Ask the Expert

Do you spend a lot of time in the sun?
You may be at risk for skin cancer.
Learn more about your risks of melanoma from a skin cancer expert.

Now that summer is upon us, golfers, tennis players and other outdoor lovers should think twice before going out without sun protection. Exposure to ultraviolet light is one of the key risk factors for melanoma, a highly malignant form of skin cancer. This month, Dr. Jeffrey Muench, a surgical oncologist with Suburban Hospital in Bethesda, provides information on prevention, diagnosis and treatment. Dr. Muench attended the University of Virginia Medical School, then went on to the University of South Florida in Tampa for his residency. He later earned his Fellowship in surgical oncology at the National Cancer Institute in Bethesda.

What is melanoma?

Melanoma is a skin cancer that arises in cells called "melanocytes" – cells that produce the brown pigment called melanin. Melanomas are more common on skin that is exposed to sunlight, such as arms and legs. While it is believed that sun can play a significant role in melanoma development, what exactly causes melanoma is not known.

How frequently is melanoma diagnosed?

An estimated 52,000 new cases of melanoma are diagnosed each year. That translates into about one in five Americans developing skin cancer in their lifetime. About 8,000 people die of melanoma every year in the U.S.

How dangerous is melanoma?

Skin cancer is one of the fastest growing and most difficult to track cancers in the world, with melanoma being the most serious form. In the U.S., melanoma is the second most prominent cancer in the less than 65 age group. Advanced melanoma can spread throughout the body and has a higher rate of fatality. When detected at its early stage, surgical removal cures the disease in most cases. If the disease has spread to the lymph nodes, the five-year survival is about 24 to 69 percent. If the disease has spread to distant organs like the liver, brain and bones, the five-year survival rate is often less than 10 percent

Isn’t melanoma an older person’s disease?

No. The majority of a person’s lifetime skin exposure and skin damage occurs before he or she turns 18. In fact, approximately 30 percent of all melanomas occur in people who are younger than 45. Melanoma is currently the most common cancer in women between the ages of 25 and 29.

What are the risk factors for melanoma?

Genetic factors are the most important of the known risk factors, including the familiar tendency to develop melanoma, numerous prominent moles, and atypical moles. Between 5 and 10 percent of people who develop melanoma have a family history of the disease. You are also more at risk if you are of Caucasian ancestry and have fair skin. African-Americans with darker skin get melanoma, but their risk is 20-fold less than for fair-skinned people. However, no racial group is immune.

Those who are immune-suppressed from AIDS, lymphoma, or other diseases are also at increased risk. In addition, overexposure to ultraviolet radiation in sunlight is believed to be a contributing factor to many cases of melanoma; short periods of intense exposure, such as sunbathing, is associated with a two-fold increase in melanoma risk. Frequent visits to tanning salons, increase your exposure to ultraviolet radiation and therefore increases your risk. Finally, people who are sun sensitive, tan poorly or not at all, have a 2 to 3-fold increase of risk. While this scientifically difficult to quantify, it is believed that the risk increase is much more with ultraviolet exposure.

How can I prevent melanoma?

Sun avoidance and protection are strongly recommended. Avoid deliberate sunbathing; wear a wide-brimmed hat, UV-blocking sunglasses and protective clothing. Avoid being outdoors in the middle of the day when UV light is most intense. When playing sports like tennis, for instance, schedule early morning or evening matches to prevent sun overexposure. Using sunscreens with an SPF of 15 or higher is also recommended.

What does SPF mean?

SPF, or Sun Protective Factor, measures the length of time a product protects against skin reddening from UVB (Ultraviolet B), compared to how long the skin takes to redden without protection. For example, if it takes 20 minutes without protection to begin reddening, using an SPF 15 sunscreen theoretically prevents reddening 15 times longer – or about 5 hours. SPF higher than 30 blocks only 4 percent more UVB, but may be helpful for those with sensitive skin and those already diagnosed with skin cancer. While SPF is the universal measurement of UVB protection, no comparable standard exists for UVA (Ultraviolet A).

What’s the difference between UVB and UVA?

UVB are the burning rays. These short-wave rays produce sunburn and are considered the main cause of skin cancer. UVA are the aging rays. These long-wave rays penetrate the skin more deeply than UVB, adding to the UVB’s harmful effects, promoting skin cancer, wrinkles, blotching and premature aging of the skin.

Are there check-ups my physician can perform to screen for melanoma?

A yearly skin examination by your dermatologist is highly recommended. Self skin exams can be performed in between dermatologist visits. Examining your skin regularly for any suspicious mole is the best way to detect skin cancer when it can still be surgically removed successfully. All parts of the body should be viewed -- front, back, under arms, palms, backs of legs and feet, including the spaces between your toes and the soles of your feet. Also use a mirror to examine the back of your neck and part your hair to look at your scalp.

What kind of moles should I look for?

Signs of melanoma may include Asymmetry in moles, irregular Borders, changing Color, (some moles become clear in the center, red and blue color is also a sign), and increasing Diameter. These are known as the ABCD rules of melanoma. However, even if your moles are small, if they have other atypical features it might be wise to have them regularly examined or removed.

How dangerous are tanning beds?

Most tanning beds provide UVA light, eliminating the potential for sunburn and stimulating the development of a tan. However, the UVA penetrates into the skin and still causes damage. The cumulative effective of ultraviolet radiation, whether from indoor and outdoor tanning, may contribute to the development of skin cancer. There is however no documented evidence suggesting that tanning beds are in fact hazardous.

What is the treatment for melanoma?

Various forms of treatment are available, depending on the stage of the tumor, the patient's age and physical condition, and any other conditions the patient may have. Many clinical trials of new therapies are available through Suburban Hospital's Cancer Program and the National Cancer Institute in Bethesda.

For a referral to a dermatologist, or to use our free 24-hour Nurse Advice Line, call Suburban On-Call at (301) 896-3939.