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Melanoma Fact Sheet

Members:
Or G. Cohen, Mr G. Dempster, Mz E. Tzetis, Prof. F. Jordaan, Or G. Levy, Or J. Malan, Or G. McAdam, Or Nel, Or B. Ritchie, Or P. Scott, Prof. W. Sinclair, Or C. Thatcher, Or D. Vorobiof, Mr B. Van Reenen (CANSA), Or E. Bam.

  1. Melanoma - Definition/Diagnosis/lncidence
  2. Sun wise behaviour
  3. Sunscreen debate
  4. Vitamin D issue
  5. Sun bed issue
  6. Skin screening
  7. Melanoma management - Every patient needs follow up according to guidelines.
  8. Future trends - Reverse the incidence, funding, registry.

Melanoma is a type of skin cancer that derives from the pigment producing cells (Melanocytes) in the skin. It can, unlike other forms of skin cancer (basal cell carcinoma and squamous cell carcinoma) spread rapidly through the lymph or blood system to other major organs (bone, brain, liver etc). If detected early on, it carries an excellent prognosis. If left late, it can be a rapidly fatal disease.

South Africa has got one of the highest incidence, if not the highest, of Malignant Melanoma in the world (similar to that of Australia). To date we do not have accurate statistics, but the estimated figure for the Cape 2009 is 69 new cases per year per population of 100 000 Caucasians, Australia is 65 per 100 000. This translates to 1 in 1429 people will develop a Malignant Melanoma. Comparing this to figures from 1990 -1995 it was 22.2 per 100 000 for females and 27.5 per 100 000 for males. This rose to 33.5 per 100 000 for females and 36.9 per 100 000 for males from 2000 - 2003. Clearly something needs to be done to address the risk factors and to try and reverse this trend.

SUNWISE BEHAVIOUR;
Melanoma develops in a person with a genetic predisposition coupled with excessive, unprotected sun exposure. So far more than 20 gene mutations have been identified which play a role in the transformation from a normal cell to a Melanoma cell. Some forms of Melanoma have also been linked to overexposure to UV radiation, in particular sun binges and blistering sunburns in childhood. It therefore seems imperative to implement sun wise behaviour:

  • Avoid direct, unprotected sun exposure seeking shade wherever possible.
  • Cover up with sun protective clothing, i.e. hat, long sleeve shirt, and trousers.
  • Use a high factor sunscreen on unprotected skin, i.e. face, arms, hands etc.

SUNSCREEN DEBATE:
There seems to be a lot of controversy about the use of sunscreen in general and the right sunscreen in particular. The current SPF system only addresses UVB protection and is poorly understood by the general public. The SPF relates to a time factor, namely the time any individual can spend in the sun longer without burning. This depends on the skin type but also the so called 11 safe sun time" (SST), which is area specific. The SST depends on the UV concentration. measured, i.e. 10 minutes in Cape Town between November and March. So the SPF of 10 increase the SST to 10 minutes x 10 SPF ·:=100 minutes (just under 2 hours). Bear in mind that a sun exposure of 10 hours or more is not unusual in summer.

UVA protection is not standardized yet and even more confusing for the consumer. Whilst the experts of this world are still debating a unified message, we can formulate the following advice regarding sunscreen use:

A good sunscreen should:

  • Clearly have UVA and UVB protection.
  • Ideally be tested, by a neutral organization (i.e. CANSA) for safety and efficacy.

The higher the SPF (and UVA protection) the better, because if one uses too little, the efficacy drops dramatically. Any sunscreen should be reapplied frequently - there is no such thing as a daylong protection. There is not "one" right sunscreen, it must fit the activity it is used for, i.e. a surfer requires a different sunscreen to a runner, children and men often prefer sprays while women prefer creams etc.

VITAMIN D ISSUE:
There has been lots of publicity around the fact that people think they produce insufficient amounts of Vitamin 0 if they are using sunscreens on a regular basis. This has been proven wrong, in particular in a sunny country like South Africa. - The main source of Vitamin D comes from food. - There are no reported cases of children and teenagers with Vitamin 0 deficiency and they are people needing strict sun protection. - An area of 10cm squared (size of the back of your hand) exposed to sun exposure for 10 minutes is producing sufficient amounts of Vitamin D. - No sunscreen will ever give you complete and absolute protection from UV radiation.

SUNBED ISSUE:
In the past the UVA radiation emitted by sunbeds was thought to cause only ageing of the skin but to be relatively harmless. Genetic and molecular studies have now proven the causative relationship bet0een UVA and development of Malignant Melanoma. Sunbeds do not deliver a 'safe tan' and all machines should carry a serious health warning similar to that found on cigarettes, i.e. 'The use of this machine can cause skin cancer'.

SKIN SCREENING:
The prognosis of Malignant Melanoma depends on early diagnosis and management. A surgically removed early Melanoma (i.e. Melanoma in situ) carries an excellent prognosis whilst a Melanoma detected late can carry a high mortality rate. Although regular skin checks by a Dermatologist are desirable, it will be restricted to follow up of risk patients (i.e. patients with more than 50 moles, more than 5 atypical moles and patients with own or family history of Malignant Melanoma). However, the public should be educated to do self checks on a regular basis following the ABCD rule where:

  • A stands for Asymmetry
  • B for Border; irregular
  • C for Colour; more than one colour
  • D for Diameter; greater than 5mm or any lesion which grows
  • E for Elevation

Any sensation (itch, pain, bleeding) is also cause for concern. If any suspicious lesion gets noted, a Doctor should be consulted. Even today 80% of all Melanomas get detected by the patients and not the Doctors.

MELANOMA MANAGEMENT:
Once a patient is diagnosed it is vital that they get followed up on a regular basis according to the guidelines by a Dermatologist with or without an Oncologist. The chance of developing a second primary Melanoma is 10%. Multi disciplinary follow up in late stage disease or thick Melanoma should be encouraged.

FUTURE TRENDS:
It is unlikely that our environment is going to change and produce less harmful UV radiation. Hence it is imperative to aim for a behavioural change to adapt to our ozone depleted atmosphere. People need to be educated about sun wise behaviour and strongly encouraged to avoid sunburns. Educational programs must run continuously. Schools, sports associations, parents and teenagers should be targeted. Lectures, videos, magazines, radio and TV ads and programs should be used to spread the message. Risk groups should be identified and followed up on a regular basis. The initiation of a melanoma registry would provide useful and vital information regarding the recognition and management of this serious disease.

SUMMARY:
The short message is:

  • Never burn your skin, cover up and protect.
  • Always use sun protective clothing and the highest factor sunscreen (SPF 30 or higher).
  • DON'T use sun beds.
  • DON'T worry about Vitamin D deficiency or bad chemicals in the sunscreens. (Remember a chemical may cause cancer, the sun will cause cancer)
  • Check your skin on a regular basis.

See a doctor or Dermatologist if you are at risk or have a mole you think is not all right.
In 2010, Vichy is proud to be able to develop its educational mission, by forming a unique partnership with the South· African Melanoma Advisory Board

 

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