By Jennifer Wider, MD
The incidence of melanoma, the deadliest form of skin cancer, is on the rise in the United States. It is the most common cancer among young adults between the ages of 25 and 29. Both women and men of all ages are at risk, but it seems that women diagnosed with melanoma have a better survival rate than men. Early detection and treatment is important.
Melanoma is the cancer that befell an Arlington, Va., woman, whose tragic demise made national headlines this week. Susan Torres, 26 years old and pregnant, suffered a stroke in May after melanoma spread to her brain. Although brain dead, she was kept on life support for three months to allow her fetus to develop. Though premature, the baby was delivered healthy by Caesarean section on Tuesday. Torres was removed from life support on Wednesday and died.
As people make their last dashes to the beach in August through Labor Day, or spend any substantial time exposed to the sun, they need to be aware of how melanoma can affect them.
Long-term exposure to the sun increases a person's risk to all types of skin cancer including melanoma and the less serious types: basal-cell and squamous-cell carcinoma. Melanoma begins in the cells that make skin pigmentation called melanocytes. If not detected early, it can spread to other parts of the body.
"Melanoma is the deadliest skin cancer because it has the greatest potential to metastasize," says Norman Levine, M.D., professor of dermatology at the University of Arizona College of Medicine in Tucson. "The other common skin cancers, namely basal cell carcinoma and squamous cell carcinoma can spread to other areas, but this rarely occurs."
Melanoma accounts for six out of every seven deaths from skin cancer. It tends to run in families and can develop in pre-existing moles or develop on its own.
Melanoma affects women and men differently. In women, melanoma often develops in the extremities, most commonly the lower limbs. In men, melanoma is most often found on the trunk, on the area between the shoulders and hips. In both sexes, melanoma can appear on the palms or soles and under the fingernails or toenails. The risk of melanoma increases as people age, but it affects all age groups.
In a 2003 study published in the dermatology journal SKINmed, researchers found that women with melanoma had a better survival rate than men with the disease. In general, a poorer prognosis was found in older patients of both sexes. However, lead author Sarah Brenner, M.D., wrote: "Women had a better prognosis in all age groups, including pre-menopausal and post-menopausal groups."
The reasons for a better survival rate among women are not fully clear.
"There is one school of thought that women are more careful about their health issues and examine themselves more regularly and thus, find tumors earlier in the course of the disease," Levine said. But many experts disagree because studies have shown that melanomas in men and women seem to be similar in size when the diagnosis is made.
Reviewing current and historical research studies, Brenner and her colleagues examined the role female hormones may play in melanoma survival. They concluded that more research was needed to determine the exact role of estrogen and other related hormones.
Early detection is the key to a good survival rate for both genders. The American Academy of Dermatology recommends a yearly skin cancer screening for the general population.
"The most important warning sign of any melanoma is a mole that is changing. This usually involves a color change or a surface texture change," Levine said. People with a family history of melanoma or an excess of moles need to be more vigilant. Early diagnosis is associated with a markedly improved prognosis.
Melanoma is three to four times more common in individuals with light or fair skin. Individuals with dark skin, however, are also susceptible to the harmful effects of the sun, so everyone should examine their skin for changes carefully and regularly.
Prevention is also a key to success. Excess sun exposure increases your risk for developing melanoma or other skin cancers. You should avoid sun exposure during its peak times, from 10 a.m. to 3 p.m. When exposed to the sun, you should also cover up by wearing a hat and a long-sleeved shirt and pants when possible. Sunscreen is also an important tool for protection and should be applied to all parts of the body exposed to sun and reapplied frequently. You should use a sunscreen with an SPF of 15 of higher.
Dr. Jennifer Wider wrote the above article for the Society for Women's Health Research, and it appeared on the August 4, 2005, issue of the society's Web site. The Society for Women's Health Research is the nation's only non-profit organization whose mission is to improve the health of all women through research, education and advocacy. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the need for more information about conditions affecting women disproportionately, predominately, or differently than men. The Society advocates increased funding for research on women's health; encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease; promotes the inclusion of women in medical research studies; and informs women, providers, policy makers and media about contemporary women's health issues. Visit the Society's Web site at www.womenshealthresearch.org for more information.
Sources
Brenner S, Mashiah J. Malignant Melanoma: It Pays to Be a Woman. SKINmed 2(3):183-187, 2003.
