Melanoma: know the facts
Posted on 28 February 2018
We have a complicated relationship with a particularly powerful universal life-force: the sun. Understand it well, and it keeps us healthy and vibrant; abuse its power and its radiation can lead to a particularly pernicious form of skin cancer called melanoma.
Melanoma affects about 1500 sun worshippers in South Africa every year, especially those with a genetic predisposition to the disease. With most cases of melanoma being identified first by the patient, it pays to be informed.
Here’s what you need to know:
Get to know your skin
It’s essential to know all the marks on your skin, be vigilant about any changes and ideally see your dermatologist annually.
If a melanoma is detected early, there is a good chance of survival. See a dermatologist once a year and do self-checks of your skin regularly following the ABCDE rule.
- A: Asymmetry
- B: Border; irregular
- C: Colour; more than one colour
- D: Diameter; greater than 6mm or any lesion which grows
- E: Elevation
‘We advise our patients to come in for annual mole maps,’ says a dermatologist at Mediclinic Potchefstroom, Dr Lize Reichert. ‘In fact, this can be started as early as the teenage years and allows us to keep a baseline record which we can build upon to detect any concerning changes to the skin’.
Any lesion on the skin that crusts and bleeds also merits an investigation. Dr Reichert adds that any new dark lesions that appear after the age of 30 should receive immediate medical attention.
If a melanoma is detected late, it becomes difficult, if not impossible to treat.
Avoid the sun and cover up first
It’s a myth that you need to be a sun worshipper or expose yourself to sunlight without wearing sunscreen in order to get enough vitamin D. Ten minutes of sun exposure and a diet rich in vitamin D such as seafood, milk and eggs will give you sufficient amounts of vitamin D.
‘The best way to protect your skin is to limit your sun exposure (seek shade or stay indoors when the sun is the strongest, roughly between 10 am and 4 pm) and use physical barriers such as hats and T-shirts,’ explain Dr Reichert. You can then cover up with sunscreen according to Dr Reichert. This means using at least seven teaspoons of sunscreen offering protection from both UVA and UVB rays. This translates to roughly one teaspoon of sunscreen on each arm, your face and neck and two teaspoons per leg.
The best treatment for early melanomas is still excision
Dr Reichert explains that removing a melanoma is the first line treatment of choice.
She cautions, however, that melanomas eventually spread vertically as well as radially, and for every millimetre that it has spread downwards, the dermatologist needs to remove a centimetre of flesh.
The patient is then referred to an oncologist for any further treatments that may be required such as chemotherapy.
‘There are also certain biological or immune therapy treatments available for patients with a family history of the disease,’ Dr Reichert explains, however they are normally quite expensive.
Unlike chemotherapy, which kills cancer cells, immunotherapy acts on the cells of the immune system, to help them attack cancer.
Checkpoint inhibitors have been approved to treat advanced melanoma (and also Hodgkin’s lymphoma and cancers of the lung, kidney and bladder). Checkpoint inhibitors are intravenous drugs that block a mechanism that cancer cells use to shut down the immune system.
Although immunotherapy is extremely successful in some cases (and especially in some melanomas), for some people the drugs either help temporarily or don’t work at all and may cause autoimmune conditions.