Dermatologists and skin cancer experts, especially before and during the summer months, write articles and give speeches on the harmful effects of sun exposure on the skin: the risk for melanoma and other skin cancers and premature aging of the skin. Despite all efforts, beaches are filled with people tanning in the midday sun, streets are filled with people with a pink-red burnt or bronze skin and tanning salons are filled with clients. Why can’t we deliver our message? Tanning is harmful to our skin just like smoking is harmful to our lungs.
Melanoma is the deadliest form of skin cancer. One person dies every hour from melanoma in the U.S. There are more than 76,250 estimated new cases of invasive melanoma in the U.S. annually resulting in over 9,180 deaths per year. It is the fifth and sixth most common cancer in men and women, respectively. If melanoma is diagnosed early, it is typically cured with surgery. However, advanced disease has a poor outcome and can lead to death.
Warning signs of melanoma. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. The ABCDE rule of melanoma indicates that melanomas are typically asymmetric, have irregular borders, irregular color, a diameter greater than 6 mm, and evolve. However, not all melanomas follow this rule and have all of these characteristics.
What are the risk factors for melanoma? Everyone is at some risk for melanoma. However, increased risk depends on several factors: fair skin, increased sun exposure, increased number of moles, dysplastic or atypical moles (benign moles with special features), large moles from birth, having had melanoma and other persons in the family with melanoma.
Melanoma as a genetic disease. Cancer results from an accumulation of genetic changes in the DNA that leads to uncontrolled growth of cells. Thus, melanoma is a genetic disorder. Even though melanomas can look similar on the skin (usually brown or black and irregular), recent studies show that genetic changes in one melanoma can be quite different than the other. These findings imply that there are many different types of melanomas. The future requires genetic characterization of a person’s melanoma and treating the patient based on these findings.
The link between melanoma and sun exposure. The majority of melanomas develop on the skin (~95 percent). Rare forms are present such as those that develop in the eye, mouth, gut and the genitalia. Clinical studies that were carried out in the past decades suggested sun exposure (ultraviolet radiation) as a critical factor in promoting melanoma development of the skin. Recent genetic studies examining changes in the DNA now provide evidence that melanoma of the skin is closely related to ultraviolet-related damage. One exception, however, is the sun-protected sites of the skin, such as palms and soles, for which the reason of their development is beyond sun exposure. These recent scientific studies confirm sun exposure as a critical element in the majority of melanomas of the skin.
Tanning and indoor tanning (tanning booths or beds) increase one’s risk for melanoma. Indoor tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors. Those who tan indoors only four times a year increase their risk of developing melanoma by 11 percent. There is an alarming increase of melanoma among young women possibly due to increased use of indoor tanning in this age group.
These studies provide further evidence linking sun exposure to melanoma. One can avoid harmful sun exposure by avoiding the midday sun (11 a.m.-4 p.m.), using protective clothing and by frequent sun block (SPF>30) application. Indoor tanning should never be used. More importantly, one can enjoy the summer months without being subjected to significant levels of ultraviolet radiation by using these measures.
As in other cancers, prevention strategies are of utmost importance. Routine skin cancer screenings and close surveillance of individuals at high risk for melanoma lead to early recognition, treatment and cure. May is Skin Cancer Awareness Month. In May, free skin cancer screenings are offered by dermatologists throughout the U.S. The Mount Sinai Department of Dermatology will be conducting a free Melanoma Cancer Screening on Thursday, May 23. We are encouraging everyone to take this potentially lifesaving step by coming in to obtain a total body skin examination. This free screening will be held between 3-5 p.m. We will be accepting all walk-ins. No appointment is necessary. Have skin cancer screenings and save your life.
Tanning not only predisposes individuals for melanoma, but for other skin cancers and for premature skin aging: wrinkles, sagging of the skin, brown and red spots. Do you still want to tan? Do you still want to ignore skin cancer screenings? Wake up America!