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Tuesday, August 20, 2013
Dear Dr. Camardi:
It is with a very heavy heart that I write to you to tell you that Mary Jo passed away in Florida at the age of 33 last month from melanoma.
She was a free spirit who loved people and loved life but I think she thought that the rules didn't apply to her.
She stopped coming to you years back after you sent her to get the first mole taken off because the dermatologist said the same things you were saying and she didn't want you or me or anybody to tell her to take the proper precautions for her skin while she was sunbathing.
What hurts me more than anything is that she had a warning with the first biopsy but she didn't change her behavior.
She just did not have to die so young.
- Rocky Mount
Malignant melanoma is an extremely lethal form of skin cancer registering an estimated 120,000 new cases per year, according to the American Cancer Society, leading to about 10,000 deaths per year.
The most common trigger of these growths is the ultraviolet radiation in sunlight that causes damage to specific skin cells called melanocytes, which allow the body to tan in response to sunshine. It's is a protective mechanism that the body has evolved , and therein lies the tale: The body considers too much sunlight dangerous.
Sunlight has two types of ultraviolet radiation that are dangerous to the skin: UVA (or "aging" rays that increase age spots and skin wrinkles) and UVB (or "burn" rays, as they lead to an increased risk of cancer).
Tanning history is important, as children who have had blistering sunburns early in life are at increased risk for developing malignant melanoma later.
It has been estimated that more than 40 percent of people suffer sunburn at least once per year. As such, how much sunlight we are exposed to over time also plays a role. This brings up the topic of using tanning booths or tanning beds.
Please talk to your doctor before using either . Melanomas often resemble moles, and most are black or brown , although I have seen melanomas presenting as blue, white, pink or red.
The guidelines for requesting a biopsy of a suspicious lesion are known as the "ABCDE" of melanoma.
"A" stands for "asymmetrical" or irregular in shape. If you draw a line down the middle of the lesion and the two halves do not match, then it's asymmetrical and you should get a biopsy.
"B" stands for border. If you look at the lesion and the margins have notches or are uneven, you should call your doctor .
"C" stands for color, and if the lesion has uneven or multiple colors, as I noted before, see a doctor.
"D" stands for diameter, and the easy guide is to compare the lesion to the diameter of a pencil eraser. If it is that size or bigger, it's time to make an appointment.
"E" stands for evolving, or changing. Any change in size, color, shape or how it may feel, including itching or bleeding, means it's time to reach for the phone.
The challenge in all of this is to "get it right" and biopsy only the cancers. Frankly, that's impossible. I'd rather do 10 normal biopsies to find one melanoma and treat it at its earliest stage.
But prevention is the best medicine. One of the most interesting aspects of this problem for me, especially in geriatrics, is how certain common medications can make your skin more sensitive to the sun. These include medications in the ibuprofen class of anti-inflammatory drugs, some antihistamines, certain blood pressure drugs, sunscreen preparations containing a substance called PABA, topical anesthetics and even herbals like St. John's wort.
These hidden issues are why you must read the drug information on any preparation you use and discuss it with your doctor before going out in the sun.
When you do go out in the sun, take a defensive attitude . Protect your skin from harmful UV radiation by checking the UV index before you go outside, and do the following: 1. Use a sunscreen with an SPF (sun protection factor) of at least 30 and reapply it often during the day. 2. Wear a wide-brimmed hat, long-sleeved clothing that is now being made with UV protectants, and UV blocking sunglasses. 3. Sunburns can happen anytime, but the key hours are between 10 a.m. and 4 p.m. 4. Sit under an umbrella or in the shade and not in direct sunlight.
The cavalier attitude that we may have grown up with regarding the sun must change. Many patients I have counseled feel all this is "way too much for beach time." Given the dire consequences of melanoma, I say it is not.
Words can't address the enormity of your loss, but accept my thanks for a chance to share this information on such an important topic .
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.
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