The Skin Cancer Foundation Journal

MAY 2015

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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higher risk than those with brown eyes, darker hair, and darker skin. Especially vulnerable are those of Celtic descent who have many risk fac- tors; with red hair, blue or hazel eyes, and pale white Type I freckled skin, they cannot tan and always burn, so they are particularly vulnerable to UV-induced cell damage and skin cancer. In fact, recent early research suggests that these vulnerable people may face an extra danger: Their skin may naturally develop melanomas even if they spend their lives in a cave. This is because people with red hair and freckles produce a lighter skin pigment called pheomelanin. Compared to the darker, more universal pigment eumelanin, which is somewhat sun-protective, pheomelanin may naturally produce higher levels of potentially carcinogenic molecules called free radicals not just in response to sun exposure, but even without sun exposure. 3 GENETICS: Many of the aforementioned risk factors are tied to genetics. For example, people of Celtic descent often have blue or hazel eyes, red hair, and pale skin that burns and can't tan, all of which makes them more melanoma-prone, thus melanoma often runs in their families. One of the most commonly implicated g e n e s i n m e l a n o m a r i s k i s t h e M C 1 R (melanocortin 1 receptor) gene, a key regula- tor of hair, skin, and eye color. When MC1R signaling is low or abnormal, less pigmenta- tion is produced, resulting in light eyes, light hair, fair skin, reduced UV protection and increased risk of melanoma and other skin cancers. A completely non-functional MC1R causes red hair; producing pheomel- anin instead of eumelanin, it is in fact often called the "red-hair gene." People with this gene are exceptionally melanoma-prone. 4 Two other genes, p53 and CDKN2A, have been particularly linked to familial melanoma. In the future, families might be screened to identify members carrying any of these defective genes, which could increase their vigilance in practicing sun protection and self-examination as well as going in for frequent professional skin examinations. However, the consensus of melanoma experts is that genetic testing is not yet warranted for most people. 1 GENDER: Until age 49, significantly more women de- velop melanoma than men; 2 women aged 39 and under have a higher probability of devel- oping melanoma than any other cancer ex- cept breast cancer. 2 Young women's greater use of tanning machines may be a contributor. However, from age 50 on, possibly because of greater lifetime sun exposure, significantly more men than women develop melanoma. 2 Furthermore, melanoma survival rates are worse for men than for women at all ages, partly because they less frequently examine their own skin or seek physician skin exams; their melanomas are thus detected later. MOLES: Many people are born with a certain number of moles, and sun exposure can increase that number over a lifetime. It can also damage ex- isting moles so that they one day turn cancerous. Approximately half of all melanomas de- velop in preexisting moles, and the greater the number of moles someone has, the greater their odds of developing melanoma, regardless of their skin type. A study pre- sented in 2014 showed that having any moles – even normal moles – can more than quadruple your melanoma risk. 5 Most moles are benign, but some have abnormal features resembling those of melanoma. Called dysplastic nevi or atypical moles, they can sometimes turn cancerous, and people who have them are 7 to 27 times more likely to develop melanoma than the general public. People with numerous moles, including some atypical moles, are at excep- tionally high risk of developing the disease . 5 1. Does the patient live in Northern, Central or Southern United States? SOUTH 2. What is the patient's gender? MALE 3. What is the patient's race? NON-HISPANIC WHITE 4. What is the patient's age? 63 5. Has the patient ever had a blistering sunburn? YES 6. Is the patient's complexion light, medium or dark? LIGHT 7. How many moles larger than 5mm in diameter are on the patient's back? TWO OR MORE 8. How many moles less than or equal to 5mm in diameter are on the patient's back? SEVEN TO SIXTEEN 9. How extensive is the freckling on the patient's back and shoulders? MILD 10. Does the patient have severe solar damage on the shoulders? YES Figure 1. One of the best-known melanoma risk assessment tools, developed by the National Cancer Institute (NCI), estimates someone's risk of developing melanoma over the next 5 years (http://www. cancer.gov/melanomarisktool/). The tool, designed to be utilized by healthcare professionals during a physical exam, incorporates a key series of risk factors through questions asking about history of blistering sunburns, complexion, number of moles, and the degree of freckling and sun damage. The risk obtained is applicable only to non-Hispanic whites, and is not to be used by patients who have a personal or family history of melanoma (who already have a highly increased risk of developing melanoma). The following is an example of the NCI melanoma risk assesment tool. Based on responses to the questions, the tool estimates that this particular patient has a 1.79 percent chance of developing melanoma in the next five years. The Five-Year Absolute Risk of Melanoma is 1.79%. For every 1,000 men living in this region with these characteristics, on average 17.9 will develop melanoma in the next 5 years. These results are based upon the answers below. 84

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