We caught up with Dr. Afton Chavez, MD, FAAD on Melanoma Monday to talk about all things melanoma. Dr. Afton Chavez is a board-certified dermatologist based in Cambridge, Massachusetts. She is currently training in Mohs Micrographic Surgery and Dermatologic Oncology at Beth Israel Lahey Health. Beyond providing excellent patient care, she is interested in finding innovative and creative solutions to dermatologic and global public health problems through technology, design, social media, and integrative medicine.
What is melanoma?
Melanoma is a type of skin cancer. When we think about skin cancer, we put them into two general buckets – non-melanomas and melanomas. The non-melanomas are the ones like Basel cell and Squamous cell. These are most common, but the good thing is that they’re less likely to spread to other parts of the body, and therefore are less deadly. The problem is that they can grow, invade that local tissue wherever they are, and cause disfigurement. So, they are a problem and we still take them very seriously.
Melanoma is less common but more deadly. Melanoma can metastasize, spread to other parts of the body, and it can affect someone’s lifespan – meaning it can kill them. Melanoma comes from the pigment-producing cells in the skin and those are called the melanocytes. So, that’s why it’s called melanoma.
What are the causes?
The main causes for melanoma are UV radiation (sun exposure, tanning beds, etc) and then genetics. About 10% of people who get melanoma have a family history of melanoma, and that can be due to underlying genetic mutations which are carried in the family lineage.
Who can develop melanoma?
Anyone can develop melanoma, but there are certain risk factors that can make an individual more susceptible. Those with fair skin, people who have lighter hair colour, lighter coloured eyes, who are prone to freckling and sunburns – all of those people have less natural pigment in their skin to protect them from UV damage.
Where on the body can melanoma occur?
Melanoma can essentially come up anywhere. The most common locations are on the trunk, particularly the back for males, and the lower extremities (lower legs) for females. And then, also the arms, the head, and neck - those areas where you’re getting chronic sun exposure.
How do I know if I have melanoma?
The classic teaching is the ABCDE’s to search for and detect melanomas.
A is for asymmetry - so if it’s not symmetric on both sides or are uneven.
B is for border – irregular borders, jagged areas.
C is for colour – if there are multiple different shades of brown, black, tints of blue, white, pink. Or, if one of the moles has a different colour from all the other moles, that can be a tip-off to melanoma.
D is for diameter – look for anything bigger than an eraser tip. You’re looking for larger legions unless they’re caught earlier.
E is for evolution - Have a partner take pictures of the back, or regularly look at the back and areas that are hard to see. And keep an eye on things and if you notice a new spot come up or an area that’s changing, sometimes that can be a tip-off to a potential melanoma.
Can melanoma be prevented?
Whenever we think about any tip of prevention of a cancer of a disease, we think about modifiable risk factors; characteristics, or behaviours that can be changed to affect the outcome. We cannot change our genetics, but what we can change is our UV exposure. That’s why dermatologists go so crazy about preaching sun protection because we know that this is a very simple intervention we can do to actually fight skin cancer.
The way that we do this is, first of all, avoid tanning beds. Second, avoid going outside during the peak hours of daylight. That’s around 10am to about 2 to 4pm. If you are going out during that time, seek shade, wear sun protective clothing, and use sunscreen. You want to have broad-spectrum UVA UVB coverage sunscreen, with at least a minimum of SPF 30. Apply it at least 15 minutes before you go outside, and then reapply it at least every 2 hours, but potentially even more often than that, particularly if you are sweating or swimming.
My preferred sun protection method is to use sun-protective clothing and by that, we mean UPF clothing – special clothing that is knit in a way that it blocks the UV light from getting into the skin and it serves as a form of sun protection. That’s my go-to for when I’m spending long periods of time outside. You know, anything more than, really half an hour or an hour. You want to look for broad-brimmed hats so that they can cover the ears and sunglasses as you can get skin cancers around the eyes. And don’t forget to put sun protection on your lips, as well, because you can get skin cancers on your lips.