Melanoma can be deadly. But experts say it's easy to protect your skin and catch it early
Damage from sun’s UV rays is the main cause of melanoma
Across the country, the days are getting warmer, and soon you may be digging out your straw hat and reaching for last summer's bottle of sunscreen.
But did you know that melanoma experts recommend wearing sunscreen 365 days a year?
"The first thing I did this morning was get up in the dark and put on my sunscreen," said Dr. Julia Carroll, a dermatologist in Toronto.
Carroll said she doesn't bother checking the weather first, because ultraviolet, or UV rays — the main risk factor for melanoma — can harm your skin no matter the season.
"It's the [ultraviolet] B levels that go up and down, and ultraviolet A levels are the ones that go deep in and can damage the DNA," Carroll told Dr. Brian Goldman, host of CBC's The Dose.
Melanoma is a type of skin cancer that occurs in our melanocytes, the cells in our skin that make pigment.
UV rays from either the sun or from tanning beds damage the melanocytes, said Dr. Elaine McWhirter, a medical oncologist at the Juravinski Cancer Centre in Hamilton and associate professor at McMaster University.
"Their inability to repair that damage to the DNA is what leads to overgrowth and tumours," said McWhirter.
Rates of melanoma are going up in Canada, but experts say this type of skin cancer is highly preventable if you protect yourself from sun exposure and check your skin for irregular moles.
Who is most at risk?
If you have fair skin that burns easily, many freckles or moles, or you've had more than two blistering sunburns before the age of 20, you are at higher risk for melanoma, say experts.
Simon Blakesley was diagnosed with melanoma in 2015. He believes he developed it from many years of sun exposure as a child growing up in southern Ontario.
"We ran around outside, got thoroughly sunburned and then in the evening, sprayed with pain-relieving kinds of things or rubbed with butter where it was really badly burned," said Blakesley, who now lives in Whitehorse and is a retired educator.
"There was really no understanding or awareness about the longer term effects of sun exposure."
After Blakesley had his melanoma removed and learned more about the risk factors, he talked about it with his three older brothers and his father.
His brothers got checked, but his dad refused.
"Being the youngest, I think he thought 'Ah, I don't need to listen to you,'" said Blakesley.
But about a year later, "he started developing lesions on his back, which once they started bleeding, he knew that he had to go see a doctor."
Blakesley's father was diagnosed with an aggressive melanoma that had already spread to his lymph nodes.
After a number of painful surgeries, he chose medical assistance in dying in 2018, said Blakesley.
"The melanoma was so aggressive, so disfiguring, so demoralizing. It basically destroyed his outer body on his back and his shoulder," he said.
Blakesley said after his father's death, he felt guilty about not pushing his father to go to the doctor sooner.
He now tries to spread the message about melanoma as often as he can.
"I don't think people have taken it seriously enough because it's often seen as a cosmetic or a vanity kind of thing," he said.
"I know through my own first-hand experience … how melanoma can basically deconstruct your body."
Early detection is key
Experts say since melanoma shows up on the skin, it is easy to spot it early and get it treated before it spreads.
"What happens with a melanoma is when you first start to see those changes, it grows along the surface of the skin," said Carroll.
"Over time it starts to grow down and that's when it then metastasizes and can become deadly."
Experts recommend putting a reminder in your calendar to check your skin for irregular spots or moles once a month.
You can follow the ABC's of mole evaluation, said Carroll and McWhirter.
- A — Asymmetry. The mole should be symmetrical, or a uniform shape.
- B — Border. The mole should have smooth borders, not jagged or fuzzy edges.
- C — Colour. The mole should be a uniform brown colour. Melanomas are often black, blue, reddish or bleeding.
- D — Diameter. The mole should be no more than 6 mm across, or about the size of a pencil eraser.
- E — Evolution and Elevation. Melanoma often changes over time, unlike a benign mole which will stay the same. Melanomas can also rise above the surface of the skin.
- F — Family. If you have a grouping or family of moles, they should all look the same. Melanomas tend to stand out.
If you spot any of these signs while checking your moles, you should see a dermatologist, experts say.
How can you protect yourself from the sun?
Along with checking his skin regularly for moles and seeing a dermatologist yearly, Blakesley now takes a very different approach to sun protection.
He works as an aviation photographer and often spends all day outside.
"I always wear full cover. I'm always wearing a hat. Any exposed skin, it's always a minimum 30 SPF," said Blakesley.
Experts say there are three key strategies for sun protection:
- Avoid peak hours.
- Cover up as much as you can.
- Wear a high SPF sunscreen.
Peak hours for sun exposure are 10 a.m. to 4 p.m., said McWhirter, so try your best to plan outdoor activities earlier or later in the day.
"But we have to be practical. Our summers are short, people like to get outside," she said.
That's why she recommends SPF-based clothing, which have a weave that blocks UV rays, and a wide-brimmed hat.
If you are outside during the middle of the day, Carroll recommends seeking shade, covering up, and of course, applying sunscreen.
Which sunscreen is the best?
Both Carroll and McWhirter said the most important thing to look for in a sunscreen — beyond an SPF of at least 30 — is a product you like.
"The best sunscreen is the one you're willing to wear. And there are sprays, there are lotions, there are sticks, there are powders," said Carroll.
It's key to reapply every two hours when you're outside, or after you sweat or go swimming.
"Putting that on once in the morning and being out for the day is insufficient," said McWhirter.
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If it's not a sunny day, you might assume you don't need sunscreen, but that's a myth, added McWhirter.
"If it's cloudy you might not feel that same heat in your skin but unfortunately the UV rays are still getting through," she said.
If you have darker skin you can still get melanoma, experts say, but it is more often a type that's not caused by sun exposure.
It's called acral lentiginous melanoma, found on areas of the skin that aren't typically exposed to sun, and scientists aren't yet sure what causes it.
"Bottoms of the feet, between the toes, skin cancers in those areas are more common in people with more darkly pigmented skin," said Carroll.
Experts recommend that everyone wear sunscreen, regardless of the shade of your skin.
What happens after a melanoma diagnosis?
Dermatologists like Carroll, along with primary health care providers, are on the front lines of identifying and diagnosing melanoma.
If Carroll sees something suspicious on a patient's skin, she gets it biopsied, she said.
If the mole turns out to be a melanoma, Carroll said she tells her patients it's not the worst news.
"It would be worse if it was on you and we didn't know. So now at least we know and we can move forward and do something about it," she said.
Some dermatologists do surgery in their offices to remove melanomas, and surgical oncologists also perform surgery, depending on the severity, said Carroll.
A medical oncologist such as McWhirter sees patients whose melanoma is at least stage 2, meaning it has started to spread below the skin.
Advancements in melanoma treatments
Over the past 15 years, there has been a significant evolution in the treatments offered for melanoma, said McWhirter.
Chemotherapy doesn't work for melanoma, she said, but there are two broad types of treatments: immunotherapy, which is intravenous, and molecularly targeted therapy, which comes in pill form.
Before these newer types of treatments were offered, only about 25 per cent of patients with stage 4 melanoma would live for one year after being diagnosed, she said.
"Now when we offer treatments, we're seeing in the range of about 50 per cent of patients alive and well five years after starting treatment," said McWhirter.
It's rewarding to be in a field with such considerable improvement in treatments, she said.
"They're not perfect. Patients do still die of metastatic melanoma, but we've really made significant and important gains in the lives of our patients who are dealing with melanoma."
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