Melanoma (Skin Cancer)
Despite warnings, people keep soaking up sun
Public campaigns remind people to protect themselves from the sun's ultraviolet rays. Sunscreen companies market their wares hither and yon. More people understand the causes of skin cancer and melanoma than ever before.
So why do melanoma rates continue to rise by about 3 percent a year? Because, experts say, many people still think a tanned skin is a sign of health and beauty, and they've been taught that the best fun occurs out in the sun.
"Leading thoughts are that more and more people equate leisure with getting out in the sun and getting a tan," said Dr. Conway C. Huang, associate professor of dermatology at the University of Alabama at Birmingham. "The message about skin cancer is effectively conveyed to the public. I think a lot of people know the sun is bad. But it hasn't resulted in a change in behavior."
As a result, experts continue to puzzle over how to best convince people to protect themselves from the sun -- an issue front and center during May, which has been designated Melanoma/Skin Cancer Protection Month.
Skin cancer is the most common form of cancer, accounting for at least half of all cancers, and most cases are considered to be sun-related, according to the American Cancer Society.
More than 1 million cases of non-melanoma skin cancer are diagnosed annually in the United States, the Cancer Society says. Melanoma, the most serious type of skin cancer, occurs in less than 5 percent of all skin cancer cases but causes the vast majority of deaths from skin cancer: an estimated 8,110 of the 10,850 deaths each year from skin cancer.
Tanning occurs when ultraviolet light damages the skin. The damage goes deep into skin cells, affecting their DNA. Too much damage can result in skin cancer or melanoma.
"The fact your skin becomes more pigmented is a sign that damage has occurred," Huang said. "It's like if you are coughing up phlegm, you likely have the flu."
And it's the sense of invincibility that young people carry with them that might be largely to blame for skin cancer rates continuing to climb, many health experts believe.
"Young people never think bad things happen to them," said Dr. Martin A. Weinstock, professor of dermatology and community health at Brown University and chairman of the skin care advisory committee for the American Cancer Society. "It's always the other person."
Huang agrees. "Young people simply are not threatened or concerned with the fact they might contract skin cancer," he said.
Popular myths surrounding tanning also play a role, the experts say. For example, people still believe that getting a base tan before spending more time out in the sun will protect them from a bad burn. In fact, that base tan is simply sun damage and does nothing to keep a person safe from additional doses of ultraviolet radiation.
As Huang put it: "You shouldn't get some sun damage to mitigate other sun damage."
Attitudes also are influenced by popular culture, Weinstock said. Just as smoking shown in movies would probably cause more people to pick up the habit, images of tanned icons can send folks scurrying to the beaches, backyards and tanning beds.
"We were doing OK when Madonna was popular," Weinstock said. "When Britney Spears became popular, it got harder. It's not all about medicine. Cultural icons and mores have a huge impact."
So, some say, does the wide availability and limited regulation of tanning salons. The ultraviolet rays from a tanning booth, after all, are no less dangerous than those from the sun. One study found that regular use of tanning beds increases melanoma risk by a factor of eight, according to the American Cancer Society. Even occasional use nearly tripled a person's chances of developing melanoma.
"It's really teenagers and young adults who are the primary users of tanning parlors," Weinstock said. "In young people, skin cancer is increasingly more in women than in men. That may be due to indoor tanning."
So, how to address these factors? Experts recommend better regulation of tanning salons to keep out kids younger than 18. Studies, however, have shown that laws intended to restrict and limit teenagers' access to tanning parlors don't work, largely because of lax enforcement.
The message being sent to young people about the sun and tanning is being revamped to better press teens' buttons, Huang said. If messages about death don't matter to kids, who feel invincible, what will?
"Outreach has changed to focus on the cosmetic damage the sun does," Huang said. "Tanning causes wrinkles, stuff like that."
Caddell did nothing about it for a few months. But then it started to itch and, after a time, started to bleed. So, in July 2004, she went to the doctor to see if there might be a problem.
"I had a feeling something wasn't quite right with it," said Caddell, now 45 and living in Fayetteville, N.C. And she was right. The mole was biopsied and diagnosed as melanoma.
She went in a couple of weeks later and had the mole removed by a wide-excision surgery, which removes some surrounding skin along with the cancerous area. The surrounding skin came back clear of cancer, and Caddell went on with her life."At the time, you think, 'It's just cancer; it's just something you get taken off,' " Caddell said. "I just didn't get alarmed."
But about a year later, Caddell came down with a terrible bronchial infection that she struggled with for more than a month. "I had this rattle in my chest and this bad, croupy cough," she said. She went to an urgent-care facility one weekend, when things had gotten particularly bad, and had a chest X-ray taken to see what was what. "I did have pneumonia, but they also saw some shadows on the X-ray," Caddell said.
They sent her for a CT scan of her lungs, which raised their suspicions that her earlier melanoma might have spread. "I kind of had a feeling what that was," she said. "I was starting to panic. I was in a state of disbelief." She said that a lung specialist performed a lung biopsy via a tube through her nose. The test came back positive for melanoma.
And then things got worse. Caddell immediately went to an oncologist, who ordered a full-body PET scan to see if the cancer had spread any further. Caddell had a tumor wrapped around her esophagus. She had cancer in both lungs. Cancer had spread all through the lymph nodes in her chest. There was cancer on her liver, and two cancerous "hot spots" on her hip bone and shoulder bone.
"The doctor looked at the floor, and he told me where it was located," she said. It was everywhere. She had stage 4 cancer. "I said, 'What do I do?' He said, 'Most likely you have six months to a year. I have nothing here to offer you.' "
But the oncologist did refer her to a melanoma expert at Duke University, and that expert recommended a round of high-dose immunotherapy. It was a long shot: 12 percent of patients partially respond to it, and just 7 percent have a complete and successful response.
Caddell spent nine months in and out of intensive care at Duke. "It brings all your vitals and all your organs to the brink of toxicity, where everything shuts down," she said. But Caddell ended up being part of the 7 percent. "After I finished all treatments in June 2006, I was declared cancer-free," she said. "It's nothing short of a miracle."
She still suffers some side effects from the treatment, including fatigue and short-term memory loss. But she just shrugs it off. "There are no words to explain the gratitude," she said. "I almost have to pinch myself that I'm still here. Ninety-five percent of stage 4 melanoma patients are dead within two years -- and here I am."
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