Melanoma knows no age

Summer has arrived, and on cue, Florida’s beaches are teeming with residents and tourists alike. They come to rest, play and bask in the warm sunshine. But too much of that sunshine can carry a price – in the form of wrinkles at best, cancer at worst.

The American Cancer Society (ACS) estimated 60,000 new cases of melanoma will be diagnosed in America in 2007, with more than 8,000 ending in death. Skin cancer is the most frequently diagnosed of all cancers, and melanoma is particularly likely to be diagnosed in younger people.

At 15, Kaitlyn Schlabaugh was one of the youngest patients her doctors had seen when she was diagnosed with a malignant melanoma on her foot. Fortunately, her melanoma was quickly noticed and removed before it could spread. Her case, however, illustrates the importance of education about a disease that doesn’t discriminate in the age of its victims.

Kaitlyn visited her dermatologist to remove the mole on her foot, but the doctor thought it looked suspicious and ordered a biopsy. Kaitlyn and her parents couldn’t believe it when the results came back cancerous.

“(I felt) shock, really. I was kind of scared,” Kaitlyn said in a phone interview. “(My parents) felt complete shock and were probably more scared than I was.”

While most victims claimed by the disease are aging white males, melanoma kills more women ages 25-29 than any other cancer, according to the Shade Foundation, a group devoted to melanoma research and advocacy.

“It’s hard to keep (people) out of the sun,” said Egilda Terenzi, USF director of Student Health Services. “They love the look.”

At increased risk for skin cancer are people with fair skin, light hair and freckles, according to the ACS. Though they have the same proportion of melanocytes as darker-complected people, their skin shows a weaker response to the sun. Kaitlyn didn’t call herself fair-skinned, but said she has freckles, blue eyes and blonde hair.

As chief of Cutaneous Oncology at Moffitt, Vernon Sondak, M.D., calls melanoma a “disease of intermittent sun exposure.” The cancer can emerge when skin unused to sun exposure is severely burned.

“It’s the very intense exposure without protection that’s the biggest risk for melanoma,” said Sondak.

People with a family history of melanoma should exercise caution when in the sun. Sondak said some people are genetically more likely to develop melanoma. These people could have what doctors call atypical moles, which are larger and more abnormal in appearance than ordinary moles. The larger the number of atypical moles, the greater potential one has to develop melanoma.

Unlike other skin cancers, melanoma is particularly dangerous because, if left untreated, it usually spreads via lymph nodes to other parts of the body. When Kaitlyn was referred to Moffitt and treated for melanoma, doctors removed some lymph nodes from her groin to test. Her cancer had not spread.

Amy Megan, Kaitlyn’s mother, said her daughter had a harsh reaction to the anesthetic. They anxiously awaited the results from the lymph node test for two weeks.

“Watching your child in pain, it’s a terrible feeling,” said Megan.

Megan was at work when she got a call from her daughter’s dermatologist. She said she was so shaken she didn’t hear the doctor’s instructions.

“I was sitting there, he kept talking but I wasn’t listening,” she said. “I kept saying ‘OK.’ When I got off the phone, I burst into tears.”

According to the ACS, melanoma is cancer of the melanocytes, the pigment-producing cells in the skin responsible for skin color. It is diagnosed when either an existing mole becomes malignant and grows out of proportion, or when a new blot appears on otherwise clear skin. The agent that causes the aberration is ultraviolet (UV) radiation from the sun and tanning beds.

Sondak explained the mechanics of sunburns: Exposure to sunlight triggers the melanocytes to secrete melanin, a substance that works to screen the sun’s rays and preserve the skin’s integrity. A tan works like clothing or sunscreen – a literal physical barrier between damaging heat and the sensitive cells underneath.

If the duration and intensity of exposure overwhelms the body’s natural defenses, the skin will burn the same way anything else does, said Sondak. In these cases, the outermost cells of the skin are damaged and often killed, resulting in peeling. No person, however dark, is fully immune, but the darker the skin, the more natural protection is provided.

Some popular notions exist that a tan can effectively protect the skin in the long-term, but Neil Fenske, M.D., disagrees. A professor of dermatology at USF, Fenske said that while a tan can provide some protection, it is significantly weaker than sunscreen and less reliable than staying in the shade.

“A tan is sign of skin injury,” he said.

To lessen the chance of melanoma and other skin cancers, Sondak advises people to wear protective clothing – wide-brimmed hats, pants and long-sleeved shirts – during peak sunlight hours (10 a.m.-2 p.m.) or to stay inside at those times. Otherwise, people should wear sunscreen.

They must do so evenly and consistently, though, Sondak said, reapplying every few hours or after swimming or strenuous exercise.

“The big problem with sunscreen as a preventative strategy is that so often people go out into the sun and leave the sunscreen on the shelf at home,” said Sondak. “(People) rely on sunscreen and forget an awful lot, and then wind up with no protection.”

People should consult their doctors if there is a change in an existing mole or the emergence of a new one, especially if the mole is discolored, misshapen or otherwise abnormal-looking. If detected early, melanoma likely can be completely removed.

Kaitlynis living proof. Due as much to the sharpness of her dermatologist as to good luck, her melanoma was removed and she is free of cancer today.

“She feels what happened to her happened for a reason,” said Megan.

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