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Melanoma May Come Back; Monitor Closely, Experts Say

Breaking News - October 2005 - Week 2

(Oct 12, 2005)

Healthcare in  the News

-- For individuals who have already had melanoma, there is a greater risk of developing a second, or even third, round of this often deadly skin cancer, according to a report in the Journal of the American Medical Association (JAMA).

Picture of a man and a woman walking on the beach

And, according to a new study, your risk is even higher of developing additional melanomas if you have other family members who have had the disease, or you have a history of abnormal moles, called dysplastic nevi.

According to the National Institutes of Health (NIH), about one out of every 10 persons has at least one unusual (or atypical) mole that looks different from an ordinary mole. The medical term for these unusual moles is dysplastic nevi.

The NIH states that physicians believe that dysplastic nevi are more likely than ordinary moles to develop into a type of skin cancer called melanoma. Because of this, moles should be checked regularly by a physician or nurse specialist, especially if they look unusual, grow larger, or change in color, outline, or in any other way.

"If you've had melanoma, there's a very significant risk you'll get a second," says study author Dr. Daniel Coit, an attending surgeon and co-leader of the melanoma disease management team at Memorial Sloan-Kettering Cancer Center in New York City.

"If you have the other risk factors - family history or dysplastic nevi - that risk is even higher, and you should go back [to your physician] for skin surveillance at least twice a year," he says.

Melanoma Has a High Cure Rate

Nearly 60,000 Americans are diagnosed with melanoma each year, according to the American Cancer Society, and nearly 8,000 people die from the disease annually.

The good news is, when caught early, melanoma is curable, says Dr. Jean-Claude Bystryn, a professor of dermatology at New York University School of Medicine.

For the current study, Dr. Coit and his colleagues included 4,484 people who had been diagnosed with melanoma for the first time between 1996 and 2002. All were patients at Memorial Sloan-Kettering Cancer Center, and were followed for an average of 2.2 years.

During the study period, 385 people from the original group - or 8.6 percent - developed two or more melanomas. Seventy-eight percent of this group had two melanomas. Fifty-nine percent developed the second tumor during the year following the diagnosis of the first.

Twenty-one percent of those who had more than one melanoma had at least one family member who also had melanoma. Just 12 percent of those with a single melanoma had a family history of the disease.

Almost 40 percent of those who had a second or third melanoma also had dysplastic nevi, while only 18 percent of those with a single tumor had a history of these abnormal moles.

The researchers estimated that the overall five-year risk of a second melanoma in those who have had the disease already is 11.4 percent. For those with a family history of the disease, that risk jumps to 19.1 percent and for those with dysplastic nevi, the risk is even higher at 23.7 percent.

"If you've had a melanoma, your new best friend is your dermatologist," Dr. Coit notes. "Go back for skin surveillance at a minimum twice a year. If you have the other risk factors, you may need to be seen more often than that."

Dr. Coit remarks, "The only intervention we have is skin surveillance, and if you're diagnosed in surveillance, melanoma is quite curable."

Dr. Bystryn says this study confirms what dermatologists have known for a long time: "If you have one melanoma, you're likely to get another one."

He adds that this study "reaffirms the need to be followed closely by your physician, to look at your own skin once a month, and to minimize your sun exposure."

Prevention Is Key

To prevent melanoma from occurring in the first place, Dr. Bystryn recommends keeping sun exposure to a minimum.

"A lot of melanoma is due to too much sun exposure," he says. "Don't go out in the sun to deliberately tan. If you're going to be out in the sun, try to do it in the early morning or late afternoon.

"If you're out when the sun is strong enough to give you a tan, use a sunscreen with an SPF of 30 or more, and reapply every couple of hours between 10 a.m. and 3 p.m," Dr. Bystryn explains.

Checking your own skin is also important. Dr. Bystryn says if you have any mole that looks or feels unusual, is itching, bleeding, or enlarging, have your physician exam it.

He recommends examining your own skin monthly, and having a physician check your skin at least once a year, more if you have a family history of melanoma, have a lot of moles, suffered a lot of sunburns, or have fair skin, blue eyes, and blond hair.

Always consult your physician for more information.


For more information on health and wellness, please visit health information modules on this Web site.


What Is Melanoma?

Melanoma is a disease of the skin in which cancer cells are found in the melanocytes, the cells that produce color in the skin or pigment known as melanin.

Melanoma usually occurs in adults, but it may occasionally be found in children and adolescents.

Melanoma may also be called cutaneous melanoma or malignant melanoma. Melanoma is the rarest, but most virulent, form of skin cancer.

Melanoma is a more serious type of cancer than the more common basal cell cancer, or squamous cell cancer.

Although the incidence of melanoma is lower than other types of skin cancer, it has the highest death rate and is responsible for 75 percent of all deaths from skin cancer.

Melanoma most often appears on fair-skinned men and women, but persons with other skin types can be affected.

Rarely, melanomas can form in parts of the body not covered by skin such as the eyes, mouth, vagina, large intestine, and other internal organs.

Persons with the following characteristics may be at an increased risk for melanoma:

  • blond or red hair
  • blue eyes
  • fair complexion
  • family history of melanoma
  • a changed or changing mole
  • many ordinary moles (more than 50)
  • many freckles
  • an immunosuppressive disorder
  • dysplastic nevi
  • sun exposure - the amount of time spent unprotected in the sun directly affects your risk of skin cancer.
  • inability to tan

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease.

Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Dark-brown or black skin is not a guarantee against melanoma.

African Americans can develop this cancer, especially on the palms of the hands, soles of the feet, under nails, or in the mouth.

The following are the most common symptoms of melanoma:

  • change in the size, shape, or color of a mole
  • oozing or bleeding from a mole
  • a mole that feels itchy, hard, lumpy, swollen, or tender to the touch

Because most malignant melanoma cells still produce melanin, melanoma tumors are often shaded brown or black.

Melanoma can also appear on the body as a new mole.

Men most often develop melanoma on the area of the body between the shoulders and hips, or on the head or neck.

Women most often develop melanoma on the arms and legs.

However, melanoma can spread quickly to other parts of the body through the lymph system, or through the blood.

Like most cancers, melanoma is best treated when it is diagnosed early.

Always consult your physician for a diagnosis.

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