Cancer Survivors Face Increased Risk of Melanoma; Melanoma Survivors Even More
Melanoma the most aggressive, dangerous skin cancer, fifth most common cancer among men, seventh among women
Scar after removal of melanoma from top of senior citizens head
Dec. 19, 2011 New research brings bad news for cancer survivors and, in particular, melanoma skin cancer survivors, who
are most often senior men. A report in the Archives of Dermatology, one of the JAMA/Archives journals, finds all cancer
survivors have an increased risk of melanoma and this risk his greatest for those who have already been diagnosed with melanoma.
Melanoma is one of the most aggressive forms of skin cancer. Also known as cutaneous (skin) melanoma (CM), it is the
fifth most commonly diagnosed cancer among U.S. men and the seventh most commonly diagnosed cancer among U.S. women.
It is estimated there will be over 70,000 new cases of CM in the U.S. this year and
there will be about 8,800 deaths. There is also ocular melanoma, which
occurs in the colored part of the eye. It is
much less common than skin melanoma, striking about 2,500 U.S. adults each year.
The incidence of CM is increasing and death rates from the disease have not significantly diminished, according to
background information in the article. The greatest risk factor for CM development is UV radiation exposure, though this risk is affected by
patients' race and genetics.
Senior Citizens major targets of skin cancer; bout
one in five 70-year-olds have had non-melanoma skin cancers, and most
who were affected have had more than one
Couples encouraged to examine each other for
suspicious moles that could be skin cancer. Researchers estimate that 40
50% of people in the U.S. who live to age 65 will have nonmelanoma
skin cancer at least once.
Geoffrey B. Yang, B.S., a medical student at Case Western Reserve School of Medicine, Cleveland, Ohio, and colleagues
analyzed data from the Surveillance, Epidemiology, and End Results database (1988-2007) to understand the risk of cutaneous melanoma following
a previous cancer.
The study included 70,819 patients with CM as a first primary cancer (median age of 54 years at the time of melanoma
diagnosis) and 6,353 patients with CM (median age 70 years at the time of melanoma diagnosis) following a previous cancer.
The greatest number of melanomas developed among patients with a previous melanoma diagnosis - a finding consistent with
other studies. Among patients younger than 45 years at first cancer diagnosis, 777 developed CM, with significantly higher risks among those
with prior CM, other skin cancer, Kaposi sarcoma, female breast cancer and lymphoma.
Patients 45 years of age or older at first cancer diagnosis had significantly higher risk of developing CM following
prior CM, other skin cancers, ocular melanoma, female breast cancer, prostate cancer, lymphoma and leukemia.
"Characteristics associated with better survival in both cohorts included female sex, age younger than 45 years at
melanoma diagnosis, being married, being white vs. black, decreasing Breslow depth [how deeply tumor cells have invaded], lack of tumor
ulceration, no nodal involvement, and absence of metastases [the spread of cancer from the primary tumor to other locations in the body]," the
authors write.
"Given that cutaneous melanoma is the most common second primary cancer in patients with a first CM (a risk that remains
elevated for over 15 years), our results suggest the need for continued skin surveillance in melanoma survivors," they conclude.
Melanoma can also occur in the colored part of the eye. For information about that form of melanoma, see
melanoma of the eye. Ocular melanoma, also known as uveal
melanoma, is the most common primary cancer of the eye in adults - about 2,500 adults every year in the U.S.
Survivors of one melanoma appear approximately nine
times as likely as the general population to develop a second melanoma, according to a study published in the Journal of the American Medical
Association in March of 2010.
Porcia T. Bradford, M.D., and colleagues at the National Cancer
Institute, Bethesda, Md., used nine cancer registries to identify 89,515
patients who survived at least two months after an initial melanoma
diagnosis between 1973 and 2006.
Of these, 10,857 (12.1 percent) developed one or
more additional primary cancers, such that their overall risk of another
cancer increased by 28 percent. One-fourth of these subsequent cancers
were primary melanomas. Women with head and neck melanoma and patients
younger than 30 had additionally increased risks of a subsequent
melanoma.
