The Deadliest Skin Cancer

Although there are several different types of skin cancer, most don't become life-threatening because they aren't likely to spread to other parts of the body. Unfortunately, melanoma is different. If not caught early, melanoma can spread from the skin to other organs — often with deadly results.

And this serious skin cancer is no longer considered just an older person's disease. Rates are on the rise — especially among people in their teens and 20s — and research shows that the increase may be partly related to ultraviolet (UV) sun exposure during childhood. In the United States alone, the percentage of people who develop melanoma has more than doubled in the past three decades.

If there's any good news about melanoma, it's this: You have the power to substantially lower your family's risk of getting it by protecting kids from the sun, paying attention to the moles on their skin, and making sure they know from an early age just how important it is to take sun safety seriously.

About Melanoma

Melanoma is a type of cancer that begins in the melanocytes — the cells deep within the epidermis (the outermost layer of the skin) whose function is to produce melanin, the pigment that gives skin its color. Dark-skinned people have cells that naturally produce a lot of melanin, while fair-skinned people produce much less.

Melanocytes commonly cluster together to form skin growths called moles (or nevi, in medical terms). Most people have several moles — maybe even dozens — and in most cases they don't cause any problems. They may be flat or raised, large or small, light or dark, and can appear anywhere on the body.

Sometimes, though, melanocytes can malfunction. Because of a genetic change (mutation), they can begin growing out of control, sticking together to form lesions or tumors, crowding out healthy cells, and damaging surrounding tissue. This is cancer.

Melanoma that's caught early, when it's still on the surface of the skin, can be cured. But undetected melanoma can grow downward into the skin until it reaches the blood vessels and lymphatic system. These two systems can act like a highway for the cancer cells, allowing them easy access to distant organs like the lungs or the brain. That's why early detection is so important.

How People Get It

How does a normal melanocyte become malignant? Researchers believe it's probably a combination of genetic and behavioral factors. But one of the most important common denominators is sun damage. Cells that have been damaged by UV rays are more likely to become cancerous over time.

And though you might think that occupational exposure — being in the sun because you work outside, for example — would be associated with a higher risk, research has shown that it's actually recreational exposure that has the potential to do the most damage. So short bouts of bad, blistering sunburn that a child may get during a day at the beach or the park or even on the family vacation may be more harmful than lower level, everyday exposure.

Among teens and young adults, there is an eight-fold higher risk of melanoma among tanning bed users, who are also exposed to "concentrated" doses of UV rays.

Of course, there may be other reasons for the increase in overexposure to harmful rays. Perhaps the thinning of the ozone layer or clothing styles that expose more skin have also contributed to the risk. Or maybe, as people live longer and become more are aware of the disease, more cases of skin cancer are naturally going to be diagnosed. But more likely today's melanoma rates have as much to do with lingering misconceptions about tanning from years ago.

Not long ago, most people — including doctors — thought it was safe and even healthy to lather up with oil and tan as much as they wanted. In the 1960s and '70s, metallic reflectors and baby oil were all the rage. Then, in the 1980s, tanning beds and sun lamps became popular, and many people began believing it was actually safer to get a "base tan" indoors before heading out into the summer sun or going on a tropical vacation.

Risk Factors for Melanoma

Today we know better. Still, certain risk factors can increase a person's chance of developing melanoma, including:

• a fair complexion (light skin that freckles or burns easily, blue eyes, or blond or red hair)
• having many moles (typically more than 25)
• UV exposure (whether from the sun or a tanning bed)
• having a history of frequent or severe sunburns
• having a relative with melanoma or a family history of irregular moles
• age (older people are still at greater risk)
• having a previous melanoma (moles typically don't grow back after being removed, but a person who's had melanoma once is more likely to have a recurrence somewhere else)

But melanoma doesn't discriminate. Though less likely, people can still get it even if they're dark skinned (people of African heritage are more likely to get it under the nails, or on the palms and soles), young, and have no family history. It appears that behavior — too much sun worshipping and not enough skin protection — can override these other risk factors.

