Shyness doesn't always pay health dividends

Is it a benign mole or malignant melanoma? This is an important question as the number of cases of melanoma continues to increase. It's shocking that the incidence of new cases is now greater than the combined number of breast, lung, prostate and large bowel cancers. So how can you prevent dying from this disease?

Rudyard Kipling, the English novelist, gave some sound advice when he wrote, "Only mad dogs and Englishmen go out in the noonday sun." Too much sun exposure is the cause of many melanomas. Remember that if your shadow is shorter than you, it's time to get out of the sun.

Dr. Allan Halpern, chief of dermatology at Memorial Sloan-Kettering Cancer Center in New York City, says people who have 50 or more moles on their body have a greater risk of developing melanoma. Moreover, the risk increases if you have red or blond hair, blue or green eyes or tend to burn easily. It's also safer if you don't have freckles.

Halpern adds that children who get sunburns at an early age, the ones they never forget, are also at greater risk. So are those who have worked outdoors for a number of summers.

The male "macho" image or the thought, "it won't happen to me," place men at greater risk than women. Men tend to spend more time outdoors, are less diligent about skin protection and less likely to use sunscreen.

People of colour have a higher death rate from melanoma than those of lighter skin. The primary reason is their melanomas are less likely to be seen until they reach an advanced stage. They are also more likely to get melanomas on areas of the body where they're more difficult to detect such as on soles of the feet.

How can you tell the difference between a benign mole and one that can kill you? Sometimes it's as easy as rolling off a log because its appearance is dramatic. For instance, melanomas can come in a variety of colours. Some are black and darker around the outside. Others contain a mixture of colours including white, purple, blue or red. Nearly all dangerous moles have irregular or indefinite margins. And most are larger than the rubber on the end of a pencil.

Dr. Kettering says warning bells should go off if a mole develops a tingling sensation or itches, grows larger, becomes ulcerated or bleeds easily.

The problem is that some melanomas are the shade of skin and are easily missed even by experts. Several years ago, one study showed that dermatologists, plastic surgeons and surgeons failed to make the diagnosis in 35 per cent of cases.

So there's an old surgical maxim that's wise to heed in questionable cases: "When in doubt, cut it out." No doctor wants to remove a normal appendix. But excising a suspect mole harms no one even if the final diagnosis is benign.

To decrease the death rate from melanoma it's important to do an annual check of your naked body. But since you have to be Houdini to see your back, find a willing partner to help you out. Then if there's any doubt, see your doctor.

Years ago, after watching a friend die from melanoma, my wife and I decided to get our skin checked by a dermatologist. His nurse asked, "Do you want to be examined together?"

I thought, "Why not? It will save the doctor's time." So I removed everything except my shorts.

My wife retorted, "Surely, you don't think I'm going to take off all my clothes and stand here naked when the doctor enters!"

"It will save time," I said. But I didn't win that debate.

However you check your moles, there is some good news. The five-year survival rate for melanomas is 98 per cent if they are treated early before they metastasize to the lymph nodes.

Don't forget to use sunscreen and stay far away from tanning beds. And when in doubt, cut it out, as it may save your life.

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Republished from the Winnipeg Free Press print edition July 29, 2011 A21