"The risk remains elevated more than 20 years after
the initial melanoma diagnosis. This increased risk may be owing to
behavioral factors, genetic susceptibility or medical surveillance," the
authors conclude. "Melanoma survivors should remain under surveillance
not only for recurrence but also for future primary melanomas and other
cancers."
More About Melanoma
Do You Have Melanoma?
Melanoma is the most serious type of
skin
cancer. Often the first sign of melanoma is a change in the size, shape, color or feel of a mole. Most melanomas have a black or
black-blue area. Melanoma may also appear as a new mole. It may be black, abnormal or "ugly looking."
Thinking of "ABCD" can help you remember what to watch for:
● Asymmetry -
the shape of one half does not match the other
● Border - the
edges are ragged, blurred or irregular
● Color - the
color in uneven and may include shades of black, brown and tan
● Diameter -
there is a change in size, usually an increase
Melanoma can be cured if it is diagnosed and treated early. If melanoma is not removed in its early
stages, cancer cells may grow downward from the skin surface and invade healthy tissue. If it spreads to other parts of the body it can be
difficult to control.
The American Cancer Society recommends professional skin examinations every year for people older than
40, and every 3 years for people ages 20 - 40.
You should also examine your skin once a month, using a mirror to check hard-to-see places. Call your
doctor if you notice any changes.
The best way to prevent skin cancer is to reduce your exposure to sunlight. Ultraviolet light is most
intense between 10 a.m. and 4 p.m., so try to avoid sun exposure during these hours. Protect the skin by wearing hats, long-sleeved shirts,
long skirts, or pants.
● Apply high-quality sunscreens with sun protection factor (SPF) ratings of at least 15, even when you
are only going outdoors for a short time.
● Apply a large amount of sunscreen on all exposed areas, including ears and feet.
● Look for sunscreens that block both UVA and UVB light.
● Use a waterproof formula.
● Apply sunscreen at least 30 minutes before going outside, and reapply it frequently, especially
after swimming.
● Use sunscreen in winter, too. Protect yourself even on cloudy days.
Other important facts to help you avoid too much sun exposure:
● Avoid surfaces that reflect light more, such as water, sand, concrete, and white-painted areas.
● The dangers are greater closer to the start of summer.
● Skin burns faster at higher altitudes.
● Avoid sun lamps, tanning beds, and tanning salons.
Types of Skin Cancer
Skin cancers are named for the type of cells that become malignant (cancer). The three most common types are:
● Melanoma: Melanoma begins in melanocytes (pigment cells). Most melanocytes are in the skin.
See the
picture of a melanocyte and other skin cells.
Melanoma can occur on any skin surface. In men, it's often found on the skin on the head, on the neck, or between the shoulders and the hips.
In women, it's often found on the skin on the lower legs or between the shoulders and the hips.
Melanoma is rare in people with dark skin. When it does develop in peoprk szusually found under the fingernails, under the
toenails, on the palms of the hands, or onsoles of the feet.
● Basal cell skin cancer: Basal cell skin cancer begins in the basal cell layer of the skin. It
usually occurs in places that have been in the sun. For example, the face is the most common place to find basal cell skin cancer.
In people with fair skin, basal cell skin cancer is the most common type of skin cancer.
● Squamous cell skin cancer: Squamous cell skin cancer begins in squamous cells. In people with dark skin, squamous
cell skin cancer is the most common type of skin cancer, and it's usually found in places that are not in the sun, such as the legs or feet.
However, in people with fair skin, squamous cell skin cancer usually occurs on parts of the skin that have been in the sun, such as the head,
face, ears, and neck.
Unlike moles, skin cancer can invade the normal tissue nearby. Also, skin cancer can spread throughout the body. Melanoma
is more likely than other skin cancers to spread to other parts of the body. Squamous cell skin cancer sometimes spreads to other parts of the
body, but basal cell skin cancer rarely does.
When skin cancer cells do spread, they break away from the original growth and enter blood vessels or lymph vessels. The
cancer cells may be found in nearby
lymph nodes. The cancer cells can also spread to other tissues and attach there to form new tumors that may damage those tissues.
