Scientists now have precise and accurate tools to predict the risk of melanoma skin cancer. But these tools have yet to find their way into medical practice, according to an editorial published last month in JAMA Dermatology.
And that’s too bad. Because melanoma is the ONE truly malignant form of skin cancer.
But remember, it only accounts for nine percent of all skin cancers. The remaining 91 percent of skin “cancers” grow on the surface of the skin. But they do NOT invade. They do NOT metastasize. And they do NOT kill the patient.
In fact, under the microscope, these non-melanoma skin growths look like “grade zero,” or “grade one-half cancer,” when the minimum for a real cancer is supposed to be “grade one.” And doctors can easily remove these growths in their office. As I have reported many times, we should not even call these growths “cancer.”
Nonetheless, dermatologists and mainstream doctors continue to throw around “blanket” recommendations that everyone to avoid the sun, use toxic sun blockers, count up the numbers of skin moles, get regular screenings, and other old advice based on imprecise mythology rather than medical science.
One result, is that we now face a nationwide epidemic of vitamin D deficiency due to lack of sun exposure.
Instead of just throwing out these “blanket” recommendations, most of which are ridiculous, we need better tools to accurately identify people at increased risk for melanoma skin cancer, the one truly deadly form of the disease. Only this small sub-group of people need to take special precautions with sun exposure and skin cancer screenings.
Unfortunately, most guidelines that identify people at high melanoma risk consider single factors, such as skin pigmentation or family history. But accurate risk prediction models should incorporate and weigh multiple risk factors to better evaluate the real risk. Unfortunately, in primary care settings, where practitioners are given less and less time for individual patients, it is often difficult to find the time to evaluate all these factors.
On the upside, self-assessment is a good option.
In fact, a new risk prediction model from Australia — where melanoma is a major medical problem — is based on self-assessment. Researchers recently tested the accuracy of this new prediction model using data from the Australian Melanoma Family Study on 629 cases and 535 controls.
This model assesses hair color, density of nevus (or skin moles), first-degree family history, previous occurrence of non-melanoma skin “cancer” growths, and use of artificial tanning beds over a lifetime.
Two things to note about this new model. For one, sun exposure itself was not a risk factor in this model. Second, you can assess all these risk factors yourself.
Overall, the developers of this tool found that red hair and density of skin moles were the strongest predictors of melanoma in the study. This finding makes sense, as red haired people usually have light skin pigmentation as well as a relative inability to develop a tan. I reported previously on another study that found total number of moles is not a risk factor for melanoma. In this study, moles are back on the radar screen — not for their number but for their density and still, perhaps, something to consider.
More hope to save lives
I believe this self-assessment tool offers hope for preventing and catching more cases of melanoma at an earlier stage…which is critical for survival. In fact, in another recent study, patients who received an early diagnosis, before the cancer had metastasized (spread to other organs or tissues), had survival rates as high as 98 percent. On the other hand, patients who received a diagnosis after the melanoma had metastasized had survival rates of just 16 percent.
So effective early diagnosis is the key.
The researchers who developed this risk prediction model also developed a computer program that could one day be used in clinic waiting rooms or online.
In the meantime, we should end the blanket, routine recommendations to avoid the sun completely. These ridiculous recommendations hurt the population as a whole. Instead, make it a point to evaluate your own risk of melanoma using the checklist outlined above. If you’re in the clear, go ahead and spend 10-15 minutes in the sun without sunscreen every day this summer.
“Development and External Validation of a Melanoma Risk Prediction Model Based on Self-assessed Risk Factors,” JAMA Dermatology 2016 Jun 8
“Identifying individuals at high risk of melanoma: A practical predictor of absolute risk,”J Clinical Oncology.2006;24(22):3590-3596