Signs and Symptoms

Many melanomas start out as a mole or a bump on the skin. Of course, not every mole is cancerous — far from it. What's more telling is whether a mole has undergone any kind of recent change, whether in size, shape, or color.

That's why it's important to look at your child's skin (and, of course, your own) and take a mental snapshot — kind of like a mole roadmap — so you'll know what's normal. With that as a baseline, you'll be able to spot any changes early.

The ABCDE Rule

Keep the ABCDE rule in mind when checking moles:

• A for asymmetry: If you were to cut the mole down the middle, would the left and the right sides look different?
• B for border: Are the edges blurry and undefined? Does it appear to be spreading sideways?
• C for color: Does the mole look darker or lighter than usual, or does it have an area of new color — perhaps black, blue, purple, red, or white?
• D for diameter: Is the mole larger than the eraser on a pencil top?
• E for elevation: Does it have a raised or bumpy surface?

If you answered yes to any of these questions about an existing mole — or if you notice a new mole, or one that's started to itch or bleed — see your doctor right away. The most common places for melanoma to occur are on the trunk, head, and neck for boys, and the lower legs for girls.

If a melanoma is suspected, the doctor will perform a biopsy by removing all or part of the mole and examining its cells under a microscope. Not only can a biopsy tell if the cells are cancerous, it can also be used to tell how deeply it has penetrated the skin and can predict its risk of spreading. Knowing these details will help the doctor map out a treatment plan.

Treatment

Once doctors confirm melanoma, treatment depends on how big and deep the lesion is, what part of the body it's on, and whether it has spread to other parts of the body. The process of determining this information is called staging. Although staging is a complicated procedure that involves both physical exams and lab tests, the basic premise is that the lower the stage, the better the prognosis.

Treatment for melanoma typically includes surgery to remove the lesion, and possibly radiation (high-energy X-rays that are directed at tumors) or chemotherapy (cancer-fighting drugs) if doctors suspect that cells may have traveled to other areas of the body.

Immunotherapy (also known as biologic therapy) — in which doctors stimulate the body's own immune system to fight cancer cells — may also be used alongside these other treatments.

Prevention

Although you can't control how fair their skin is or whether they have a relative with cancerous moles, you can lower your kids' risk of developing melanoma. The most important is to limit sun exposure by:

• keeping kids younger than 6 months out of the sun entirely, because their skin is extremely sensitive
  
• for kids 6 months and older, using sunscreen with an SPF of at least 15 every day
  
• avoiding the strongest sun of the day — between 10 a.m. and 4 p.m.
  
• encouraging kids to wear a wide-brimmed hat and long, loose cotton clothing, especially if they tend to burn easily
  
• making sure your teen understands the dangers of tanning salons
  
• being a good role model yourself

Also, encourage kids to check their moles frequently (they may need some help with those hard-to-reach areas, like the back and scalp). Help kids keep dated records of the moles' location, size, shape, and color, and remind them not to wait to bring anything suspicious to your attention so you can have it checked out.

Just as important, encourage them from an early age to think about and take responsibility for their own sun safety. For very young kids, it helps to keep it fun. Make a game out of applying sunscreen, whether it's racing each other to lather up or making up a silly song about slathering on the lotion. For older kids, keep some sunscreen by the front door and make putting it on a prerequisite for playing outside (you may even consider rewarding them every time they remember without being told).

For teens, seeing some pictures of normal vs. sun-damaged or cancerous skin can really drive the message home that the choices they make today can absolutely have an effect on their health tomorrow.

Not all skin cancer is melanoma, but every case of melanoma is serious. So now that you know more about it, do what you can to lower kids' risk and empower them to make smart choices about sun safety. After all, the best defense is a good offense.

Reviewed by: Christopher N. Frantz, MD
Date reviewed: August 2011