Esther Cepeda: Don’t bake your DNA in the sun

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Esther J. Cepeda
August 26, 2015

CHICAGO -- Former President Jimmy Carter got me to schedule a doctor’s appointment and buy sunscreen.

When I heard that Carter has four spots of melanoma on his brain, I felt a bit of a gut punch. Melanoma? What is skin cancer doing on the president’s brain?

I thought I knew a good bit about melanoma. But even I didn’t know that sometimes, as may be the case with Carter, early skin melanoma tumors can just go away on their own, making them no longer outwardly visible, but then go on to spread malignancy to other organs.

“About 97 or 98 percent of metastatic melanoma which spreads … to another organ is initially from skin,” Omeed Memar, a board-certified dermatologist and an assistant professor of clinical dermatology at Northwestern University, told me. “Sometimes a dark spot becomes white. And on an older person [who might have] many spots, it’s just hard to find.”

Ugh. Now in addition to worrying about all our freckles and moles, we need to worry about white spots, too?

I was aware of the standard skin-cancer red flags because I’ve already had suspicious-looking moles removed. But that was more than five years ago, and Memar explained that the research on skin cancer has gotten much better and there’s much more to know now.

He noted that one person dies of melanoma every hour, and about 74,000 new cases of invasive melanoma will be diagnosed in the U.S. in 2015.

“Melanoma is only 2 percent of skin cancers but represents the vast majority of skin-cancer deaths. If you catch it at an early stage before it spreads to a lymph node, there’s a 98 percent cure rate,” Memar said. “But if it hits a lymph node, that’s a 63 percent survival rate. And once it hits organs, we’re talking 10 percent.”

That’s the problem though. The data tell us that African-Americans, Hispanics and others with medium to dark skin tones believe that their melanin-rich skin protects them from skin cancer.

But that couldn’t be further from the truth.

Memar told me that not only are darker-skinned minorities more susceptible to certain types of skin cancer due to certain genetic and environmental factors—Latinos, Chinese and Japanese tend to develop basal-cell carcinoma, the most common skin cancer, while African-Americans and Indians are at higher risk for the second-most common form, squamous cell carcinoma—but all darker-skinned people are more susceptible to acral lentiginous melanoma, an especially virulent form that typically appears on the palms of the hands and soles of the feet.

I told Memar he was making my stomach ache.

“Look, the most important thing is to not bake your DNA. Put on the sunscreen, shield yourself from the sun, and if you have a family history of skin cancer, go to the doctor,” Memar said.

But—and this is a big, big but—I know from personal experience that when you go to the doctor and say, “I’m worried about this mole,” he or she usually takes a fleeting glance and declares, “You’re fine.” Any hope of a referral to a dermatologist goes out the window.

“This is the sad state of managed care,” Memar said. “The fact is, there have been blinded studies that have found that when a dermatologist looks at a mole and says, ‘It’s benign,’ I’m only 65 percent accurate. But when a general practitioner says the same, they’re only 45 percent accurate. You’d do better to flip a coin.”

I finished my interview with Memar and made a long-overdue doctor’s appointment for my annual exam, during which I will use my new script.

“If you have a family or past history, bring it to the doctor’s attention,” Memar said. “If that’s not the case, I don’t want people to lie, but if you really are concerned you say: ‘My mole is changing’ or ‘I’m afraid this is melanoma’ or ‘This spot has been increasing in size,’ those are the words that will get you to a dermatologist.”

Don’t be like me and the 63 percent of African-Americans and Hispanics who don’t wear sunscreen. I’ve always hated the feel and smell but managed to find some store-brand ultra-dry, fragrance-free options that won’t break the bank.

And if you’re concerned, push your doctor to help you get an expert look at your skin.

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