It’s particularly insidious because it can crop up in unusual places that escape detection, allowing it to grow deeper and wider and possibly even spread to other parts of the body. (Photo: Getty Images)
Examining patients for skin cancer is all in a day’s work for San Antonio dermatologist Vivian Bucay, MD, but the leading expert never could have guessed that a near-deadly melanoma would hit so close to home.
It was a spring day in May 2006 when Bucay saw flaky skin in her belly button and stopped to take a closer look. “I initially just thought it was eczema or psoriasis,” Bucay tells Yahoo Health, citing the common dermal conditions that are marked by scaly skin. She took a biopsy of the shedding to see what was causing the flakes. The results were bone-chilling: A melanoma had been growing unnoticed in her navel, and had now developed into stage III cancer.
The mother of three young daughters soon underwent two surgeries to remove the melanoma, along with 28 lymph nodes that revealed a stubborn spreading of the cancer — but the melanoma spread to her lungs and accelerated to a stage IV diagnosis, which has a five-year survival rate of just 15 to 20 percent.
As a final resort, Bucay underwent treatment in “blind faith” with Proleukin (interleuckin 2), a drug that is delivered intravenously in the intensive care unit due to its potentially serious side effects and toxicities. The drug reportedly works about 6 percent of the time in such advanced cancer cases. “At that time, it was the only drug approved by the [Food and Drug Administration] for stage IV melanoma,” remembers Bucay. In spite of the overwhelming odds, the treatment miraculously worked after two cycles of 14 treatments each, spaced 12 weeks apart, and pushed the cancer into complete and durable remission. The dermatologist now counts herself as a survivor — albeit a very shaken up one.
Melanoma is the deadliest form of skin cancer.
While it accounts for less than 2 percent of all skin cancer cases (most diagnoses are basal cell carcinoma), melanoma is responsible for the vast majority of skin cancer deaths. According to the Skin Cancer Foundation, 1 in 50 men and women will be diagnosed with a melanoma in their lifetime.
In women, the legs used to be most at risk, but the chest area has recently overtaken as the most common area for a melanoma diagnosis. In men, it’s the back. However, melanoma is especially insidious because it can crop up in unusual places that escape detection, allowing it to grow deeper and wider and possibly even spread to other parts of the body — as it did in Bucay’s case, starting out hidden in the navel.
Melanoma can develop anywhere that melanocytes (pigment-producing cells) are present.
“I’ve detected melanomas between the toes, under the nails, on the palms of hands and soles of feet, in the scalp and between the buttock cheeks,” says New York dermatologist, Whitney Bowe, MD. “I’ve diagnosed a melanoma behind the ear, and one just inside the lower lip of a patient who thought he had bit his lip — the area kept bleeding,” she adds.
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Cancer is probably the last thing on a person’s mind when visiting the salon or spa, but having someone else look at areas of your body that you can’t easily see yourself can prove critical for melanoma detection. “Hairdressers can be a valuable resource, as they may be the very first to see an unusual spot on someone’s scalp,” says Bucay.
While a self-examination of one’s nails is easy enough for most men, manicure and pedicure time may be the only opportunity for many women to see their nails uncovered by polish. “If you’re at the salon, put that magazine down and look at your toes during your pedicure — you’re looking for dark bands or streaks in the nails, especially ones that have various shades within the band, like brown, black, and blue,” says Bowe. Both experts say it’s wise to remove nail polish on fingers and toes before annual skin exams with your doctor.
Melanoma can also develop in the eye, which is why dermatologists recommend wearing sunglasses with ultraviolet protection and getting routine eye exams for detection and overall health. Although much rarer still, melanomas can also begin in the lungs, the gastrointestinal tract, and the meninges, which is the membrane that covers the brain and spinal cord, says Bucay.
People of color are more likely to be diagnosed with and die from melanomas in these unusual areas.
“While we know UV light plays a role in melanomas found on Caucasian skin, the primary risk factors for melanoma in people with skin of color has yet to be determined. That’s why patients with darker skin might get melanomas in areas that we don’t commonly associate with sun exposure,” says Bowe.
In African-Americans, Asians, Native Americans, and Hawaiians, melanomas are most likely to appear in the mouth, on palms of hands, on soles of feet, and under the nails. Singer Bob Marley is a tragic statistic; he died at the young age of 36 after a melanoma that originated underneath his nail metastasized to his lungs and brain. In dark-skinned Hispanics, the feet are the most common location for melanoma, adds Bowe.
While the incidence of melanoma continues to rise — a phenomenon many experts attribute to the rise of tanning-bed use in last few generations — there is some good news.
“There are many more options to treat advanced disease, and tests can now be performed on stage I and II melanomas that can help determine whether that melanoma expresses certain genetic markers that suggest it has a higher chance of metastasizing,” says Bucay. That means doctors can more closely follow at-risk patients.
As if such a close death scare and months of undergoing difficult cancer treatments weren’t frightening enough for Bucay, the statistics are grim: Survivors of melanoma are about nine times as likely as the general population to develop another melanoma, according to the Skin Cancer Foundation. And the 10-year survival rate for stage IV melanoma survivors is 10 to 15 percent.
Bucay now asks her hairdresser to check her scalp, her ophthalmologist to check her eyes, and her gynecologist to check hard-to-see areas for emerging spots. She is more diligent about applying (and reapplying) sunscreen, the most vital preventive step for anyone.
Every morning, the dermatologist now takes a polypodium leucotomos extract supplement known as Heliocare, which is derived from a tropical fern that helps increase skin’s natural resistance to the sun. She pops a second capsule in the afternoon if she’s out in the sun. Maintaining healthy levels of vitamin D is another important part of prevention, as studies have found that this nutrient plays an important role in the body’s immune system in protecting against cancer.
“I believe more than ever in getting anything that looks even vaguely suspicious checked out by a dermatologist,” says Bucay. “Get to know your skin. It could save your life.”