Melanoma. The dark side of the sun. A. Wiggin

Melanoma The dark side of the sun

By Abigail Wiggin

Asthe days get longer and warmer, the first thought many Canadians have after a tough winter is about hitting the beach or pool and soaking up some sun. Unfortunately, that bright sun has a very dark side and is responsible for causing up to 85% of all melanoma cases.

Melanoma is a potentially deadly form of skin cancer that develops when the melanocyte cells of the skin grow rapidly and divide uncontrollably, eventually causing a cancerous growth or tumour. Melanoma is one of the most common cancers diagnosed in Canadians aged 15 to 59. It is also one of the few cancers with rapidly rising rates of diagnoses and incidence rates have been climbing for the past 25 years.

Overexposure to the sun and artificial sources of ultraviolet radiation is one of the most significant and preventable causes of melanoma. The impact of high amounts of UV radiation on the skin is so severe that just one blistering sunburn before the age of 20 significantly increases the chance of a melanoma diagnosis. Tanning bed usage even further increases these odds, and among those who first used a tanning bed before the age of 35, the risk of a melanoma diagnosis increased by 59%.

The bright side is that melanoma is very preventable, often easily detectable, and simple lifestyle changes and daily habits can have a huge and lasting impact. A sunburn may seem temporary, but the impacts of sun damage on the skin are long lasting. Let’s start summer 2023 on the right foot by implementing safe summer skin care now.

Protect yourself like a pro

Sun safety is essential for preventing melanoma or other forms of skin cancer from occurring. Sunlight is made up of both UVA and UVB rays, both of which penetrate the skin and cause damage. UV rays can also go through clouds, windows, fog, haze, car windshields, and lightweight clothing. To protect yourself from the sun and UV rays you can:

1 Limit the time you spend in UV rays

• Avoid outdoor activities when the sun is strongest, between 11 a.m. and 3 p.m. If you are outdoors during these times, stay in the shade as much as possible.

• Protect yourself from sunlight reflected by water, ice, snow, sand and pavement. If you’re sitting on a dock this summer, remember that UV rays reflected off water increases your UV exposure by 25%.

2 Wear protective clothing

• Clothes made of tightly woven fabrics that cover your arms and legs (for example, see-through materials are not tightly woven)

• Special sun protective clothes with ultraviolet protection factor (UPF) 50 or more.

• A hat with a wide brim that shades your face, neck, and ears.

• Sunglasses with 100% UVA and UVB protection.

Abbie Wiggin is the Manager, Community Programs and Resources at Melanoma Canada where she connects with melanoma and skin cancer patients and caregivers, providing counselling services, healthcare navigation, and advocacy. She also facilitates support services such as the Cancer Coaching program, Peer-to-Peer program, and monthly support groups.

Overexposure to the sun and artificial sources of ultraviolet radiation is one of the most significant and preventable causes of melanoma. The impact of high amounts of UV radiation on the skin is so severe that just one blistering sunburn before the age of 20 significantly increases the chance of a melanoma diagnosis.

3 Use sunscreen the right way

• Apply a broad-spectrum, water-resistant sunscreen with a minimum SPF of 30, ideally SPF 50, 30 minutes before sun exposure.

• Reapply every two hours, or more often after sweating or swimming.

4 Remember, there is no such thing as a safe tan

• There is no such thing as a healthy or safe tan and any tan or change in skin colour is a sign of skin damage.

• The concept of a “base tan” (the idea that a light tan will prevent burning) is a myth and a “base tan” provides little to no protection against sunburn or sun damage.

• Tanning is not a safe source of vitamin D, which is best achieved through maintaining a healthy, vitamin D-rich diet, and taking vitamin D supplements.

ABCDE: 5 letters that can save your life

Survival rates for melanoma are high when it is detected early and unlike other cancers, melanoma is often clearly visible to the naked eye on the skin. Because about 75% of melanomas are detected by patients themselves, we recommend monthly skin self-examinations using the ABCDE’s of

ABCDE: 5 letters that can save your life

A – Asymmetry The two halves of the mole have different shapes.

B – Border The edge of the mole is irregular. It may look blurred, ragged, or notched. Pigment may spread into the skin around the mole.

