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Melanoma: Not Just a Summer Disease

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7 common myths that can increase your risk.

When the temperatures drop outside, most people assume that they’re at much lower risk for sun-related conditions such as melanoma. But that’s a myth.

What you may not realize: Temperature does not affect the intensity of ultraviolet (UV) radiation, so the sun exposure you get in the winter can be just as damaging as what you get in the summer.

Fortunately, there are plenty of steps you can take to minimize your risk for melanoma—the deadliest skin cancer—but you must be able to separate the myths from reality. Seven common myths…

MYTH 1: Melanoma is a rare disease. Most Americans get regular cancer screenings, including mammograms and colonoscopies. Yet many of the same people have never been screened for melanoma. They assume that they don’t need to be screened, especially if they’re careful to avoid too much sun.

Fact: More than 70,000 Americans are diagnosed with melanoma annually. This exceeds the annual incidence of other cancers such as malignancies of the thyroid or pancreas and non-Hodgkin’s lymphoma.

In addition to performing regular self-exams of their skin, most adults over age 50 should receive a head-to-toe annual skin exam by a doctor who can see places you can’t. People with a family history (especially in a parent, sibling or child) of any type of skin cancer and those with fair skin, blond or red hair and/or light eyes should speak to their doctors for advice on screening frequency. Among Caucasians, the lifetime risk of getting melanoma is about one in 50. The risk is lower in Latinos and African-Americans.

MYTH 2: You can’t get melanoma if you avoid the sun. Reducing sun exposure—with sunscreen and protective clothing, for example—substantially lowers one’s risk for melanoma but does not eliminate it.

Fact: Melanoma can occur on any part of the body, including places that sunlight doesn’t hit, such as near the anus, between the toes and even on the genitals.

Research has shown that intermittent and intense sun exposure on areas that are usually covered, such as the trunk, arms or legs, is a major cause of melanoma.

MYTH 3: Sunscreen prevents melanoma. It helps but is not a guarantee.

Fact: Most people who use sunscreen and then spend the day outside are probably exposed to enough UV radiation to increase their risk for melanoma or other skin cancers.

Reason: Every sunscreen has a sun-protection factor (SPF) number. In the laboratory, a high SPF translates into more sun protection, but most people don’t understand how to achieve this in real life.

When manufacturers test sunscreens, they apply 2 mg of sunscreen per square centimeter of skin. Then a number is assigned to the product, depending on how quickly the skin shows UV-related changes. For the average adult to achieve the same level of protection, he/she would have to apply 1.4 ounces (the amount held in one shot glass) of sunscreen over his/her body.

Virtually no one uses that much. An average-sized tube would be gone after just three or four applications. A product with an SPF of 30 in the laboratory might rate only 10 in real-world applications.

Sunscreen does help but not as much as such protections as wearing tightly woven clothing (which doesn’t have to be reapplied and isn’t greasy) and staying in the shade (away from the reflection from snow, sand, etc.).

My advice: Opt for a sunscreen product with an SPF of at least 30…apply the amount recommended above…reapply it every two hours…and make sure that it provides protection against both UVB (sunburn-causing) radiation, which mostly damages the skin’s superficial layers, and UVA (cancer-causing) radiation, which penetrates more deeply than UVB rays.

Recommended products: Coppertone UltraGuard…Neutrogena Ultra Sheer Dry-Touch Sunblock…and Banana Boat SunWear. These have been shown to provide good UVB/UVA protection.

Also be sure to use sunscreen throughout the winter months—and don’t forget your lips, backs of your hands and tops of your ears. And wear sunglasses with total UV protection—excessive sun exposure may increase risk for melanoma in the eye and does increase risk for eye conditions such as cataracts. Even if you’re trying to get your vitamin D from sun exposure, don’t stay in the sun more than 10 minutes without protection.

MYTH 4: Tanning booths are safer than they used to be. The tanning industry tells customers that getting an artificial tan will help prevent sunburns and cancer. They also claim that tanning is necessary to produce vitamin D.

Fact: The lights that are used in tanning booths primarily emit dangerous UVA radiation…vitamin D is mainly synthesized from exposure to UVB. Getting a tan never reduces the risk for melanoma—every tan is dangerous.

Important finding: In a study published in the Journal of the National Cancer Institute, people who used tanning salons at least once a month were 55% more likely to develop melanoma than those who don’t get artificial tans.

MYTH 5: You’re safe in the car. Many people assume that they’re protected from the sun when traveling in a car. However, during long car trips on sunny days, it’s common for exposed skin to redden if it’s near the car window.

Fact: Car window glass blocks UVB exposure but only 30% of UVA. But factory-coated windshields block most UVB and UVA radiation.

Important research: A study in the Journal of the American Academy of Dermatology that looked at melanomas that occurred on one side of the body found 52% on the left side. In Australia, where the driver’s seat is on the right side of the car, more melanoma is found on that side.

Helpful: Tinting the side windows even further can help. More important: Wear a long-sleeved shirt on long car trips…keep the window closed…and use sunscreen.

MYTH 6: Melanoma appears as an ugly black mole. Some melanomas are ugly and some are black. Just as often, they’re neither. People who don’t know this can miss the chance for an early diagnosis.

Fact: Many melanomas are amelanotic—that is, they don’t produce melanin, which means they can resemble normal skin. Or they might be pink, purple or red.

Important: Look for a mole or other type of skin change that looks different from other moles and skin in the same area.

When you examine your own skin once a month, also be alert for moles that could be described by A, B, C, D or E: Asymmetric, in which the two halves of a mole are different…an irregular Border…variations in Color…a Diameter greater than 6 mm (about one-quarter inch)…and Evolution, a change in the appearance over time.

MYTH 7: Melanoma is usually fatal. Melanoma is often described as a lethal skin cancer.

Fact: It’s a dangerous cancer because it’s more likely to spread than many other cancers. Between 8,000 and 9,000 Americans die from melanoma every year.

Good news: More than 95% of melanoma patients survive if the cancer is detected and removed at an early stage, when patients need only minor surgery to remove the cancer and no chemotherapy or radiation. Once the cancer is removed, it’s unlikely to return.

More advanced cancers don’t respond as readily to treatment—but with new developments, the survival rate is increasing. For example, a study of 675 patients with particularly dangerous melanoma tumors found that the drug vemurafenib (Zelboraf) reduced the risk for death during a recent six-month study by 63%. The drug was approved by the FDA for late-stage melanoma late last year.

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Source: Steven Q. Wang, MD, director of dermatologic surgery and dermatology at Memorial Sloan-Kettering Cancer Center in Basking Ridge, New Jersey. He specializes in melanoma and other skin cancers, and the use of microscopically controlled (Mohs) surgery for treating skin cancer. He is the author of Beating Melanoma: A Five-Step Survival Guide (Johns Hopkins). Date: February 1, 2012 Publication: Bottom Line Health
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