August 4, 2006

Doctor’s Corner:

Malignant Melanoma, a deadly form of skin cancer

By Eduardo Grunvald, M.D.

One of the most difficult cases I have encountered in my career involved a 35-year-old Mexican mother of three young children. I first met her during hospital rounds. She was one of 15 patients that morning. But unlike the others, she would not survive her illness.

This young mother was suffering from malignant melanoma, a deadly form of skin cancer. Six weeks later she died.

Tragically, her untimely death may have been preventable.

Melanoma is a type of cancer that if caught and treated early can be completely cured. It is the seventh most common cancer in the United States. In 2005 approximately 40,000 Americans were diagnosed with early melanoma and another 60,000 were diagnosed with the advanced form. Since 1930 it is estimated there has been a 2000 percent increase in the incidence of this disease!

If detected at its earliest stages, long term survival rates reach nearly 100 percent. At later stages the survival rates drop to anywhere between 15 and 65 percent, depending on the extent of spread.

Melanoma is much more common in Caucasians, but Hispanics may be at higher risk of dying of this disease because of decreased access to medical care and other reasons that may delay early diagnosis. Whether you are dark or light complected, don’t ignore what your skin can tell you.

Although melanoma is the least common of several types of skin cancers, it is clearly the most aggressive. It develops when melanocytes – the cells that produce the pigment in the skin and make typical moles – start to reproduce uncontrollably.

The major risk factors include a history of extensive sun exposure and fair skin. So why are Hispanics, who are less likely to have high risk skin types, more likely to die from this cancer?

For a variety of reasons, according to experts, many are less likely to seek medical care for routine preventative services or minor problems, resulting in a decreased likelihood that early skin cancers will be diagnosed. To compound this problem, skin cancer detection efforts usually target whites more intensely than Hispanics. And medical providers in general are less likely to have melanoma on their radars when encountering patients at lower risk.

Historically, most public health studies have focused on non-Hispanic whites. Earlier this year however, a study from the University of Southern California detected a rising incidence of advanced melanoma in Hispanic males living in this state.

The message is to take responsibility for self-surveillance of any suspicious moles or skin lesions. In general, moles that have irregular borders, different colors or shades within the borders, large size, or do not look the same from one side to the other should be evaluated by a medical professional. Even if just one mole looks different, check it out.

Melanoma is a very sneaky cancer. It is notorious for not following rules. In fact, it can appear on areas not typically exposed to the sun – in-between the toes, behind the ears, under toenails. In Hispanics and African-Americans it is also more likely to present in the legs or feet, areas that are less commonly examined closely.

No one is immune to this deadly disease. Raise the issue of skin cancer screening with your doctor. Your own vigilance may save your life.

Dr. Grunvald is Assistant Clinical Professor, Department of Medicine at the Perlman Internal Medicine Group, UCSD Medical Center.

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