Melanoma Day was observed recently. The Sunday Observer spoke to Consultant Dermatologist and a senior member of the Sri Lanka College of Dermatologists, Dr. Januka Galahitiyawa to get more answers to this emerging disease which is still unfamiliar to most people in Sri Lanka.
Following are excerpts.
Q. Melanoma Day was observed recently. What is Melanoma and why is it important to set aside a special day to discuss it? As this is a subject most readers are unfamiliar with, can you explain what it is in simple layman language for their benefit?
A. Melanoma (also called malignant melanoma) is the most serious type of skin cancer, that starts in the pigment-producing skin cells (melanocytes) and the number of melanoma cases diagnosed annually is increasing faster than that for any other cancer. There are several factors that cause it - some which you can do something about, others which are beyond your control.
Too much sun, particularly getting sunburnt, falls into the former category ‘intermittent’ sun exposure is a major risk factor such as getting a lot of sun just a few times a year; on holiday, for example, but then staying indoors, working in an office perhaps, for the rest of the year. People who are outside most of the time, like gardeners, are not at an increased risk of melanoma. About 6 out of 10 cases of melanoma are thought to be caused by sun exposure.
Q. Are fairer people more in danger of getting Melanoma than dark skinned people? Why?
A. Melanoma is uncommon in dark-skinned people, as they have more protective melanin in their skin, while those most at risk of sunlight skin damage are people with fair skin - in particular, those with skin which always burns and never tans, those with red or blond hair and green or blue eyes.
Q. What about fair people In Sri Lanka?
A. Sri Lankans have brown skin, ranging from light brown to dark brown skin. So we have eumelanin which protects us from sun damage. That said, even though the prevalence is low in Sri Lanka, still we have the risk of getting melanomas.
Q. So what are the factors that we can control?
A. Using sunbeds or similar tanning machines which emit UV light. Damage caused by sunbeds seems to be worse in people with red hair and freckles and also in young people under the age of 20 years. Having a weakened immune system (for example, due to HIV infection, or if you are taking immunosuppressive medicines, perhaps after an organ transplant) also increases the chance of getting a melanoma.
Q. Factors beyond our control?
A. Some people get melanoma without having had much sun exposure in their lives. For these people, melanoma has developed because of a genetic mutation: this is beyond their control and there is nothing that can be done to prevent it.
Q. Can children get Melonoma?
A. Though melanoma is mostly an adult disease, children’s skin is most vulnerable to damage. Sun exposure in childhood is the most damaging. People who had a lot of freckling in childhood, or had frequent or severe sunburn in childhood, are most at risk of developing melanoma as adults. The damage to the skin can occur many years before cancer actually develops.
Q. Can it be inherited? If you have a family history of skin cancer will it make you too more vulnerable to Melanoma?
A. According to a study approximately 5–12 percent of melanomas are hereditary, and hereditary melanomas tend to have different mutation profiles to non-hereditary melanomas. A family history. If a close blood relative develops melanoma then your risk is approximately doubled. This increased risk may be due to a shared family lifestyle of frequent sun exposure and/or having fair skin. It may also be due to inherited faulty genes.
Around one in ten people with melanoma will have a relative who has also had a melanoma. Further research aims to clarify the role of these and other genes which may be involved. Gene testing for melanoma is not yet possible. As a rule, if you have a family history of melanoma you should take extra care to protect your skin from sun damage. Also, check your skin regularly for early signs of melanoma
Q. Can already existing skin conditions heighten the chances of getting Melonoma?
A. Melanomas generally grow from fresh skin. They are a new mole that grows over a few months. Generally speaking if you’ve had a mole for years it is very unlikely to change into a melanoma. If a long-standing mole does change though, it’s always best to get it checked by a doctor.Melanomas can grow on skin that is very hard to see yourself: on the back of your shoulder blade, the sole of your foot, or in between your buttocks (what doctors call the ‘natal cleft’).
Q. What are the first signs of Melonoma to watch out for?
A. The features of asymmetry, poorly defined edges, variations in colour and larger size that are typical of a melanoma. These features are different from the benign moles which are smaller with well-defined edges and consistent colour.
Some melanomas are not dark, some are nice and smooth to the naked eye, and a melanoma has to start somewhere, so at some point it will have been small. The size of a mole doesn’t really correlate at all to whether it is cancerous.
Q. How is it diagnosed?
A. Diagnosing melanoma with the naked eye is very hard and there are no particularly accurate ways to do it. Two scoring systems have been developed which can help guide patients and doctors as to whether a mole needs to be seen by a specialist:
- The ABCDE rule:
- Asymmetry of a mole (not being a circle, or an oval).
- Border irregularity (instead of having a smooth outline).
- Colour being uneven (instead of one colour all over).
- Diameter more than 6 mm.
- E stands for evolving (a mole that is changing or getting bigger) or expert: see an expert if you’re worried.
- The 7-point checklist:
- The three major features of change in size; an irregular border; or an irregular colour.
- And the four minor features of a size more than 7 mm; inflammation of a mole (where it gets red); oozing or crusting; and a change in sensation or itch.
However, some melanomas score very low on these checklists and so you might be falsely reassured; on the other hand some completely harmless moles or bumps score very highly and don’t need cutting out.
Most skin specialists, and some family doctors, use a handheld microscope called a dermatoscope to help diagnose melanoma. By looking closely at a mole through the dermatoscope a doctor can quite confidently ‘rule out’ melanoma and tell you the mole is harmless
Q. Initial treatment for suspected Melanoma?
A. If the dermatoscope shows a suspicious mole then most specialists will advise to have it cut out (excised. If a melanoma is suspected the Dermatologist would do an excisional biopsy (where the mole and some surrounding skin will be cut out.).
If the doctor is sure that all the melanoma cells have been removed and the melanoma cells are confined to the top layer of skin, no further treatment may be needed. Otherwise, a second operation called a wide local excision is usually advised. to remove an area of normal skin around where the melanoma had been (before it was removed with excisional biopsy to make sure any cells which may have grown in the local area of skin have been removed. Most cases are diagnosed at stage 1 when there is a very good chance that simply cutting out the melanoma fully will cure the condition.
Q. Future outlook for Melanoma patients?
A. The prognosis for people with malignant melanomas has been improving over 25 years and people with melanomas now have amongst the best outlook for any cancer. Around three quarters of people who have a melanoma removed will have no further problems-depending on what stage the disease is.
Q. Your message to the public?
A. If you develop a lump or patch on the skin, which you are unsure about, or if a mole grows out of fresh skin and you are worried about it, you should seek a dermatologist’s advice immediately. have a suspicious mole or wart see your Dermatologist without delay.