Julie had numerous moles, and she had come to take them for granted. When she noticed that one on her leg was beginning to grow bigger and change in shape and color, she promptly reported it to her doctor.
The growth on her leg was melanoma, the most serious of skin cancers. When melanoma is detected early and removed, as Julie's was, treatment and recovery are uneventful, with a survival rate of about 98 percent. When it goes unnoticed, a seemingly insignificant growth can develop rapidly into an invasive, life-threatening cancer. For melanoma that has spread to other parts of the body, the survival rate is only about 16 percent.
Any spot on the skin that develops a sore that does not heal completely within two weeks, continues to itch, or occasionally bleeds easily, should be checked by a doctor. It may not be cancer, but it is better to be safe than sorry.
With about 55,000 new cases a year, melanoma represents only 5 percent of all skin cancers, but it is the most deadly, accounting for 71 percent of skin cancer deaths. And incidence is growing steadily at about 3 percent a year.
The good news is that Americans are becoming better at detecting and reporting suspicious growths early. The bad news is that they continue to follow a sun-centered lifestyle that increases the risk of skin cancer.
All skin cancers are associated with exposure to the ultraviolet (UV) rays of sunlight. For the less serious types of skin cancer, basal and squamous cell carcinoma, the correlation is direct. These cancers are more likely to occur on sun-exposed skin of older persons who have spent a good part of their lives outdoors.
For melanoma, the relationship is more complex and ambiguous. Persons who have worked outside all their lives have a lower risk than those who have worked inside, and melanomas often develop on areas of the body rarely exposed to the sun, such as the sole of the foot.
For most Americans, youth is the time of greatest exposure to the sun, and it's generally believed that melanoma occurs after many years in persons who suffered even one or two bad sunburns in adolescence or childhood. Another theory is that intermittent may be worse than constant exposure.
UV rays may also affect the body in less direct ways. One recent study found that children with numerous moles (a risk factor for melanoma) developed fewer moles and freckles on unexposed, as well as exposed, areas of the body when they used sunscreen for a three-year period.
Researchers now believe there may be at least two different types of persons likely to get melanoma � those who develop cancer in response to high sun exposure and those with a genetic susceptibility.
At greatest risk are fair-skinned persons � particularly redheads and blondes with a tendency to have numerous freckles or moles. The number of moles a person has is a strong predictor of future risk, and exposure to the sun typically increases the number of moles in these persons. Dark skin offers protection, but African Americans can and do get melanoma as well as other skin cancers.
For prevention, dermatologists stress the importance of protecting your skin with clothing and sunscreen (SPF of at least 15) any time you venture into the sunlight. Long pants, long-sleeved shirts and tightly woven, dark colored fabrics are best. And it's best to avoid direct exposure to sunlight during the most intense periods � 11 a.m. to 1 p.m.
The other major preventive strategy is to try to identify suspicious skin growths at an early stage through regular skin examinations � by you and by your health care professionals.
Some early melanomas resemble a mole and may develop out of an existing mole or a new one. It's important to keep an eye on all lesions on your skin and look for anything new, unusual or different.
The formula for detection is ABCDE: Asymmetrical in shape; irregular Borders, Color that's variegated with black, brown, tan and sometimes red, white or blue; Diameter greater than six millimeters, and Elevation above skin level. E could also be for Evolution: Whether from an existing or new growth, the melanoma is likely to change very rapidly, in size, color and overall appearance.
Several benign skin growths display at least some of these traits and can be easily be mistaken for melanoma. At the same time, many melanomas have traits subtle enough that they go unnoticed even by trained eyes.
The best course is to avoid the sun as much as possible and know your ABCDEs. Become familiar with all the spots, freckles, moles and growths that inhabit your skin, and if you spot an "ugly duckling," don't lose time reporting it.