Caring Currents

When Should We Worry About Melanoma? Now, Experts Say

Last updated: Jan 21, 2009

Here comes the sun ♫dee dah doo dah♫
Image by kyz used under the creative commons attribution license.

Rates of melanoma -- the deadliest type of skin cancer -- are rising by more than 3 percent each year, and the increase is real. It's not due to better screening and detection methods, a Stanford researcher announced last week.

Older folks of Caucasian extraction are most at risk , making this information very important for those of us watching out for the health of our fathers, spouses, and other family members.

The incidence of melanoma has more than doubled over the past 20 years, but controversy has raged among experts about whether the increase in cases is simply due to better detection, or because melanoma really is becoming more common.The new study suggests it's the latter,  says Eleni Linos, who led a team from the dermatology department at Stanford University Medical Center.

Linos examined more than 70,000 cases of melanoma diagnosed between 1992 and 2004 and found that melanoma rates went up over all socioeconomic groups -- even those at the lower end of the spectrum with less access to health care. Also, the increase held true over all levels of tumor thickness.

Why does this matter? Because it suggests that better detection is not simply catching more early stage tumors -- there simply are more of them to catch. The researchers were particularly alarmed by the rapid increase in thicker, or later-stage melanomas, because skin cancers detected later are harder to cure. They were also concerned about an increase in melanoma in younger women, which they attributed to tanning .

Catching melanoma early and treating it aggressively is hugely important; The five-year survival rate for those whose melanoma is detected early is 92 percent compared with less than 50 percent for those whose cancer is already Stage IV. Last year I saw this tragedy unfold at close hand when an old friend lost her father -- who loved to fly fish and would fish all day whenever possible -- to melanoma that wasn't caught until it had spread to his liver.

So make sure your parents, other family members -- and you -- get every suspicious mole checked out as soon as you notice it. Also, make sure your doctor's up to date on some key research that can make a big difference in determining whether a melanoma has begun to spread, or metastasize. Everyone diagnosed with melanoma needs to ask their doctors about:

  1. A sentinel node biopsy. Melanoma is much more likely to prove fatal if it has spread to the lymph nodes, but only 20 percent of those with melanoma have lymph node involvement. A procedure called lymphatic mapping and sentinal node biopsy pioneered by Donald Morton of the John Wayne Cancer Institute in Santa Monica, California, showed that finding the "sentinel" lymph nodes and screening them for melanoma cut recurrence rates by 26 percent.
  2. The "MCW melanoma cocktail" test. This is a new quicker detection method developed at the Medical College of Wisconsin that allows doctors to test the sentinal lymph nodes for cancer cells while the patient is still on the operating table. Instead of waiting 24 to 48 hours for results to come back from the lab, patients can have results from the "MCW melanoma cocktail" test within 30 minutes and, if cancer cells are present, can have their regional lymph nodes removed during the same surgery.
  3. immediate removal of all lymph nodes if sentinel node test is positive. Morton's recent research has shown that if the sentinel nodes are found to have cancer, it's best to have all the lymph nodes removed immediately. Of those treated this way, 71 percent were cancer-free after 5 years, compared with 53 percent who did not have their lymph nodes removed.

Lastly, as the days begin getting longer and we look towards Spring, remember to avoid dangerous sun exposure. Experts recommend maintaining a careful balance; 15 minutes a day to boost vitamin D production, but if you're going to be out longer than that, it's essential to cover up as much as possible and use a strong sunscreen.