The Derm Group



As summer approaches and people spend more time outdoors, doctors urge them to protect themselves from the sun. Whether heading to the beach or the mountains, working in the garden or taking a leisurely bicycle ride around the park, a good sunscreen, a hat and sunglasses, are a must, they say.

“Many people don’t really grab how harmful sun exposure can be,” said Janice Mehnert, an oncologist in the melanoma and soft tissue oncology program at Rutgers Cancer Institute of New Jersey in New Brunswick. She added that overexposure to the sun’s ultraviolet rays (UVA and UVB) is still the number one cause of melanoma, the most deadly type of skin cancer.

Melanoma has been on the rise for at least 30 years, according to the American Cancer Society.

While melanoma accounts for less than 2 percent of skin cancers, it is responsible for the majority of skin cancer deaths. In 2013, more than 75,000 Americans were diagnosed with melanoma and more than 9,000 people died from the disease, according to the ACS.

While the risk of melanoma increases with age, recent research illustrates that it is not uncommon to find it in people younger than 30.

In fact, a recent study conducted by the Mayo Clinic found melanoma to be one of the most common cancers in young adults, especially in young women. The study, which identified patients aged 18 to 39 years who had a first lifetime diagnosis of melanoma from 1970 through 2009 in Olmsted County, Minnesota, found that melanoma had increased eight-fold for women and four-fold for men.

Mehnert said she has seen an increase in melanoma in young women, and attributed most of it to the quest for a fashionable tan. Both UVA, the dominant tanning ray, and UVB, the rays that cause the skin to burn, have been implicated in the development of skin cancers. Tanning, regardless of whether it’s done outdoors or in a salon, causes cumulative damage over time, she said.

Melanomas can appear anywhere on the skin, including the scalp, but they are most commonly found on the chest and back, legs, neck and face. If you have darker skin, your risk of melanoma occurring at one of these sites is lower but the palms of your hands, soles of your feet, and under your nails are still vulnerable spots, according to the ACS.

“If caught early, the vast majority of melanomas are curable,” Mehnert said. “And, although there are more treatment options today than ever before, the later it is caught, the lower one’s chances of survival.” Once cancer cells have spread to the lymph nodes and other parts of the body, it is more difficult to treat, she said.


The standard treatment for melanoma is immunotherapy, Mehnert said, adding that currently, the only FDA-approved immunotherapy drug is interferon, which can have side effects, the most common ones being fatigue, flu-like symptoms, loss of appetite, nausea and a metallic taste in the mouth.

Clinical trials are also an option. “In the past seven years, there have been major studies and three or four major melanoma therapies have resulted,” she said. “It’s very encouraging.”

Daniel Groisser, medical director at both the Dermatology Group in West Orange and Live Sun Smart, a locally based melanoma awareness organization, recommends yearly full-body checks by a dermatologist for people age 20 and older, more frequently for those in high-risk categories.

The characteristics that doctors look for when examining a patient for moles are:
• A for Asymmetry: One half of a mole or birthmark does not match the other.
• B for Border: The edges are irregular or ragged.
• C for Color: The color is not uniform and may include shades of brown or black, or sometimes with patches of pink, red, white or blue.
• D for Diameter: The spot is greater than 1 centimeter across (about the size of a pencil eraser), although melanomas can sometimes be even smaller.

If a mole looks suspicious, he said, it is removed and sent to be tested. “The biopsy will confirm whether it’s dysplastic, meaning atypical, or an actual melanoma.”

Most dysplastic moles do not become cancerous, he said, but people who have them are at a higher risk for developing melanoma. People with a history of dysplastic moles, he said, need to be diligent about regular skin screenings.

He recommends wearing a daily sunscreen with an SPF of at least 30 that protects against both UVA and UVB rays, as well as protective clothing, hats and sunglasses. If you are fair-skinned, with blonde or red hair, blue or green eyes, and freckles, you should limit sun exposure as much as possible.


In addition to sun exposure, other risk factors for melanoma, according to Groisser, include having had multiple sunburns as a child, especially blistering ones, environmental factors and certain medical conditions or drugs that make skin more sensitive to the sun or suppress the immune system.

There is also a hereditary component. “It’s important to know your family history as it pertains to skin cancer,” Mehnert said, “especially immediate family members. This way, family members can get screened as well. For families with a strong predisposition to melanoma, there is genetic counseling and registries where by signing up, they can learn about new research and treatments.”