C – Colour The colour of the mole is uneven. The mole may have different shades of tan, brown, and black, sometimes with blue, gray, red, pink, or white.

D – Diameter

While melanomas are usually greater than 6 mm (the size of a pencil eraser) when diagnosed, they can be smaller.

E – Evolving

Example:

The mole has changed in the past few weeks or months. It may be itchy, scaling or bleeding.

Source: American Academy of Dermatology aad.org

https://www.aad.org/

melanoma. If you detect any changes to your moles or skin, contact your doctor for a referral to a dermatologist as soon as possible.

Sign up for our skin check reminders

Scan the QR codes or visit: melanoma network.ca/3ways

Warning signs of melanoma

Normal moles tend to have an even colour and can be pink, tan or brown. They are mostly round or oval and smooth. They also tend to be smaller than the width of a pencil eraser. The first signs of melanoma can be:

• A change in a mole you already have, such as a change in its shape, colour, size, surface, or texture.

• A new mole that appears.

• In some cases, the first sign of a problem is a swollen lymph node.

The odd ones out

Some forms of cutaneous (skin) melanoma, such as acral lentiginous melanoma, mucosal melanoma, and subungual melanoma, are often found on areas of the body that are not typically exposed to sunlight/high UV radiation, such as the soles of the feet, in between toes, nasal passages, or even genital and anal areas. Because melanoma is a cancer of melanocytes, which are found within skin cells, melanoma can potentially form anywhere on the body. These forms of melanoma are relatively rare and are not known to be caused by UV radiation, but monitoring and checking your body, including those areas that are less exposed to the sun, is still essential in potentially detecting any abnormalities or growths.

Other important factors

Melanomas can look very different from each other:

• Some melanomas may have all the ABCDE signs, others may only have one or two.

• Some forms of melanoma do not follow the ABCDE rule at all (for example, nodular melanoma follows the EFC rule: elevated, firm, and growing).

• Acral lentiginous melanoma can present as dark spots or bruises on the palms of the hands or soles of the feet that do not go away or won’t heal.

• Subungual melanoma can present as a dark vertical stripe on the fingernails or toenails.

Advanced melanomas may have changes in their texture or feel, and may:

• Become hard or bumpy.

• Look scraped or raw, and it may ooze or bleed.

• Be itchy, sore, or even painful.

Since not all melanomas fit the ABCDE pattern, always keep a look out for the “ugly duckling”—a mole or lesion that does not look like the others that you have. If it is changing, itching, bleeding, or scabbing, visit your doctor for a referral to a dermatologist.

Watch our guided skin self-exam video

Skin cancer can be a big deal. Checking for it isn’t. Scan the QR code for a guided skin exam.

Melanoma risk factors

• UV radiation exposure is the most significant risk factor for developing melanoma.

• 85% of skin cancers are caused by UV radiation and overexposure is the number one preventable risk factor for melanoma.

• Even just one severe sunburn with blistering raises the risk of developing melanoma.

• Sustaining just five sunburns as a teenager can make an adult 80 percent more likely to develop melanoma during their lifetime.

• The total amount of sun exposure in your lifetime is a risk factor, especially if it is high.

• People who habitually tan during adolescence and young adulthood have a higher risk of developing melanoma skin cancer later in life.

• Even people who tan without burning have a higher chance of melanoma due to high overall and prolonged exposure to the sun.

Canadian Melanoma Statistics

87,000 Canadians were diagnosed with melanoma in 2021 (an 8.5% increase from 2020).

1 in 41 males

1 in 51 females Based on annual trends from the past 40 years, melanoma rates have increased 2.2% each year in men, and 1.4% each year for females.

Canadian Cancer Society (https://cancer.ca/en/research/cancer-statistics/canadian-cancer-statistics)

• Tanning beds and sun lamps produce artificial UV light and therefore increase the risk of melanoma.

A personal or family history of melanoma is also a risk factor.

• People who have had a past melanoma have a higher chance of developing another.

• Having at least two close relatives with melanoma is also a risk factor, as it can run in families.

