Health Letter, June 2013
The following article by Dr. Erin Marcus appeared on the website New America Media, www.newamericamedia.org. It is reprinted with permission.
The mole on Ivis Febus-Sampayo’s face looked odd. But it wasn’t until her son needed treatment for acne that she went to a dermatologist. “As mothers, we’re working, we’re busy,” she says. “I forgot about me and called the dermatologist to make sure my son was getting taken care of.
The doctor removed a sliver of Febus-Sampayo’s mole and reassured her that it was probably nothing to worry about. Two weeks later, she received a diagnosis she never imagined possible: melanoma.
“I’m of olive complexion, I’m not a sun worshiper, I never baked in the sun, and I don’t like the beach,” says Febus-Sampayo, a 55-year-old Latina who was born in Spanish Harlem and has spent much of her life in the New York City area. “At no time did I ever think I could have skin cancer.
But anyone can get skin cancer, and over the past few decades, the incidence of melanoma, the most aggressive and deadly form of the disease, has increased faster than that of any other form of cancer. Once comparatively rare, melanoma has become the fifth most common type of cancer in men and the seventh most common in women.
Even though black and Hispanic Americans are less likely to develop melanoma, they are more likely than white non-Hispanics to be diagnosed after the disease has spread and is thus more difficult to treat.
“There’s a misconception that if you have darker skin, you will not get melanoma,” says Dr. Claudio Dansky Ullmann, a researcher at the National Cancer Institute. “It may be that you are less sensitive or less likely to develop it, but that doesn’t mean you aren’t going to develop it.”
Exposure to ultraviolet radiation from the sun is the biggest risk factor for melanoma and skin cancers generally, and the one that people can do the most to avoid. (Genetics and some skin and immune conditions can increase risk, and some studies suggest that workers exposed to polychlorinated biphenyls (PCBs) may be at increased risk, too.)
Cancer specialists stress that it’s important for everyone to protect their skin, regardless of their pigmentation. The American Cancer Society (ACS) promotes a “Slip, Slop, Slap, Wrap” approach — meaning slip on protective clothing (the tighter weave, the better), slop on sunscreen (and re-slather every two hours), slap on a hat (with a two- to three-inch brim all around), and use wrap-around sunglasses that block ultraviolet light (melanoma can start inside the eye, too). The ACS and other groups also recommend minimizing outdoor activities between 10 a.m. and 4 p.m., when the sun’s rays are strongest.
There’s been some controversy about the safety of sunscreens, and the Food and Drug Administration plans to issue new guidelines on their use later this year. Meanwhile, the Environmental Working Group, a research and advocacy organization that has raised questions about the safety of many sunscreens, has created its own rating system for consumers. For more information, visit www.ewg.org/2012sunscreen.
Dermatologists have traditionally recommended using sunscreen with an SPF (sun protection factor) of 30 or greater. But Dr. Robert Kirsner, a professor of dermatology at the University of Miami Miller School of Medicine, says that a suncreen’s SPF is less important than whether a lotion protects against UVA (ultraviolet A) as well as UVB (ultraviolet B) rays.
Of course, the best protection is to limit time spent in the sun and avoid tanning salons. For people who work outdoors, doctors recommend covering up with a hat, long sleeves and pants and, when possible, staying in the shade.
Another key part of preventing deaths from skin cancer is early detection, since the prognosis is better when the disease is caught early. The American Academy of Dermatology (AAD) urges everyone to get regular skin exams by a medical professional, and the ACS recommends monthly self-exams. For people without health insurance, the AAD organizes free skin screenings, as does the Skin Cancer Foundation.
Many dermatologists recommend using an “ABCDEF” approach to examine skin and urge people to seek medical attention for moles and skin lesions that show one or more of the following characteristics:
- Asymmetrical shape
- Irregular borders
- More than one color
- Diameter more than 5 millimeters (i.e., about the width of a typical pencil eraser)
- Evolving, meaning that the suspicious mole or lesion seems to be changing
- Funny looking (there is no published research to back up this last point, just common sense)
Experts also stress the importance of inspecting fingernails and toenails, the soles of the feet, and areas that are normally covered by clothing, such as the groin. Some studies indicate that black people in particular often develop melanomas on the bottom of the feet.
In Febus-Sampayo’s case, the melanoma was caught at an early stage. A few days after surgery to remove the growth, she returned to her job as the director of Latina Share, a New York-based support and advocacy group for women with breast and ovarian cancer. She now wears a hat and applies sunscreen every day.
I think it’s really important that people understand you don’t have to be fair-skinned, with blue eyes and blonde hair to get skin cancer,” she says. “We need to become advocates for our own health, especially in the Latino community, where it’s always family first. I always tell women, you need to take care of yourself — if you’re not here, you can’t take care of them.