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In recent years, there has been a decline in the age at which patients begin to develop malignant melanoma. This is the aftermath of the belief that has been prevailing over the years that only a tanned body is attractive and that it is necessary to obtain this tan at all costs. Experts from the Sublimed medical center in Krakow say about the risk we incur by exposing ourselves to the sun’s rays.
This year, beautiful sunny weather has been with us for several months and it can be expected that it will stay with us for the next few months. We love them, but be careful with the sun, because you can use it wisely and in moderation. So certainly not like in the 80s and 90s – then the cult of the tan reigned supreme back then. Back in those years, when you came back from your vacation without a tan, it was like the vacation had failed or had not taken place! “Frying yourself” is now taking its toll, sometimes even in the case of XNUMX-year-olds – realizes Dr. Kamila Białek-Galas, a dermatologist at Sublimed.
How solar radiation affects us
When completing a toiletry bag before going on vacation, we stand in front of the shelf with cosmetics with a filter and we can feel, to put it mildly, lost. So let’s organize the information on the types of ultraviolet radiation. – It consists of three types of bands. The first is UVA, which accounts for as much as 95 percent. UV radiation is also the main cause of skin photoaging. This radiation damages the collagen fibers. It penetrates through glass and can therefore affect people inside or in the car. May cause cataracts and clouding of the lens. It causes an immediate tan – explains Dr. Kamila Białek-Galas.
The second type is UVB radiation, which is responsible for the formation of sunburn. It does not pass through the glass, but it penetrates through water, so it is possible to get burned even while bathing. And as you know, nothing enjoys in the summer like jumping into the lake, splashing in the sea waves or in the hotel swimming pool. The fact that we are “covered” by water does not matter in this case. After the erythema has subsided, as a result of the UVB radiation, a tan is created – for the most part, still welcome -. We forget that the dark side is damage to the DNA of skin cells, which can lead to the formation of cancer. For the record, the Sublimed specialist also describes – less often discussed – the type of UVC radiation that is captured by the ozone layer of the atmosphere. – It does not reach the ground, but in the future, when the ozone hole grows larger, it will certainly have biological significance. It irritates the conjunctiva and can damage your eyesight. In addition, it has a toxic effect on cells, which has been used, among others, in the production of germicidal lamps.
Serious consequences postponed in time
In the past decades – although even today you can find adherents of this approach – children were urged to expose themselves to the sun so that they would not “scare” with pale skin. However, the awareness of the consequences was many times smaller. What consequences? – The development of precancerous lesions and skin malignancies such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma may be a late effect of overexposure to ultraviolet radiation. This effect is related to the DNA damaging effect of the above-mentioned UVB radiation and (to a lesser extent) UVA radiation, the doctor explains.
“The silent killer” – truth or exaggeration?
Melanoma is called one of the most dangerous cancers. This is due to, inter alia, two ways of metastasis: through the blood vessels and through the lymphatic vessels. This makes it possible to proceed relatively quickly with this neoplasm. Another reason for such a dangerous nature of melanoma is the postponement of symptoms, i.e. the fact that patients consult a doctor when the melanoma is already advanced. There is a perception that it must be a large black “mole”, but this is not necessarily the case! It often develops de novo, i.e. within unchanged skin. It is estimated that 70% of melanomas develop outside the affected skin, only 30% within pigmented nevi. – The smallest melanoma diagnosed by me was only 1 millimeter! You should pay attention to all pigmentation changes within our body and control the entire skin. This is still a neglected activity that you should regularly do yourself at home. The self-examination takes only a few minutes and requires only good lighting and a mirror, the dermatologist says.
What should worry us? According to the “ABCDE” rule (Asymetry, Boarders, Color, Diameter, Evolution), special attention should be paid to all signs that are characterized by: asymmetry, irregular, jagged borders, they have more than one color, their diameter has increased (we especially pay attention to on skin lesions that are more than 6 mm in diameter). The appearance of changes within the nevus, e.g. protrusions, shape changes or the occurrence of inflammation in its vicinity should be a signal that they must be examined in a dermatologist’s office. He has equipment (such as a videodermatoscope) and knowledge to help him fully diagnose moles, pigmentation disorders, and other disturbing skin lesions. In a healthy person, such a test should be performed once a year. But what if after examination it turns out that the change is suspicious?
Which birthmarks are eligible for removal?
– The most frequently qualified marks for excision are those that have changed their character, i.e. the patient has started itching, enlarged, ulcerated, for example covered with a scab (although it is not necessary at all). We also remove skin lesions that the dermatologist saw during a dermatoscopic or videodermatoscopic examination and found them “suspicious” – atypical or found it to be melanoma – explains Sublimed surgeon Dr. Marta Kołodziej-Rzepa. – Another situation when we need to remove a nevus is the patient’s concern about a specific change and when we know that there is a family history of melanoma – he adds.
Surgical removal is the only way to eliminate melanoma. – First of all, we remove the change completely, with a minimum margin, i.e. we perform the so-called excisional biopsy. If the histopathological examination (under the microscope) confirms that it is a melanoma, depending on the degree of advancement, we cut the scar, widen the margins and perform a sentinel node biopsy. If melanoma spreads, we start supplementary pharmacological treatment ordered by an oncologist – the surgeon Sublimed describes the procedure. An important feature is the depth of the infiltration. It determines the margin with which the change is cut.
After melanoma excision, do we have peace of mind?
– If we remove melanoma in its non-invasive form (so-called in situ), it is enough to cut the scar and further observation of the patient. In the more advanced form, we perform the sentinel node biopsy procedure. It consists in applying the isotope to the area of the scar, and then we observe the “path” it is taking. It reaches the lymph nodes to which there is a runoff from a given location. So, for example, if we have removed melanoma from the lower limb, the node is most often located in the groin area. If from the upper limb, the runoff will most likely end in the armpit. There are more problematic locations, such as the dorsal one, from which the runoff may exit either in the groin or in the armpit. We excise this lymph node, examine it histopathologically and depending on the result, we choose the next procedure: if there are no melanoma cells in this node, we observe the patient, perform control examinations: ultrasound of the lymph nodes, ultrasound of the abdomen, chest image. The patient comes to us every 3 months, we check his skin, we make dermatological consultations – Dr. Kołodziej-Rzepa outlines the procedure in the first case.
However, if the presence of melanoma in the lymph nodes is confirmed, the scope of the procedure is extended to include additional lymph nodes. Often, after its implementation, the lymph has nowhere to drain and patients complain of lymphoedema in the limbs. This is a complication of its own, but does not affect the functioning of the entire body. We have a lot of lymph nodes in our body that can cope with this situation. The situation is thus under control, but such a person must be under constant, systematic observation. When dissemination occurs, additional treatment is initiated by clinical oncologists.
Particularly exposed to the development of melanoma
The professional medical procedures described above can scare you, and certainly give you much food for thought. Why allow this type of risk at all, where in the extreme case you can bear the highest price? What are the groups most at risk of developing the disease? These are patients who have suffered sunburn in their lifetime. Then the previously mentioned patients with a family history of melanoma or they had already had it in the past. Another group are people who have a lot of pigmented moles. It is estimated that if a patient has more than 50 moles, the risk of developing the disease is greater. Bright skin phototype: the first or the second – characteristic of the Caucasian race, i.e. the most popular in our country – is another obvious feature that should effectively sensitize us to mindless sunbathing. Blonde hair, light eyes, skin after exposure to the sun does not turn brown, but red? Then, strong sun protection is especially necessary.