Durban resident Graham Mortlock knows he has a fair skin and has always taken care to protect it from the sun. However, this did not prevent him from developing a melanoma, the least common but most dangerous of all the skin cancers.
Graham said that he hoped his story would spread awareness about cancer and more particularly melanoma, which is a very aggressive form of cancer.
Dr Lucille Heslop, an oncologist at the Netcare Parklands Hospital in Durban who treated Graham, says that a number of factors can increase the risks of melanoma.
These may include chronic exposure to sunlight, a family history of melanoma, fair skin, the use of tanning devices and blistering sunburns. Children are particularly vulnerable and being sunburnt during childhood increases the risks of developing melanoma later.
Graham enjoys fishing and spends quite a lot of time in the harsh Durban sun. However, he has always been careful to protect himself from it. "I have always been aware that my fair skin is vulnerable to the sun and have therefore worn wide brim hats, protective clothing and high protection factor sunscreen when I have gone out into the sun," he says.
"I can also remember getting burnt by the sun only on one or two occasions when I was a child. So it came as a great shock to me to be diagnosed with melanoma in the middle of last year."
Heslop says, however, that it may only take one or two bad incidences of sunburn as a child to increase an individual's chance of developing a melanoma. This is why it is so important for parents to ensure that their children are properly protected from the sun.
Damage by the sun
Heslop points out that although dark-skinned people are far less likely to develop melanomas than fair-skinned people, even they can be at risk. She says that a number of simple steps that can go a long way to helping us avoid this life-threatening disease.
Graham has been on the right track in wearing wide brim hats, protective clothing and sunscreen. One could also wear light-reflecting colours, she points out. There has been some controversy over whether sunscreen protects from melanoma but a recent Australian study would seem to confirm that it does.
Certainly sunscreen protects from other skin cancers and its use is highly recommended by Heslop. Adequate cover of sun exposed areas with SPF 30 in direct sunlight and SPF 8 under cover of clothes is advised. Remember that sunscreen should be reapplied after swimming as it becomes diluted.
Stay out of the sun
One should also as far as possible stay out of the sun between 09h00 and 16h00 especially in the summer months. Extra care should be taken on overcast days when the ozone layer is at its thinnest and sun rays are more penetrating.
"There is really no such thing as safe tanning, so everyone should give this activity up before they damage their skin and even place their lives at risk," she says.
Melanoma causes around three quarters of all deaths related to skin cancer. It can usually be successfully treated only if it is diagnosed and treated very early when the tumour is still small and thin, before it has had a chance to metastasise or spread to the lymph nodes and other organs of the body.
Graham's cancer was quite far advanced by the time it was discovered, but it has responded well to treatment. Treatment included surgery to remove two of his lymph nodes into which the cancer had metastasised and nearly two weeks of radiation therapy. "The treatment was difficult but I am feeling a lot better," he says now.
Unusually there were no signs of the melanoma on the surface of Graham's skin at all. "I have never had any moles, just a few freckles," he says. "The first problem I noticed was in June 2010.
I had a swollen gland behind my ear and had been feeling under the weather with flu-like symptoms. We thought at first that it might be mumps, but this was ruled out by an ear, nose and throat specialist. The lump was removed and a diagnosis of melanoma confirmed. I was then referred to Dr Heslop."
Now, 5 years since his diagnosis Graham is cancer free and enjoying life to the full again.
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Detecting a melanoma
Heslop says that while melanomas are occasionally hard to distinguish from insect bites, acne scarring or other skin blemishes, and can be difficult to identify, it is highly unusual for them not to express themselves on the skin at all, as occurred in Graham's case.
Given the fact that melanoma is best treated in its early stages it is important for people to regularly check themselves for any moles, sores, lumps or growths on the skin. They should report any changes in such skin blemishes or bleeding from a skin growth to their doctor. Watch out for changes in colour, size or texture.
Those who have a fair skin or have a family history of melanoma should have their skin checked by their dermatologist once a year.
Dr Noori Moti-Joosub, Dermatologist, Laserderm in Dunkeld in Johannesburg says South Africa has one of the highest incidences of melanoma worldwide. Recent studies have also shown that 1 minute of sun exposure in the midday Meditteranean sun is less harmful than 1 minute of exposure on a tanning bed.
A new technique called mole mapping is able to detect changes under the skin before changes become obvious on the surface.
Mole checks should be part of every melanoma prevention program. Monthly mole self-checks are imperative and one would look for any change in your pre-existing mole as well as look out for any new ones.
How mole mapping works
Mole mapping is a process of photographing each individual mole on your body at a high magnification, to determine dangerous moles or melanoma. This should be performed at least yearly by a dermatologist. If you have had any dysplastic (changing) moles, mole-mapping should be done at 6 monthly intervals.
Dr Moti-Joosub says that if you have had a melanoma, mole-mapping should be done 3 monthly for the first year and thereafter as directed by your dermatologist. Mole checks and sun-protection are the two most important factors in melaonoma prevention and are imperative in the war we are waging against this dreadful disease.
The ABCDE system is used to help people identify melanoma. Watch out for the following on moles or skin growths:
- Asymmetry - one half is different from the other.
- Borders - the growth has irregular edges.
- Colour changes from one area to another, i.e. tan to brown to black.
- Diameter - the growth is usually (but not always) larger than six millimetres (the size of a pencil eraser) in diameter.
- Elevation - thickening or asymmetrical outgrowths in pre-existing moles.
Sometimes a growth that grows rapidly, is firm to the touch and rises above the skin surface can also be a sign of a melanoma.
Keep in mind there are a number of types of moles and skin growths that are completely harmless, so do not become alarmed if you do discover something. Be sure to have it looked at as soon as possible by a dermatologist just to be on the safe side
Risk factors for skin cancer
Preventing skin cancer