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The Latest on Skin Cancer: Avoiding Melanoma

IF YOU’D SURVIVED melanoma – the deadliest form of skin cancer – you’d avoid the sun like the plague, right?

Unfortunately, that’s not always the case. When it comes to patients who’ve gone through melanoma treatment, recent findings on prevention are mixed. Just as a new study reinforces that regular self-checks remain the first line of defense, other research finds some survivors may be too casual about their subsequent sun exposure.
[See: 7 Ways to Prevent Skin Cancer.]

Say, instead, that you’re a habitual tanner who’s fortunately escaped skin cancer so far. Experts want you to realize it’s far better to prevent melanoma and other skin cancers than to someday require treatment. Covering up and staying out of strong midday sun is your best bet to sidestep key risk factors. But if you can’t avoid sun exposure, finding a good sunscreen and using it properly is vital.

On Tuesday, the Environmental Working Group released its latest annual sunscreen guide, including lists of the best and worst sunscreens for kids. EWG, a nonprofit organization advocating for health and the environment, emphasizes that sunscreen alone is not enough to prevent melanoma, and should be considered the last resort for protection.

The EWG advises consumers to steer clear of products with SPFs higher than 50-plus, which the group refers to as a “marketing gimmick” in its guideline announcement. “SPF values over 50 mislead people into thinking they are completely protected from sunburn and long-term skin damage,” David Andrews, a senior scientist at EWG, says in the statement. “But instead, they may encourage people to spend more time in the sun, exposing themselves to more, not less, ultraviolet rays.” In addition, he says, SPF 30 and SPF 100 products generally contain the same amount of the primary ingredient used to reduce dangerous UV ray exposure.

Avoid sprays as well, EWG recommends, because they don’t provide a thick, uniform coating on the skin, and pose inhalation concerns. Also avoid sunscreens with additives such as oxybenzone, which may disrupt hormones, or vitamin A, which is potentially harmful to sun-exposed skin. The new guide also offers advice on decoding sunscreen labels to help consumers pick the right products to avoid sunburn.

Sunburns are never a good sign, particularly for patients who’ve already had melanoma. While survivors are more likely to limit their sun exposure than people who’ve never had skin cancer, some melanoma patients continue to seek suntans and develop sunburns, according to a studypublished in the April issue of Cancer Epidemiology, Biomarkers & Prevention.

Lead author Rachel Isaksson Vogel, an assistant professor of obstetrics, gynecology and women’s health at the University of Minnesota, and colleagues compared behaviors of nearly 725 melanoma survivors to those of 660 people who’d never had skin cancer, all between ages 25 to 59. Those in the survivor group were diagnosed with invasive melanoma between mid-July 2004 and December 2007.

Melanoma survivors were somewhat less likely to spend an hour outside on summer weekdays, significantly less likely to have used a tanning booth or bed in the previous year, and half as likely to have suffered a sunburn in the previous year than other participants. Nearly 62 percent of survivors usually wore sunscreen, compared with about 38 percent of the rest.

“A lot of people don’t understand how serious melanoma is,” Vogel says. “It’s not quote-unquote just another skin cancer. These data apply to everybody. As much as I’m upset that 20 percent of melanoma survivors reported a sunburn – it was 40 percent in the control group. We all need to be doing a better job at preventing sunburn. Because we’re all at risk for skin cancer. Some people just are at greater risk than others.”

Older men and younger women are most affected by melanoma, Vogel says. While it’s more common in the former, melanoma rates are rising for the latter. For young women, she says, indoor tanning is likely most to blame, “but it’s also that desire to be tan however you obtain that tan.”

Survivors who aren’t careful about protecting themselves may be playing with fire, so to speak. “Some people, if they have a relatively benign experience with melanoma – they go into the office; they find out it’s melanoma; it’s removed; and that’s it for them,” Vogel says. “They might not really understand that it’s aggressive and it can be deadly.”
Protection from sun exposure must become a habit, Vogel says: “Make it routine that you put sunscreen on in the morning; that you primarily wear long-sleeve shirts; that you stay in the shade; that you have a 7 a.m. golf time instead of the middle of the day.”

It’s not enough to depend on sunscreen alone, although it’s a must when heading out into the sun. Sunscreen should be applied thickly and reapplied frequently. “And you need to put it on before you’re out in the sun,” Vogel says. “Most of us are not good at any of those.”

[See: What Causes Cancer? 5 Unlikely Claims Explained.]

Behavior change, whether it’s quitting smoking or sunbathing, is a tough nut to crack, health experts agree. “In a lot of younger people, these melanomas are probably caused by really bad burns or tanning salons,” says Dr. Adam Berger, a professor of surgery at Thomas Jefferson University in Philadelphia.

Indoor tanning is a source of frustration for health professionals who deal with its consequences. Recent laws that limit access for minors represent welcome progress. However, that doesn’t mean indoor tanning has stopped taking a toll. “I even have middle-aged men who are using tanning salons, which blows me away,” Berger says. “There’s all kinds.”

Climate change could be raising the risk for skin cancer as well, Berger says. “I do think there’s been a change in the quality of the UV light that we’re all getting and it’s probably related to climate change,” he says.

In his patients with melanoma, Berger sees the aftermath of indoor tanning and outdoor sun. “I have a lot of older patients who develop melanomas from skin damage chronically over years and there’s really not a lot we can do about that,” he says. “But they’re still pretty good about trying to stay out of the sun.”

Unfortunately, melanoma isn’t always a one-and-done condition. “About 30 percent of patients with stage 2 melanoma develop recurrence,” Berger says. “Even though people have surgery and have it removed.”

Vigilance is essential for melanoma patients, as evidenced by a new study that Berger co-wrote. Investigators from Thomas Jefferson University and the University of North Carolina analyzed data on 581 patients with stage 2 melanoma who were followed for at least one year.

In 40 percent of cases, patients picked up on their own melanoma recurrences via skin self-checks, revealed the study published in the April issue of the Journal of the American College of Surgeons. Thirty percent of recurrences were detected in scheduled physician exams and 26 percent showed up in routine imaging tests.

By doing skin self-checks, patients found new lumps or skin discolorations, spurring them to call the doctor. Other suspicious symptoms included shortness of breath or a persistent cough, seizures and bowel troubles. These symptoms led to imaging tests to make the repeat diagnosis.

With better cures for more advanced melanoma treatments now available, early detection is more important than ever. In what Berger calls a “sort of revolution in melanoma treatment” over the past seven years or so, more effective agents – such as Keytruda, Yervoy, Opdivo, Zelboraf and Mekinist – have been approved for metastatic and stage 3 melanoma.

[See: What Only Your Partner Knows About Your Health.]

Unfortunately, the need for melanoma treatments keeps growing. The Surveillance, Epidemiology and End Results program, part of the National Cancer Institute, estimates that more than 87,000 new melanoma cases will occur this year, and about 9,700 people will die of skin cancer.

You can visit the American Cancer Society online to learn how to perform a skin self-exam and get an idea of what skin cancers look like. Contact your health provider if you find any suspicious growths or abnormal-looking moles, and for more information.

Source: Health US News

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