eyes, and large numbers of moles. A family history of melanoma or pancreatic cancer can also increase your risk of melanoma.
What new and innovative melanoma treatments are available at City of Hope?
Melanoma treatment has really changed over the last few years. There are many new targeted therapies that are prolonging disease-free survival without severe toxicities. There are immunology-based therapies that have given even metastatic melanoma patients complete and lasting remissions. New treatments currently in clinical trials promise even more robust responses.
What advice do you have for patients recently diagnosed with melanoma?
Melanoma is easily treated when caught at the earliest stages. Melanoma in situ (stage 0) and Stage 1 melanomas can be completely cured with re-excision by a dermatologist or surgeon. However, thicker melanomas (Stage II and III) or metastatic melanomas are best treated by a multidisciplinary team of physicians and I would strongly recommend treatment at an NCI-designated cancer center like City of Hope. These institutions will have the most access to new therapies and clinical trials.
Since even thicker melanomas are curable with surgery for early stage disease, an experienced melanoma surgeon is critical for performing appropriate surgery and sentinel lymph node biopsy. I would also make sure that the pathology is reviewed since discordance is common, even among experts. A medical oncologist that specializes in melanoma is critical since they will be familiar with new therapies and help to enroll patients in clinical trials if patients qualify.
Ongoing evaluation by a dermatologist is also important because patients are at higher risk for developing additional new melanomas as well as nonmelanoma skin cancers. Dermatologists can also help manage many of the cutaneous side effects of chemotherapy. Any patient diagnosed with melanoma should have their family members examined for skin cancers since they are now at higher risk as well.
Why did you choose this specialty? What inspires you to do the work you do?
My inspiration comes from my patients. I am always amazed by their resilience, optimism and tenacity. I first became interested in the immunology of the skin and studied chronic wound infections as a medical student. As a resident, I also became interested in melanoma and the development of potential vaccines that harnesses the skin’s immune system to help fight cancer as well as infections.
Now, at City of Hope, I hope to translate our basic science research into clinical trials that can benefit patients with melanoma as well as other tumors. I am also very interested in skin immune system dysregulation seen with graft-versus-host disease, which can be a life threatening complication from bone marrow transplantation.
Learn more about skin cancer treatment and research at City of Hope.
Also, check out: Sunscreen 411: Tips on protecting your skin from the sun.
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