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News You Can Use 8/13/01

Long-forgotten sunburns later become melanoma

BY BEN HARDER

Beach ball, check. Swimsuits, check. Sunscreen? You bet. And sunglasses, a hat, and a shirt, as well. As throngs in thongs make their annual pilgrimage to the beach, the biggest threats to sun worshipers are not creatures lurking beneath the waves, but the sun's own rays.

Though the role of the sun's ultraviolet light in causing skin cancer is well publicized, the most deadly cancer of the skin, melanoma, continues a steady climb. According to the American Cancer Society, an estimated 51,400 cases of melanoma will be diagnosed this year, twice that of just two decades ago. When melanoma escapes early detection, survival rates are poor; about 7,800 Americans will die of the disease in 2001. Sunburns of yesteryear are now haunting some baby boomers, as melanoma often appears decades after the worst of their exposure.

Melanoma develops when pigment-producing skin cells called melanocytes turn cancerous, a process that can be triggered by prolonged exposure to ultraviolet rays. If the cancer is removed before it penetrates a full millimeter into the skin, the likelihood of recovery is over 95 percent. Once a malignancy metastasizes, however, the body's chances of fighting it off drop dramatically, with five-year survival rates below 50 percent. Melanoma cells typically disperse through the lymphatic system, eventually developing into tumors in other tissues such as the lungs or brain.

The first step is to surgically remove the cancerous lesion and a small patch of healthy skin surrounding it. A technique called sentinel node mapping can then be used to determine whether the tumor has metastasized to nearby lymph nodes.

In metastatic cases, the affected nodes are cut away. But if melanoma cells have spread beyond the lymphatic system, prognosis is poor. Researchers led by melanoma specialist John M. Kirkwood at the University of Pittsburgh Cancer Institute announced this May that a post-surgery treatment known as interferon alpha-2b reduces the hazards of relapse and death by one third. The Food and Drug Administration had approved interferon treatment in 1995, but conflicting research findings had left its effectiveness in doubt. Several promising post-surgery vaccines are in clinical trials, but none has yet been proven effective.

Early detection is key. Light-skinned people, especially those with light hair color, freckles, or moles, face the greatest risk of developing melanoma. Adults with these risk factors should be screened annually by a dermatologist and should regularly inspect moles for changes in size, color, or shape. If a mole grows or becomes asymmetrical, or a strange blemish won't go away, insist on a biopsy.

Mom was right. Youngsters who suffer blistering sunburns become particularly susceptible to melanoma later in life. Sharon Lasky, a communications consultant in Pittsburgh, got her share of sunburns as a kid. "I remember my mother telling me to stay out of the sun, but I thought I could tan like my friends," she recalls, though she has long since given up on bronzing her fair, freckled skin. Two years ago, at age 40, Lasky was diagnosed with intermediate-stage melanoma. Now free of evidence of the disease, she's taking no chances with her three children. Her 16-year-old uses more sunscreen than other girls, Lasky acknowledges, "but not enough for me!"

So slather it on. Yet by itself, even an ocean of lotion isn't enough, say specialists like Harri Vainio, a unit chief at the International Agency for Research on Cancer in Lyon, France. "Sunscreen should not be used to extend the length of time spent in the sun," he warns. The best advice? Avoid the sun when it's most intense, and if you must go out, wear tightly woven clothing and a wide-brimmed hat.

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