Melanoma- A ‘Corrosive’ Cancer: Conversations with Stephen Hammond, MD

Dr. Stephen
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Hello Readers, welcome back for our next conversation.

In our last conversation, I introduced myself and the medical specialty of diagnostic pathology. In this session I’d like to speak further on the subject of melanoma previously illustrated in the anecdote.

One of the attributes of my chosen sub-specialty of dermatopathology, the diagnosis of skin disease, is its unique position in addressing the medical and cosmetic factors that interplay in modern western culture. Skin cancer is the most common form of cancer. However, there are many types of skin cancer and we generally divide them along two broad lines: Melanoma versus Non-melanoma skin cancers. Melanoma skin cancers are more serious than non-melanoma skin cancers because they behave aggressively, tend to spread faster and are much more difficult to manage satisfactorily.

To illustrate the insidious nature of melanomas, consider these two scenarios involving a blocked kitchen sink: In the first, there is a big and visible apple core blocking the kitchen drain. What do you do? You pick it out and ‘voila’ the water drains quickly away … problem solved. Now in the second scenario there is water bubbling into the sink and there’s nothing you can see blocking the drain. You then try a plunger, but that doesn’t help either - so you call in a plumber and find out there are multiple blockages caused by corroding metal throughout the kitchen plumbing. These changes have developed over a long period of time because of certain corrosive liquids being poured down the drain. Now only a complete change of the entire tubing system will get the sink draining again. The first example is the world of more benign conditions. For example if a bone gets broken, though painful, you can see its broken and it can be set right and problem solved. The second is the world of melanomas and many of the most dangerous cancers. The physically apparent signs, the water in the sink, go unheralded until a lot of damage has already been done.

So readers what can we do about this? Well we can stop pouring the corrosive fluid in the sink or we can call the plumber in to check the tubing more regularly. I’ll bet most of us would prefer the first option. It sounds much easier and less costly too doesn’t it?

When translating this to melanomas, the corrosive fluids are known as ‘risk factors’. ‘Risk factors’ refer to certain inherent qualities (cannot be modified) or behavior patterns (can be modified) that put us at risk for developing a certain disease. The most infamous example of a behavioral pattern is smoking- the risk factor and lung cancer-the disease. In melanomas the pattern that has been linked most to developing this disease is exposure to ultra violet rays. This can take place either through direct exposure to sunlight for example sunbathing on a beach, to the use of proxy vehicles for delivering these rays-the tanning bed. In our culture, having tanned skin has become important as a cosmetic device and a lot of young women regularly engage in this exposure. As such, we are seeing a rise in the incidence of melanomas in this population.

So what can be done? It would be impractical to suggest never going out into the sun and attempting to change societal norms of what is considered beauty in order to effect timely change, which would seem an exercise in futility. We can however promote additional habits that might lessen the impact of these rays such as the use of tanning lotions. And also suggest alternatives to tanning beds such as spray tans or advocate for tighter government regulation…. which has been successfully done. Sometimes though the plumber just needs to be called in regularly. For those people with inherent qualities putting them at risk for developing melanoma such as light skin, red hair and large number of freckles, it behooves you to make those yearly trips to your dermatologist for a full skin check up. The challenges facing melanoma in ethnic populations though different are no less dangerous and relate more to socioeconomic status. I consider this to be an important risk factor in many diseases and it shall be the subject of a future conversation.  And most importantly, the running theme of our conversations, pay attention to those close to and around you. You just might help to save a life.

Advocating for healthcare changes can be somewhat daunting when different freedoms or rights appear to clash. In recognition of the legislation secured on tanning bed regulation I would like to leave you readers with a quote from Lord Acton, who was a philosopher amongst other things: "Liberty is not the power of doing what we like, but the right of being able to do what we ought."

Till our next conversation… stay informed, stay healthy.

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