Kenneth L Abbott, MD, FACP  |  5/3/2022

Melanoma Awareness Month

The poet T. S. Eliot famously wrote, “April is the cruelest month.” Although this is the first line of his most enigmatic poem, “The Waste Land,” which laments loss and destruction in the wake of the First World War, he proceeds to describe the return of warmth and new life following winter, which usually makes us glad as we anticipate the forthcoming days of sun, greenery, and holiday. We embrace spring, the season of renewal and new promise, despite the pollen. But with the shedding of thick winter clothing and the recession of days spent mostly indoors, we also confront the exposure of skin to sun and the damaging effects of solar radiation. So as spring revs up and April turns to May, as the chill air and the dreary showers wane while the sun continues to mount ever higher in the sky, we should beware those smiling rays that feel so good but can hurt so bad.

Skin cancer is associated with the harmful effects of ultraviolet (UV) radiation from the sun, particularly the kind called UVB. The most serious form of skin cancer is melanoma, a cancerous transformation of melanocytes, or pigment-containing cells that exist within the deeper layers of the skin. To a far greater extent than the more common squamous cell cancers and basal cell cancers, melanoma can be aggressive, locally progressive, and quick to spread to other regions of the body. In subsequent posts, I’ll write more about treatment of melanoma, which has undergone something of a revolution in recent years. Today I want to pay attention chiefly to awareness and prevention.

Who is at risk of developing melanoma? Anyone can get it—pigmented cells exist in everyone—and intense sun exposure is only one (albeit closely associated) risk factor. Family history is always important; some 10% of persons who develop melanoma have other family members with the disease. Persons born with high numbers of skin moles (called nevi), especially those whose nevi feature odd or atypical characteristics, are at risk. Fair-skinned individuals and those with light eye color (green, blue, hazel) and who are susceptible to freckling have a heightened risk.

What can be done? Everyone should undergo periodic skin examinations, all the more so if you have any of the known risk factors. Enjoy the sun, but best not in the middle of day when summer radiation is at its worst. Wear protective sunscreen products; waterproof 30 SPF or higher carries the American Academy of Dermatology recommendation, but even 15 SPF offers some protection. Light clothing covers, broad-brimmed hats, and sunglasses complete the smart summer outfit. Be aware that sunlight reflected off water surfaces intensifies your exposure, so be extra careful when swimming, sailing, and engaging in other water activities.

So, with all respect to Mr. Eliot, whether April is cruel or not, we can help take the sting out of May and all the months of summer by being smart in the sun.
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