Commentary: Health Care - Ounce of prevention can spare sun-lovers

The summer of sun and fun is upon us, with all its wonderful experiences and memories of traveling, beaches, sports and camping. However, this writer embraces the summer sun with mixed emotions. It recalls a friendship that began in boyhood, now terminated by my friend's passing.

This friend was a wonderful journalist who wrote so realistically and descriptively that you could almost feel you were present, enjoying all the sights, sounds and smells of the sporting events he so vividly described. This man was John Steadman, sports editor supreme. John succumbed to malignant melanoma. Other well-known people who were victims of melanoma include Bob Marley and Maureen Reagan.

I remembered that John was attended by one of the foremost experts and researchers involved in the study of melanoma, Dr. William H. Sharfman, medical director of the Medical Oncology Cancer Center at Johns Hopkins, Melanoma Section, and author of multiple scientific papers on melanoma.

In a recent interview, Dr. Sharfman informed me that the risk of melanoma is strongly related to intense, intermittent exposure to the sun. Especially susceptible to this ultraviolet exposure are those of fair skin, blonde or red haired, often with blue eyes, who may also be freckled or have multiple nevi (moles). Severe sunburns in childhood are also associated in later life with large numbers of nevi, considered an important risk factor for the development of melanoma. A family history of skin cancer increases risk.

The majority of melanoma patients will present with moles which are pathologically atypical or noted to be growing in size, shape or color, either dark or in variegated hues, especially when accompanied by bleeding, itching or ulceration.

Australia has the highest incidence of melanoma in the world, where one in 12 will develop skin cancer due to excessive sunlight, combined with outdoor recreational habits of fair-skinned individuals. There is now a law in Australia that requires children to wear a floppy hat and sunscreen protection, SPF 30 or above, whenever they are exposed to the sun. In contrast, Afro-Americans have a very small rate of melanoma, approximately 5 percent, and they usually occur mainly on the palms of the hands and the soles of the feet.

Unfortunately, the occurrence of melanoma has progressively increased to an estimated 55,000 new cases of invasive melanoma each year in the United States. This translates into one in 75 persons who will be diagnosed with melanoma in their lifetime.

Interestingly, the overall death rate has increased only slightly, indicating that most of the present-day melanomas being diagnosed are of the early, thin, flat type that can be treated effectively, even essentially cured, by wide-bordered surgical excision. This is due to the educated awareness of both physician and patient on the effects of strong sun exposure in childhood. How often today do you see mothers at the beach coating their children with anti-sunburn lotion, and making sure they are wearing hats and full bathing suits?

Early diagnosis of melanoma is absolutely critical, as once the disease has metastasized, survival is estimated to be only six to nine months. Early recognition, however, followed by removal of the lesion with wide margins, has been very successful in stemming metastatic spread. In addition, surgeons today are usually able to perform such surgery with a minimum of cosmetic damage.

Research continues in an effort to find more effective ways of treating malignant melanoma, including the possible development of vaccines, but the most important approach today to reducing the fatality rate is through education and prevention.

Robert S. Coplan, M.D., M.P.H., has spent a half century studying, practicing and writing about medicine and issues facing the health care and biotechnology industries.

Copyright 2004 Dolan Media Newswires
Provided by ProQuest Information and Learning Company. All rights Reserved.