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Skin self-exams are the most direct method for detecting potentially deadly melanoma, though the benefits remain unproved. Moles that are smaller than a pencil eraser are rarely cancerous.
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90 percent of melanoma growths are curable if caught early and removed; untreated, survival rates are worse than for lung cancer. When it comes to melanoma, vanity may be a virtue. The most direct method for detecting this deadly skin cancer is to face a mirror, clothes off, and check for suspicious moles from head to toe.
“Melanoma is the biggest no-brainer for screening,” said Myles Cockburn, a preventive medicine expert at the University of Southern California. “You’re looking right at the tumor.”
Moles at least the size of a pencil eraser are of greatest concern, since smaller spots are rarely cancerous, said Dr. David Polsky, a dermatologist at New York University School of Medicine. “To get hung up on the real small stuff is missing the bigger picture,” he said.
But changes to the color, size or shape of any mole may be an early indication of trouble, especially for someone who has a family history of melanoma or lots of unusual moles.
And while sun-drenched areas on the head or legs are likely sites for other forms of skin cancer, melanoma can develop anywhere on the body.
About 90 percent of melanoma growths are curable if caught early and surgically removed, putting the impetus on people at home to look for cancerous spots. When growths are left unchecked, the chances of surviving the disease for long are worse than for lung or colon cancer.
But in the push to make everyone better skin cancer detectives, tough obstacles — and questions — remain.
To locate the first signs of danger requires studious attention, and few people seem willing to bother. Nine to 18 percent of Americans regularly examine their own skin for melanoma, surveys show. Dermatologists, typically the first responders for skin cancer, may be quicker to schedule a Botox appointment than to verify a patient’s concern about changing moles, research shows.
Furthermore, there is no proof so far that such screening will ultimately help save any of the estimated 8,400 lives lost to melanoma each year in the United States.
“It’s still an open question,” said Dr. Marianne Berwick, a melanoma specialist at the University of New Mexico who led the largest and most rigorous investigation so far on skin self-exams. That study found that fastidious skin watchers had no better chance of surviving cancer after five years than those who did not check for moles. Two decades of follow-up have failed to show any improvement, she said.
The stakes are high. The chance of surviving melanoma turns sharply for the worse once the tumors have spread beyond their original site on the skin, making it critical to find changes early.
“There’s no really good proven therapy for advanced disease,” said Dr. Martin Weinstock, a professor of dermatology at Brown University Medical School.
Researchers have tested various treatments, including chemotherapy, radiation and the drug interferon, which show only modest effects against the later stages of melanoma. Newer drugs and vaccines are undergoing testing now. But the main reasons that melanoma survival rates have improved at all over the past 30 years are earlier detection and better screening.
Yet in the rush to get the cancer out fast, experts say they are noticing a relaxing of standards in diagnosing melanoma. Doctors these days are more likely to take out any suspicious mole out of fear of missing a cancerous one, and possibly getting sued for a missed diagnosis, these experts say.
A separate study conducted by Dr. Berwick found that 40 percent of the melanomas detected in 1988 would not have been considered cancerous 10 years earlier.
This could mean that surgeons are removing a fair share of lesions that aren’t melanoma, though even pathologists examining the same skin biopsy samples often disagree on whether the diagnosis is melanoma. At the same time, doctors who aren’t trained in spotting may be leaving harder-to-detect, slow-growing tumors behind.
“Unless you’re specifically trained as a clinician to do a skin exam, you can’t necessarily do a good one,” said Dr. Cockburn of U.S.C.
Nonetheless, like many doctors, Dr. Cockburn still believes that the odds can improve by teaching “your average Joe” to look for melanoma spots, a view shared by the American Cancer Society and other medical groups.
Enlisting the help of a spouse or partner may make it easier to track evolving moles on the body. A camera may also help. One study found that people who took photos of their skin improved their chances of detecting possible melanomas by 12 percent.
The only downside to home screening is in creating a nation of skin cancer hypochondriacs who further tilt the balance to unnecessary operations, experts warn.
But in this age of plastic surgery, the chance to overcome a deadly, but treatable, cancer is worth the risk, Dr. Cockburn said. “With the amount of stuff that gets chopped off these days,” he said, “I don’t really think there’s a problem.”
Sources: The New York Times:Oct.19.’08
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