SIDEBAR: A Hot Season for Skin Cancer News, So Expect More Questions  


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You have to tell [patients] that all is not lost. The key is in understanding that with a thin melanoma, you still have a great likelihood of being cured.

—Susan Swetter, MD

An “alarming difference” in survival outcomes between young, non-Hispanic white males and females with primary invasive melanoma (see accompanying article) is one of several skin cancer–related study findings in the news this summer. Other studies have concerned the rising rates of melanoma among young people, the recurrence of melanoma decades after initial treatment, and recalcitrant individuals who go back to using tanning beds after a diagnosis of basal cell carcinoma.

In addition, the U.S. Food and Drug Administration (FDA) announced new rules on sunscreen labeling, and a Congressional Skin Cancer Caucus was established to address issues related to raising cancer awareness, promoting screening and early detection, and improving access to treatment. All this news may prompt more questions from patients.

‘All Is Not Lost’

Susan Swetter, MD, corresponding author of the study finding that white adolescent and adult males are more likely than their female counterparts to die of melanoma,1 said that the attention focused on the survival disadvantage among males has caused concern among some young male patients who feel doomed by DNA.

“You have to tell them that all is not lost,” Dr. Swetter said in an interview with The ASCO Post. “The key is in understanding that with a thin melanoma, you still have a great likelihood of being cured. So trying to promote those behaviors that result in thinner melanoma detection are key, until we actually have some kind of biologic understanding and intervention that could be effective in preventing melanoma.” Dr. Swetter is Professor of Dermatology and Director of the Pigmented Lesion & Melanoma Program at Stanford University Medical Center and Cancer Institute in Palo Alto, California.

For the 15% of individuals who return to using tanning booths after a diagnosis of basal cell carcinoma (as reported in a research letter published online in JAMA Dermatology2), “the message would be ‘Please, don’t,’” Dr. Swetter said.

“There has been some evidence that tanning is addictive, by producing endogenous opiates and giving people a natural feeling of well-being, and I think that is a major issue. It is not just the appearance of having darker skin; it could actually have a biologic effect in producing an elevated mood,” she continued. “That’s a real problem in terms of trying to have effective primary prevention messages. Hopefully with the FDA becoming more stringent on tanning bed practices and regulations, we may be able to combat some of this excessive tanning use.”

A study in the Mayo Clinic Proceedings3 and recently reported in The New York Times4 found that between 1970 and 2009, melanoma had increased eightfold for women and fourfold for men aged 18 to 39. “There have been clinics where I’m startled to see multiple young women in their early 20s with melanoma,” Dr. Swetter said.

Different Messages for Males and Females

“There might be two different messages that physicians can impart for men and women,” Dr. Swetter said. “For women, who tend to use tanning beds more, the message could be focused on not doing so.” In addition, “we have found that preventing photoaging and looking old tends to be a more effective message in young women and adolescents than preventing skin cancer because that risk is way down the line for many of them.”

A key message to adolescent and young men would be, “Keep your shirt on” while playing sports or working outside. “We consistently see more melanomas on the trunk in men. It has been reported for decades,” Dr. Swetter stated. In the current study, 46.2% of melanomas in males were on the trunk. Because most of those melanomas are on the back, she tells male patients to “think about having someone look at your back to see if there is anything that looks different than the rest.”

Male patients should also know “that if you do get melanoma, you tend to do worse than a woman with all the matched characteristics. So if you see something new or changing, go to the doctor and don’t wait, because early detection of melanoma can save lives.” ■

References

1. Gamba CS, Clarke CA, Keegan THM, et al: Melanoma survival disadvantage in young non-Hispanic white males compared with females. JAMA Dermatol. June 26, 2013 (early release online).

2. Cartmel B, Ferrucci LM, Spain P, et al: Indoor tanning and tanning dependence in young people after a diagnosis of basal cell carcinoma. JAMA Dermatol. July 3, 2013 (early release online).

3. Reed KB, Brewer JD, Lohse CM, et al: Increasing incidence of melanoma among young adults: An epidemiological study in Olmsted County, Minnesota. Mayo Clinic Proceedings 87:328-334, 2012.

4. Fitzsimmons EG: Skin cancer on the rise in women. New York Times, July 5, 2013. Available at www.nytimes.com. Accessed July 26, 2013.


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