MD Anderson Cancer Center
Lisa Garvin: Welcome to Cancer Newsline, a podcast series from the University of Texas M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm you host, Lisa Garvin. Today, our guest is Dr. Ana Ciurea, she is an assistant professor of Dermatology here at M.D. Anderson, and with things warming up and Spring around the corner, we're going to talk about melanoma. Dr. Ciurea, you say that melanoma incidences are still on the rise.
Dr. Ana Ciurea: Yes, this is absolutely correct. In fact, in 2011, it is reported in more than 100,000 patients were diagnosed with melanoma. We know that every hour in the United States one patient dies of metastatic melanoma and we also know that one in five people living in the United States these days will have some sort of skin cancer in their lifetime.
Lisa Garvin: There's been a public education awareness campaign in place for many, many years now, are we seeing the effects of that, are people taking head and protecting their skin to prevent these cancers?
Dr. Ana Ciurea: Absolutely, in fact, we consider that a lot of new melanomas diagnosed in the last few years are because of these intense campaigns that have been going on all around the country for quite a few years. Yes, patients are more self-aware. A lot of us perform a self skin examinations more often than in the past which leads to an early detection and in fact if you look at the statistics, a lot of new melanomas diagnosed in the last few years are early melanomas and we think it's because of continuous education of the public. [Lisa Garvin:] So, the incidence rate is rising but because of self awareness rising as well.
Dr. Ana Ciurea: That's one theory and the other theory about the increase incidence of melanoma, of course, this in not proven yet, is the fact that we're living longer and that the longer we live, there is a higher incidence if getting the cancer because of our immune system which becomes weaker and weaker as we age.
Lisa Garvin: How do you keep the message fresh, how do you let people know that this is a constant vigilance kind of thing?
Dr. Ana Ciurea: Absolutely. This is every day, every patient message that I pass on my daily practice, every single patient is being informed and reminded all the time about the importance of not only sun protection but also self skin examination. I emphasize so much that we'll have to be vigilant these days, we have to get into the habit of knowing our skin and to be able to pick up anything that is catching our eye.
Lisa Garvin: I did see something online and it was a campaign. It was apparently used in Australia, but now the American Cancer Society uses it. I believe it was Slip! Slop! Slap! and Wrap! where you would slip on a shirt, you would slop on some sunscreen, you would slap on a hat, and then wrap your eyes with sunglasses, have you heard about this campaign?
Dr. Ana Ciurea: I've heard about this campaign. We have something similar here and we all believe in protection from the sun not only by applying sunscreen but also barrier protective clothing, as you mentioned large bore hats, sunglasses and long sleeve shirts and pants.
Lisa Garvin: But now, UV protectants are being built into some clothing nowadays, isn't it?
Dr. Ana Ciurea: UV protective clothing, they're all there and they are useful. They are not 100 percent protective, but they are definitely something that we should consider when we go out in the sun.
Lisa Garvin: I'm never clear on what sort of clothing should be worn outside. I seem to remember when I was younger that they said you should wear light colored clothing because the rays would bounce off of it, but now it seems like they're telling you to wear darker colored clothing, so which is it?
Dr. Ana Ciurea: Yeah, that's an interesting question that do rays is all there. We don't know exactly if lighter color are better protective than the dark colors, but I truly think what's the most important is to protect ourselves with clothing especially fabrics that they have this UVA impregnated particles that are able to retain most of the UV radiation.
Lisa Garvin: Let's talk about melanoma detection at least on the part of the person themselves. There was the old adage, I believe it's ABCDE, explain that.
Dr. Ana Ciurea: Absolutely. This is one of our best tools, we provide every single patient which comes to us. It is actually a very good mnemonic. A stands for asymmetry which means if you look at a spot, the left side doesn't quite look like the right side; that means it's an asymmetric mole. B stands for border irregularity. We like to see moles that are round or oval, smooth and uniformly pigmented borders. B is border irregularity and if it's something like that shows up on the skin, it definitely needs attention. C stands for color. Normal moles usually have one color. If we detect more than two colors, that's a sign of alert and D stands for diameter. In general, we think that most, larger than a pencil eraser should raise attention. Although, in my experience spots that are smaller than a pencil eraser can be also very dangerous. E stands for evolution which means change. If someone is watching a specific spot on the skin and that's changing in size, shape or color, that means the mole had changed and that needs attention right away.
