“We can't say with certainty what is responsible for the rise in cases of melanoma,” says Dr. Hollenberg, “but there is good reason to think that the increased risk for young women stems from the use of indoor tanning beds. Of the many risk factors for developing melanoma, the one that is easiest to control is exposure to ultraviolet (UV) radiation from the sun. What makes tanning beds so dangerous is that they emit 10-15 times more UV radiation than the midday sun.” Some states and local jurisdictions have implemented regulations aimed at preventing young people from using indoor tanning beds, such as requiring parental consent for those under 18, but the regulations are difficult to enforce. “That's why Melanoma Awareness Month is so important,” Dr. Hollenberg says. “It gives us the opportunity to help people learn how to minimize their risk and understand the importance of screening to ensure that we catch the disease in its earliest treatable stages.”
Dr. Hollenberg answers key questions about melanoma prevention, screening and risk:
How can I minimize the risk of melanoma?
The most important measure to prevent skin cancers of all types is to limit exposure to UV radiation from the sun:
Stay out of the sun during the midday hours (10am to 4pm).
Wear protective clothing, including a hat with a brim to shade the ears and neck, a shirt with sleeves to cover the shoulders and pants. The best fabric for skin protection has a tight weave to keep sunlight out.
Use a sunscreen with an SPF of at least 15 every day. Look for a sunscreen that protects against both UVA and UVB rays.
Use a higher SPF at higher elevations.
Do not sunbathe or use tanning salons! There is no such thing as a safe tan. If the skin is tan, it has already been damaged.
Who should be screened? How often?
Everyone! Unlike many other common cancers, melanoma has a wide age distribution. Rates continue to increase with age and are highest among those in their 80s, but melanoma is one of the more common cancers in young adults. Additional factors that increase risk of include having fair skin; having a history of one or more severe, blistering sunburns as a child or teenager; having many moles or unusual moles; a family history of melanoma; and a weakened immune system.
The American Cancer Society recommends periodic head-to-toe skin exams as part of routine annual checkups. In addition, medical professionals recommend monthly self-examination to identify changes in moles, freckles and other skin lesions.
What should I look for?
Skin cancers may have many different appearances. General guidelines for self-examination follow the “ABCDE” rule for danger signs:
Asymmetry: An irregular, uneven shape; one half the lesion different from the other half.
Border: Jagged or blurry edges.
Color: Various colors, often multicolored lesions of tan, dark brown, or black, sometimes pink or red, blue or white.
Diameter: 6 millimeters or larger (about the size of a pencil eraser).
Evolution: Any change in size, color, or appearance.
“The most important warning sign of melanoma is a new or changing skin lesion, regardless of its size or color, particularly if changes occur over a short period of time,” Dr. Hollenberg emphasizes. “Any suspicious finding should be brought to the attention of a physician.” The only way to accurately diagnose melanoma is with a biopsy in which all or part of the suspicious mole or growth is removed and examined microscopically by a pathologist. If melanoma is diagnosed, the next step is to determine the extent, or stage, of the cancer and the appropriate treatment. “We're seeing improved diagnosis and survival rates for melanoma,” Dr. Hollenberg concludes. “Education and prevention programs like Melanoma Awareness Month, which lead to improved screening, play an important role in combating this disease.”
Dr. George Hollenberg, founding director of Acupath Laboratories, Inc., supervises the analysis of thousands of biopsies each year, utilizing the cutting-edge technology in histology and immunocytochemistry, as well as the latest advances in computerized report preparation. He is a veteran in the fields of pathology and dermatopathology, with expertise in the areas of dysplastic nevi, melanoma and other forms of cancer. Board-certified in dermatopathology, and clinical and anatomic pathology, Dr. Hollenberg has held visiting fellowships in dermatopathology at New York University Medical Center and Jefferson University Medical Center. www.acupath.com
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