Unusual progress has been made in dermatology in the fight against skin cancer. The standard extant when I came to Nebraska was one of repeated attempts being made via surgery and radiation to cure skin cancer without histopathologic excisional guidance (modified Mohs). Cure rates were dismal. Since then, skin cancer has become 100% curable, except in a few instances of very rare types, usually below the skin, and in instances of glaring neglect.
Sadly and tragically, melanoma still kills an American every hour and a Nebraskan every five days. Yet our entire community seems relatively casual about reducing the problem. If diagnosed early and treated promptly and properly, melanoma is curable! No patient in my practice has ever displayed a local recurrence of melanoma. While curing an estimated 1,300 melanomas, fewer than ten have died from melanoma. These had spread before being seen in our office. The answer seems clear! Except for melanoma located in obscure sites or inside the body, we could go much further to stop melanoma! When patients are examined by physicians, especially interested in the problem and with specific training and experience to recognize its presence early a 100% cure rate can result. Our ability has improved every year! We can change the serious statistics!
At Rustad Dermatology, a melanoma is being removed most weeks at a stage where they don’t reoccur, yet almost all have gone undetected even during routine examinations elsewhere. Surely it’s important to have an initial though examination, even during childhood at which time suspicious moles should be identified, photographed and mapped. Subsequently, new or changing moles should be evaluated and always removed if they demonstrate signs of ensuing melanoma.
The worst advice too often given is “let’s keep an eye on it” or “that mole should be watched”. Apparently, too often significant characteristics or changes aren’t recognized. Immediate clear cut decisions must be made as to the need to remove a mole or to let it stay.
Sun exposure damages skin but to highly varying degrees depending on the susceptibility of the individual. While lighter pigmented skin is customarily more subject to damage, hereditary susceptibility to cancer in general and skin cancer in particular, is more important than sun exposure per se.
Individuals of northern and central European origin demonstrate this dramatically. Even families with fairly light skin, particularly if they tan easily, are less prone to developing all signs of skin aging to include skin cancer. Most melanomas occur on covered areas. Heredity plays a more important role than sun exposure. Squamous cell carcinoma and preceding actinic keratosis, sun damaged spots, are most clearly connected to sun exposure. The incidence of basal cell epithelioma is again more hereditary than it is environment. Sun plays a lesser role than it does in skin cancer.