It comes as no surprise to those of us familiar with Vermont that the Green Mountain state continues to receive national recognition for many of its special features. Vermont cities are routinely included in lists of top places to live in America; Vermont consistently ranks high in education, social services and as one of the healthiest places in the country. However, you may not be aware that Vermont ranks high on another less auspicious list; states with a high incidence of melanoma.
Making the List
Melanoma is a potentially lethal form of skin cancer frequently requiring surgery and occasionally other cancer therapies for management. It accounts for less than 5 percent of all skin cancers, but is responsible for the majority of skin cancer-related deaths. According to the Center for Disease Control, Vermont has one of the highest rates of melanoma in the country. Between 2001 and 2005 the rate of new melanoma cases diagnosed in Vermont was 63 percent higher than the national average. Bennington Country was found to have the highest rate of melanoma among counties nationwide, 179 percent above the national average. The CDC describes Vermont as a small state with a big problem. Fortunately, many efforts are currently underway within state health agencies, local advocacy groups, hospitals and clinicians to help address the problem. You can help to mitigate your risk by being aware of the factors leading to melanoma and the prevention measures to reduce exposure.
Risk Factors for Melanoma
Exposure to ultraviolet (UV) radiation (e.g. sun exposure, tanning booths) is recognized as the leading risk factor for melanoma. UV radiation can damage DNA in the cells of the skin (melanocytes), leading to the development of melanoma. Researchers believe that most of the UV-related damage seen in individuals with melanoma occurred decades earlier, placing them on the path to develop melanoma years later. As parents, we can invest in our children’s future health by helping them avoid damage from UV radiation. So this summer, it is important to make certain that children spending time outside (after experiencing cabin fever from a very long winter!) are appropriately protected from skin damage.
Other risk factors include:
- Fair skin and light eye color
- Family history of melanoma
- A history of three or more blistering sunburns before the age of 20
- Natural blonde or red hair
- A skin condition called actinic keratosis
- Significant freckling
- Skin that tends to burn easily rather than tan
- A history of 3 or more outdoor summer jobs as a teenager
How to Prevent Melanoma
Melanoma can often be prevented by following certain precautions. The American Cancer Society had adopted a slogan from Australia’s skin cancer prevention message to help people remember a few of these precautions. In addition to staying in the shade, remember to “Slip! Slop! Slap!®… and Wrap” when going outdoors. Slip on a shirt, slop on sunscreen, slap on a hat, and wrap on sunglasses to protect your eyes and the sensitive skin around them.
How to Identify Melanoma
Individuals should be familiar with the classic signs of melanoma and examine their skin head-to-toe once a month. We also suggest undergoing annual skin cancer screening with your primary care provider or dermatologist – and even more frequently for those at higher risk. The difference in outcomes is quite drastic comparing early versus late stage melanoma. Most patients diagnosed with early stage melanoma will enjoy an excellent prognosis. Unfortunately, patients presenting with later stages of disease will have more of a challenge.
Classic signs of melanoma include following the ABCDE pattern. Any one of these should raise the concern for a cancerous mole being present:
- Asymmetry – one half of the mole looks different than the other half
- Borders – the edges of the mole are irregular, jagged or indistinct
- Color changes – the mole may contain multiple colors or different shades
- Diameter – a mole greater than 6 mm (the size of a pencil eraser) is thought to be concerning
- Elevation – a mole found to be raised up on the skin has a higher risk of being melanoma
- Evolution – a mole changes in size, shape, color should be evaluated for melanoma.
Also, any mole that is symptomatic is a concern. Moles that itch, burn, or bleed need to be evaluated right away. Although most cancerous moles will be dark or pigmented, there is a rare non-pigmented variation of melanoma, so also beware of a mole that lightens in color. Finally, any mole that stands out or appears different from other moles on your body (e.g., the ugly duckling mole) should be assessed for the risk of being skin cancer.
Ted James, MD, is an Associate Professor of Surgery and Director of the Skin and Soft Tissue Surgical Oncology program at The University of Vermont Medical Center. He is a Board member and medical director of the New England American Cancer Society.