Melanoma, the most deadly form of skin cancer, has increased in frequency at epidemic rates in the past 20 years. We now know that avoiding sunlight and tanning beds is an important step in preventing the disease, but for many baby boomers the damage was done long ago.
That’s where early detection comes in. If detected at Stage I, its earliest stage, the five-year survival rate for melanoma is 97 percent. If the disease progresses to its most advanced stage, Stage IV, the five-year survival rate drops to 15-20 percent. So, what’s the best way to find melanoma at its earliest stage, when the prognosis is most favorable?
A recent study found that physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma. The Memorial Sloan-Kettering Cancer Center, where I completed my fellowship in surgical oncology, conducted a 10-year study of 394 patients diagnosed with 527 cutaneous (skin) melanomas and categorized the patients as either new or established.
Over the course of the study, physicians detected 63 percent of melanomas in new patients and 82 patients of melanomas in established patients, while patients self-detected only 18 percent of all melanomas. The study authors concluded: “It is crucial to emphasize that a combined strategy of physician detection and patient participation must continue to be implemented to ensure early melanoma diagnosis.”
I agree with the study’s findings, which is in line with prior recommendations and what I’m seeing in my practice. My recommendation to patients is: stay informed, continue monthly self exams and bring to your physician’s attention any suspicious moles. If your doctor tells you it’s nothing but you still feel uneasy about it, seek a second opinion. I often see patients who say, “The doctor didn’t think it would be anything, but it turned out to be a melanoma.”
To physicians, I say: Know the risk factors and include as part of an annual visit a skin cancer screening. Pay particular attention to patients with fair skin, red hair and freckles because they are most likely to have melanomas, but all patients need to be screened. For any skin type, a lesion needs to be looked at if it has been present for any period of time and then changes.
For patients diagnosed with melanoma, I suggest that they ask two important questions:
- Do I need to see a melanoma surgeon?
- Is a lymph node biopsy necessary?
Surgical oncologists operate under guidelines established by huge studies done in the 1980s at the Sydney Melanoma Unit and the University of Alabama at Birmingham. Those studies indicated that when the proper width surrounding the melanoma is removed, the rate of the cancer coming back is close to zero.
The bottom line is that patients and physicians need to work together so that melanomas can be detected and treated as early as possible. We can’t prevent cancer, but with proper screenings and early diagnoses we can greatly increase the odds of survival.
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