Lisa Garvin: But persons like myself, and you know, African Americans and others, we grow moles and skin tags, so we are constantly growing moles and they're constantly changing. How do we--do we have to have them all biopsied every year because they change? How do people who have moles deal with that?
Dr. Ana Ciurea: Not really, not everything growing on our skin needs to be removed. That's why I think it's very important for the patients to seek medical attention when they are in doubt, a dermatologist or a knowledgeable primary care physician to be able to explain the different type of skin spots that one can grow and reassure the patient especially when one sees lesions that are completely benign. So, I highly encourage everyone who has questions to let a specialist explain that and help the patient differentiate between something which is really important and something that is actually benign and will never change.
Lisa Garvin: What is mole mapping, explain that?
Dr. Ana Ciurea: Mole mapping is a very useful tool. It's a at least here at our institution is a complete set of 36 photographs that are taken by a specialist and in patients who have a lot of atypical moles, very hard to document and very hard to follow, basically a patient like that is being photographed and these are stored in the computer and are available at next visit for comparison. Not all the institutions is not something that is widely used, but here at M.D. Anderson, it's a great tool for us to follow especially suspicious or questionable moles.
Lisa Garvin: Was this something that was pioneered here, mole mapping or is it something we've just been an early adopter of?
Dr. Ana Ciurea: We've been an early adopter. To my knowledge, mole mapping wasn't as started here.
Lisa Garvin: What about people who ignore skin changes, I mean, it seems like it's fairly common at least among men and men are more affected as they age with melanoma. I've seen some pictures where they really gotten obviously bad and they just don't go to the doctor, how do you deal with that?
Dr. Ana Ciurea: That's a very difficult situation. You wish that one will detect something and seek immediate medical attention. Unfortunately, this doesn't happen always and we do in fact see patients with late stage melanoma because of late detection and it is true that recently, melanoma has shifted from disease of early adulthood and usually and women to disease more often seen and Caucasian men older than 50. It is very interesting to know that in men, melanoma shows up first on the trunk, usually the back area and this may have something to do with late detection. First of all, it's hard to look at the back unless someone is doing it, you know, on a regular basis. It is harder to spot things on the back than on the face, let's say areas that we see everyday or arms and as I said, it happens that in Caucasian men older than 50, the back area tends to be more affected and this may have to do--something to do with the fact that is being detected late instead of early.
Lisa Garvin: And I wonder if men who are--may be more predisposed to do physical labor outside, that area seems to be like an area that would be unprotected on a worker, the so-called red neck.
Dr. Ana Ciurea: Absolutely, you are perfectly right. Construction workers, people working outside a lot especially without protecting themselves from the sun they indeed tend to have more melanomas on that location.
[Lisa Garvin:] So, how are we doing going forward, are there new, there was a melanoma vaccine out there. I guess there were mixed results on that. Are there more detection and diagnosis tools and treatment tools out there?
Dr. Ana Ciurea: As far as detection tools at this point, in my opinion, it is still a lot of work in progress. FDA had approved a device, it's called MelaFind, this was in November last year. A special computerized system of analyzing moles. That means, it's actually a magnifying glass that is being applied to patient's skin to a specific skin spot that's being analyzed by the computer and the computer is able to differentiate between something which can be very dangerous or something which is benign. As I said, it's for the first time here in United States a device like this has been approved. It's still a lot of work in progress, we don't have it here currently at M.D. Anderson. We're thinking two years in the future. To me and a lot of my colleagues, it all comes to our eyes, our dermatologist's eyes, the patient's eyes and when we are in doubt we do remove the suspicious skin lesion for the pathologist to give us the final answer.
Lisa Garvin: So, in summary Dr. Ciurea, what do people need to do to prevent themselves from getting melanoma?
Dr. Ana Ciurea: I strongly recommend sun protection with a broad based sunscreen against UVA and UVB. I highly recommend barrier protective clothing including large bore hats, sunglasses, long pants and long sleeves and I also highly recommend for patients to look at their skin. It is extremely important than when something is being unnoticed they should seek immediate medical attention.
Lisa Garvin: Great, thank you very much.
Dr. Ana Ciurea: Thank you.
Lisa Garvin: If you have questions about anything you've heard today on Cancer Newsline, contact askMDAnderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in for the next podcast in our series.
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