Partner Profile

Certain physical features are also risk factors for melanoma including:

• People with pale skin, who burn easily, have a higher chance of melanoma. These people may have blonde or red hair, blue or gray eyes, or many freckles.

• Having many (or more than 50) moles raises the chance of skin cancer.

• Atypical moles (or dysplastic nevi) often run in families. A dysplastic nevus

has a greater chance of turning into melanoma than a normal mole, but the risk is relatively low.

• Dysplastic nevus syndrome (also called familial atypical multiple mole melanoma syndrome, or FAMMM) is an inherited condition where someone has many dysplastic nevi and usually a close relative who has had melanoma. People with this condition have a very high risk of melanoma.

Melanoma Canada

Melanoma

Canada is a national organization dedicated to advocating for and supporting Canadians who are living with or have been impacted by melanoma and skin cancer. We focus on providing helpful resources for patients and the public, crucial sun safety education and melanoma awareness, and psychosocial support programming to patients and their loved ones. Melanoma Canada was founded in 2009 by three-time melanoma survivor, Annette Cyr, to respond to the need for Canadian melanoma and skin cancer patients to have an organization that was focused on coordinating education and prevention efforts. Additionally, Melanoma Canada was created to provide a strong voice for advocacy in targeting funding for melanoma research and improved access to care and treatment options.

Our mission as an organization is to:

4 Support our community through current and coordinated information and services.

4 Educate Canadians on prevention, detection, and available treatment options.

4 And to advocate for timely diagnoses, improved access to care across the country, and for the best and most effective treatment options to be widely available.

We value above all:

4 Being supportive to every person affected by melanoma and skin cancer at every stage of disease or journey.

4 Being passionate about access to credible information and effective treatment.

4 Being trusted as a reliable resource for the public and our industry partners.

Lifetime probability of developing melanoma by gender in Canada: 1 in 41 males, 1 in 51 females. Contact

https://www.melanomanetwork.ca/

Our support programs include:

4 Cancer coaching

4 Phone and e-mail support

4 Peer to peer support

4 Monthly support groups

4 Private Facebook groups

4 Private online chat

4 Patient information sessions

4 Patient guides and publications

4 Clinical trial finder

Melanoma Canada’s ultimate goal is to live in a world with zero melanoma and skin cancer related deaths. LP

Other risk factors that can increase your risk of melanoma are:

• Age - About half of melanomas develop in people older than 50 years.

• Medicine - Some medicines, like antibiotics, hormones, or antidepressants, increase sensitivity to the sun and as a result can raise the chance of melanoma.

• Lowered immune system - The immune system fights infection and removes damaged cells. Some diseases and some medicines weaken the immune system. This can raise the chance of melanoma.

Melanoma does not discriminate Melanoma can occur in anyone, regardless of age, gender, or race. Whilst people of colour are less likely to be diagnosed with melanoma than individuals with light skin, they are four times more likely to be diagnosed at an advanced stage, and often face far worse health outcomes because of delayed diagnoses. Additionally, if diagnosed with

melanoma, people of colour are most often affected by acral lentiginous melanoma (ALM) or subungual melanoma (SM). This summer (and year-round!) it is important to remember that having darker skin, or skin with more melanin, does not provide sufficient protection from UV radiation, and individuals with darker skin tones are still recommended to practice the previously mentioned sun safe habits.

ALM and SM present differently than more common forms of melanoma and are often mistaken and misdiagnosed as bruises on the feet, toes, or fingernails. For more information on detecting these forms of melanoma, please watch our Melanoma Does Not Discriminate video and visit: https:// www.melanomanetwork.ca/skin-of-colour/

Safe summer skin

There is no denying the impact of the sun on our skin and the risk it poses for developing melanoma. Environmental

changes in climate and ozone layer depletion also play a role in increasing our vulnerability to the damaging effects of UV radiation. As we enter spring and summer, don’t forget to practice sun safe habits, monitor your skin, and visit your doctor if needed. A fun summer is one you won’t regret down the line. After all, the skin is your largest organ, so show it some love. LP Watch

This summer (and year-round!) it is important to remember that having darker skin, or skin with more melanin, does not provide sufficient protection from UV radiation, and individuals with darker skin tones are still recommended to practice the previously mentioned sun safe habits.