Duke Medicine HealthLine
Published: May 22, 2007
Updated: Oct. 14, 2010
A healthy, sun-kissed glow! A safe alternative to sunlight! No harmful UVB rays!
False reassurances like these from tanning salons enrage Jane Caddell. Though her sun exposure increased a bit when Caddell moved to North Carolina from Maine, she feels certain it was the indoor tanning beds she began frequenting in her late thirties that spurred her life-threatening melanoma.
For about a year and a half, she’d go with friends from work three or four days a week, sometimes dozing through the lunch hour in the warmth of the glowing bulbs. “Of course, I’m blond-haired and blue-eyed, which makes you a little more susceptible,” says Caddell. “But I just had no clue, no education on skin cancer whatsoever.”
When a new mole appeared on the inside of her knee, however, she took notice. “I really focused on this mole. I could tell there was some activity with it. Then it started to bleed a little bit. That gave me a sense of urgency, so I made an appointment with a dermatologist.”
Caddell was diagnosed with melanoma, the rarest but most deadly form of skin cancer, and referred to a surgeon. “He took out a silver-dollar sized area of skin,” she recalls, “and said the borders came out clear, so he reassured me that I had nothing to worry about.”
Indeed, surgical treatment at an early stage can often stop melanoma in its tracks. According to the American Cancer Society, around 83 percent of melanomas are diagnosed at a localized stage, meaning they have not spread beyond the outer layers of the skin. In these cases, the average five-year survival rate is 98 percent.
Unchecked, however, melanoma can invade deep down through the lower layers of the skin and spread to the lymph nodes and organs. It is not yet fully understood why melanoma is so much more aggressive than other skin cancers.
Learning why, and how to combat it, is becoming more urgent as the number of melanoma diagnoses continues to creep upwards, now nearing some 53,000 new cases annually in the United States alone.
About a year after Caddell’s mole was removed, she came down with a fever and a “relentless, croupy cough” that plagued her day and night. A chest x-ray indicated pneumonia and something far more menacing -- shadows. A CT scan revealed nodules on her lungs, her liver, and the lymph nodes in her chest. One tumor had encircled her esophagus.
“An oncologist told me that my melanoma was in stage IV,” recalls Caddell. “I said, ‘Well, how many stages are there?’ He said, ‘There’s four.’”
“Stage IV refers to the fact that the melanoma has already spread to other organs or to new places in the body, far from where it started, and is usually no longer curable with surgery,” explains Jared Gollob, MD, former director of the Biologic Therapy Program at Duke. “Interleukin-2 [IL-2] is what we give to patients with stage IV melanoma.”
Duke is among a limited number of centers in the country that can offer IL-2 chemotherapy. IL-2 hyperactivates the immune system, so the symptoms can be severe.
“After each treatment I felt like I’d just challenged the heavyweight champion of the world, I was so battered,” says Caddell, who was treated with IL-2 under Gollob’s care after her oncologist referred her to Duke. “One of the amazing things about this treatment, though, is how quickly you can rebound from it after it stops. It’s tough but doable.”
Caddell’s tumors shrank in response to the intensive treatment, and in June of 2006 she was told she was in remission and disease-free. She has since become an advocate for melanoma education and prevention through her organization Operation Sun Shield.
Caddell’s successful outcome is cause for celebration, but she’s among only 5 percent of patients with late-stage melanoma for whom IL-2 provides a cure. Hope for greater numbers may lie in combination therapy, where high-dose IL-2 is combined with experimental drugs in clinical trials to try to improve its effectiveness.
Beyond treatment, ongoing vigilance is key for the melanoma survivor. “Once you have a melanoma, your lifetime risk of having another one is five times greater,” says Duke’s Samuel Fisher, MD, who specializes in melanomas of the head and neck. “You need total body surveillance forever.”
For Caddell, who has amassed a vast collection of hats, preaches the gospel of sunblock and tanning bed avoidance to whomever will listen, and endures an anxious day of CT scans every three months to confirm she’s still cancer-free, life will never be the same, but she’s finding her peace with that. “My prize is waking every morning and getting to still be here with my family.”
The Duke Melanoma Clinic aims to help patients in the early stages make the strongest possible first strike against the disease, and to offer those with advanced melanoma more options than ever before. To learn more, visit dukehealth.org
About half of melanomas are thought to occur in just 5 percent of the population. This high-risk group includes people who have many moles (generally more than 50), large irregular moles, and a personal or family history of melanoma (two or more close relatives who have been diagnosed with melanoma). If you have one or more of these traits, regular skin checks may help save your life.
People with fair skin, blond or red hair, and blue, green, or gray eyes are at a slightly increased risk of developing melanoma; however, melanoma affects people of all races.
Acral lentiginous melanoma (ALM) accounts for 50 percent of melanomas that arise in dark skin. ALM, found on the palms and soles, beneath nails, and on mucous membranes, in its early stages may look like a bruise or nail streak.
The commonly recommended “ABCD” technique for detecting melanoma -- looking for moles that are asymmetrical, have an irregular border, have uneven color, or a diameter larger than a pencil eraser -- doesn’t address some of the most important features of early melanoma.
James Grichnik, MD, PhD, director of the melanocytic diseases section in Duke’s Division of Dermatology, favors instead an approach termed “the smoking GUN of melanoma detection.” GUN stands for growth, unusual appearance, and nonuniform structure.
“Lesions that are unusual, not matching other moles, and growing are of concern,” Grichnik explains. “If these lesions are also nonuniform, they are very worrisome for melanoma.” If you are concerned about a changing lesion on your skin, have a doctor investigate.