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Melanoma diagnosed decades later often linked to childhood sun damage

Tue., July 22, 2014

Oh, long, sunny summer days. So bright and inviting and treasured by schoolchildren.

Oh, warnings about the dangers of the long, sunny summer days and the importance of sunscreen and protective clothing for children, along with adults. So predictable.

Yet melanoma rates keep rising in the U.S. And damage caused by ultraviolet rays during childhood – both indoors and outdoors – elevates the risk for developing melanoma, the deadliest skin cancer, during adulthood.

Besides a history of sun damage, other risk factors include light skin, blue or green eyes or blond or red hair. But anyone can get skin cancer.

Ultraviolet light damages the DNA in skin cells, causing them to grow abnormally and possibly turn into cancer. It might take decades. But it starts with UV damage.

“Most of the skin cancer we have comes when we’re young and develops when we’re old,” said Dr. Benjamin Ringger, of North Idaho Dermatology, which also has an office in Liberty Lake.

But young people are sometimes diagnosed with skin cancer, too. Melanoma is the most common form of cancer for people ages 25 to 29 and the second most common cancer for people ages 15 to 29, according to the American Academy of Dermatology.

“I have performed skin cancer surgery on people ages 16 to 103,” said Dr. Chadd Sukut, of Advanced Dermatology Skin and Surgery Center, which has offices in Spokane and Coeur d’Alene.

In the U.S., melanoma rates increased about 1.5 percent a year each year from 2001 to 2010 among men and women, according to the Centers for Disease Control and Prevention.

Washington’s overall melanoma rates are among the highest in the nation, with between roughly 26 and 33.5 cases reported per 100,000 residents in 2010, according to the state Department of Health. (The state’s rates are highest in the Puget Sound region, which would rank fourth in the nation for skin cancer rates if it were its own state, according to the Health Department. The department blames a misconception that people living in cloudy climates don’t have to use sun protection.)

Washington and other states, along with the federal government, are implementing new restrictions on childhood UV exposure indoors. A new state law prohibiting people younger than 18 from using tanning beds follows an announcement last spring that the Food and Drug Administration would require tanning beds and sun lamps to carry new warnings against use by anyone under age 18.

But outside, summer games and warm days beckon. And even older kids are not great at protecting themselves from the sun.

In a national 2011 survey, 14.4 percent of girls and just 7.3 percent of boys said they routinely used an SPF 15 or higher sunscreen when they were outside for more than an hour on a sunny day.

In another national survey, done in 2010, one-third of 14- to 17-year-olds said they’d suffered a sunburn in the past year.

The relationship between sun exposure and skin cancer depends on the kind of cancer, Ringger said.

Basal cell carcinoma – the most common form of cancer overall, but rarely a life-threatening skin cancer – results almost solely from sun exposure, but it’s more associated with prolonged, less-intense sun exposure.

Melanoma is more associated with “brief, intense” UV exposure. The other biggest risk factor for melanoma is a family history of the disease. If melanoma spreads, it’s hard to treat.

Like some other cancers, melanoma essentially deactivates patients’ immune systems, allowing it to proliferate.

“It has an invisibility cloak. It’s able to make itself invisible to the immune system,” Ringger said. “And so then it’s able to spread, and spread into organs like the lungs and the brain, and then it kills you that way.”

Advances in the past five years have prolonged the lives of melanoma patients by a month or two, which is “huge in the world of melanoma,” Ringger said.

And if it’s caught very early – before it spreads to lymph nodes and organs – the five-year survival rate for people with melanoma is 98 percent, Sukut said.

Sukut said people should see a dermatologist if they see any changes in size, shape or color in skin growths, or if they have a growth that bleeds or itches.

“The earlier we can detect melanoma, the better the prognosis,” Sukut said.

Gerald Ray, a 79-year-old Spokane resident who’s had melanoma twice, said he was first urged to get a skin growth checked out by his secretary, who later died of the cancer.

Now he distributes literature on melanoma – including photos of skin growths – at grocery stores and senior centers, urging people to talk to their doctors about their own suspicious marks and growths.

Melanomas can vary greatly. They’re often jagged and asymmetrical and uneven in color, according to the National Cancer Institute at the National Institutes of Health. They change in size and appearance.

“A lot of people have growths on their skin that can be not too pretty, but they’re even,” Ray said. “A skilled dermatologist will learn to recognize the difference between the ones that are not melanoma and the ones that are.”

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