Taking Charge of the Skin You’re In: 3 Levels of Melanoma Prevention and Detection
By Pooja H. Rambhia, MD Candidate, Case Western Reserve University | 3 April 2017 | Melanoma Stories, Prevention, Treatment
No healthy person in their twenties expects they’re going to get a call one day telling them they have an invasive nodular melanoma. Despite seeing and hearing of horrible stories about young patients developing cancers, we can’t imagine it’ll happen to us. That element of surprise is exactly what 25-year-old medical student, Alissa Prior, experienced upon hearing her diagnosis.
While this younger demographic certainly may not think of themselves as an at risk group, melanoma incidence among adolescents and young adults has been on the rise, increasing upwards of 200% over the past 4 decades.The most common cancer for young adults between 25 and 29 years old, melanoma grows quickly and aggressively, and is a major cause of death in females in this age group. These alarming statistics exemplify the need for awareness and surveillance, particularly amongst a generation of young individuals who are otherwise generally quite healthy.
Alissa’s diagnosis is proof that melanoma can affect anyone. A healthy second year medical student who regularly saw a dermatologist for skin checks, it was part of her lifestyle to use sunscreen and avoid prolonged sun exposure. Taking the precautions she routinely did, it seemed improbable that she would be diagnosed with this disease. But after a classmate urged her to see a dermatologist about a concerning mole noticeable on her back, she was examined by her doctor. Days later, in the midst of her rigorous medical boards study period, Alissa was informed by her doctor that she had an invasive nodular melanoma, and was urgently scheduled to be seen by a surgical oncologist the following day. A week later, Alissa had her lesion excised with large margins in addition to three axillary lymph nodes. Pathology reports confirmed no spread of her metastatic melanoma to lymph nodes, as had been Alissa’s greatest fear. She is now grateful to be cancer free, though her story highlights the dire need to catch melanomas in an early stage to offer the best possible prognosis. The 5-year survival of stage I melanoma patients currently ranges from 92-97% and drops to as low as a staggering 15-20% in stage IV patients. These statistics confirm that early diagnosis clearly lends itself to significantly improved health outcomes.
There are a number of critical layers of protection that involve a comprehensive strategy for the prevention and early detection of melanoma. Starting at primary prevention and moving towards detection and treatment, these levels include:
LEVEL 1: DECREASE RISKY SUN BEHAVIORS
Risk factors for developing melanoma include fair skin, light hair and eye color, tanning bed use, UV exposure, family history of melanoma, more than 50 moles, sunburns at a young age, immunosuppression, and prior history of melanoma. While some of these are not modifiable risk factors, others are well within our control and deserve attention. The American Cancer Societyrecommends a number of sun protection strategies to decrease the risk of skin cancer such as sun avoidance between 10am and 4pm, use of umbrellas, protective hats, clothing, and sunscreen with an SPF of 15 or greater when sun avoidance is not possible. Despite Alissa’s low levels of risky sun behavior, she was still susceptible to melanoma, emphasizing the importance of routine and systematic skin checks.
LEVEL 2: MONTHLY SELF-SKIN EXAMINATIONS + PUBLIC AWARENESS
Heightened skin cancer surveillance begins with increased knowledge and education of irregular skin lesions, and the need to perform regular self-skin checks. The American Academy of Dermatology provides the general public with a body mole map that offers detailed information on how to look for signs of melanoma and helps patients keep track of moles/lesions – making it easy to make note of mole changes from year to year. In Alissa’s case, her melanoma was on her back – an area that was not readily visible to her. Careful monthly surveillance of more difficult to reach areas can be done with the use of a hand-held mirror to inspect the back of the scalp, neck, shoulders, upper arms, back, buttocks and legs. Monthly self-skin checks are recommended in order for patients to notice any appreciable changes.
One of the best ways to generate knowledge about self-skin checks is through public awareness campaigns, as they help younger patients understand that they too can be part of a population that is susceptible to developing melanoma. For example, the Melanoma Research Foundation initiated #GetNaked,an early detection campaign to spread knowledge and awareness about melanoma and the importance of being proactive instead of reactive. In conjunction with self-awareness, public knowledge of the importance of early detection can result in abnormal lesions of friends and family members being caught early.
LEVEL 3: ROLE OF THE MEDICAL COMMUNITY
Dermatologists play a vital role in the detection and excision of abnormal skin lesions. Patients that are deemed ‘higher-risk’ are advised to schedule yearly appointments with their dermatologist for routine skin checks. This responsibility also extends beyond the dermatologist to include primary care physicians and other medical specialties, which may have more regular contact with patients, and thus can perform consistent skin examinations for those at risk. In order to achieve a more medically diverse skin cancer surveillance network, it is vital that training be provided to other medical specialties. Increased dermatology training during pre-clinical years, during 1 and 2 of medical school, can foster a new generation of physicians, regardless of specialty, who can participate in melanoma surveillance; something that has become crucial given the staggering rise in incidence over the last 4 decades.
These three levels provide a comprehensive framework for melanoma prevention and early detection that can apply to individuals of all ages and ultimately translate to improved outcomes. Alissa’s story is testament to the fact that these proactive measures were crucial in saving her life, and can be for others as well, particularly a younger generation that otherwise considers themselves to be out of harm’s way.
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