Melanoma, the deadliest form of skin cancer, is on the rise, especially among young women. Now, according to the American Academy of Dermatology and the North American Association of Central Cancer Registries, melanoma is the second most common form of cancer in young women age 15 to 29. The incidence in these women is increasing at a faster rate than in males that age.
What’s going on? Doctors point to two likely causes. "Young patients, children and adolescents in particular, are now more likely to be sent to a dermatologist and have something biopsied than they were 20 years ago. Back then it just didn’t happen regularly," said Dr. Vernon Sondak, chairman of the Department of Cutaneous Oncology at Moffitt Cancer Center.
But, the biggest factor many doctors blame for the increase in melanoma in young women is the early and frequent use of tanning beds. Tanning beds deliver a concentrated dose of ultraviolet light — usually in 10- to 20-minute sessions — that produces a tan that might take hours to get on a sunny day at the beach or pool. And few people stop at one session. "It’s repeated high-intensity exposure that damages the DNA of skin cells that can lead to melanoma," Sondak said. "If your skin is coloring, that’s a sign of DNA damage."
Fashion icon Coco Chanel accidentally popularized tanned skin back in the 1920s after getting a sunburn during a European trip. Eventually tanned skin became associated with looking healthy. Tanning salons make it easier than ever to get that look. Pop in during your lunch hour and walk out 15 minutes later a whole new, darker color.
"The ultraviolet light exposure in a tanning bed is significantly worse than you get from sun exposure," said Dr. Nishit Patel, assistant professor of dermatology at the USF Morsani College of Medicine. "Even limited use of tanning beds can significantly increase your melanoma risk over your lifetime."
In one 2016 study from the journal JAMA Dermatology, researchers found that young women who use tanning beds are six times more likely to develop melanoma in their 20s compared to those who never tanned indoors. The researchers also found that using a tanning bed before age 35 increased melanoma risk by 75 percent.
In another study of melanoma patients, Patel said over 50 percent of those studied had tanning bed exposure. Melanoma risk goes up if you have family or genetic history of melanoma, or are fair-skinned, have light-colored eyes or more than 50 moles. Add sun exposure to tanning bed use and "that’s a fast track to getting a melanoma," Patel said.
Aside from protecting yourself from sun and UV light exposure, your next best defense against all forms of skin cancer is early detection, diagnosis and treatment. Doctors have long preached that if something looks "funny," is new, growing or changing, you should get it checked without delay. "Melanoma grows fairly quickly. Once it starts it also spreads quickly," Patel said. "Over several months it can spread to other organs and to lymph nodes where it can keep growing and spreading."
Selena Moon Mercado found that out at age 16 when she let a new spot go for almost six months before seeking medical help. Another young woman, Kaitlynn Peachey, discovered the danger of tanning beds at age 23. Both women hope that by sharing their stories others will be spared the fear of learning they have the deadliest form of skin cancer and the pain of treatment.
‘I WAS IN SHOCK’
In February 2015, Selena Moon Mercado noticed a new, dark freckle near her left knee. Within a month it became very dark and eventually turned black. At 16, the high school sophomore thought it was just "a cute freckly thing." But over the next few months, it grew and changed some more. "It became raised over the summer, got flaky and would bleed," she recalls. "My mom thought it was just an ingrown hair and kind of picked at it."
The growth became infected and developed a smell, which prompted Selena to go to her family doctor, who immediately took a sample of the growth and sent it off for biopsy. In less than a week the results came back: Selena had melanoma.
"I was in shock," Selena said. "I cried, my mom cried. I never in my life had to deal with something like that. I had no clue what melanoma was, but they said the area had cancer in all directions." Selena immersed herself in research and discovered the seriousness of the diagnosis. "I was terrified for my life," she said. The experience was even more distressing because Selena is not and has never been a sun worshiper. "I avoid the sun and if I have to go out in it for a family event or something, I cover up and use sunscreen," the now 19-year-old St. Petersburg resident said.
Selena’s doctor made an appointment for her at Moffitt Cancer Center. She had her first surgery in July 2015, to remove the main tumor. But doctors feared some of her lymph nodes might also be involved, so she had surgery to have nodes removed from her left groin area. Because some of those were positive for cancer, in early September 2015, she had another surgery to remove more nodes from her thigh. She also underwent treatment with interferon and had to report to Moffitt every morning, Monday through Friday, for a month. The treatment was so difficult she eventually had to stop it. In 2016 she had another surgery for a mole that looked suspicious but was benign. She continues to report regularly for skin checks and PET scans.
What began as an irregular, dark freckle about the size of a pencil eraser turned into a life-changing diagnosis that has left her with scars scattered over her body. The most noticeable one is about 4 inches long and spans the area near her left knee. Her treatment probably would have been very different if the freckle had been investigated months earlier, when it first appeared. Her advice? "Don’t ignore anything abnormal. Go ahead and overreact. Now I go in for the smallest thing."
‘IRREGULAR BORDERS’ A SIGN OF TROUBLE
Kaitlynn Peachey had a small mole on her upper forehead for years. But last November, a dermatologist she was seeing for something else noticed it and told her, "Kaitlynn, that has to come off. It has irregular borders." She went in the next day to have it removed.
A week later, when the biopsy results came back, Kaitlynn, now 23, learned she had melanoma. "At first, I shrugged it off," she said. "I’ve lived in Florida my whole life, I’ve gotten a lot of sun, it’s no big deal." But, back at home, she did some research and found out her small mole was in fact a big deal. "I panicked and started freaking out," she remembers. "I thought, I’m going to die from the sun. I thought every spot on my body was cancer."
Then she learned that it wasn’t just her lifelong sun exposure that probably brought on the diagnosis. When Kaitlynn turned 18 she started frequenting tanning salons. "I went every other day for about two years and spent the maximum time allowed, 10, 15, 20 minutes at some salons," she said. "It was a quick and lasting tan. Ten minutes in the tanning bed was like four hours in the sun."
Kaitlynn thought she looked better with tanned skin, and all the other girls were doing it. "It was the way to look," she said.
The dermatologist who noticed and removed Kaitlynn’s melanoma, Dr. Susan Weinkle of Bradenton, said that in her more than 35 years of practice, she is now seeing fewer deep melanomas than in the past. More people are coming in earlier to be checked and treated. Because Kaitlynn acted quickly, she didn’t require any further treatment after the mole was removed. Today, her long forehead scar is barely noticeable.
While Kaitlynn’s mole may have started out benign, her lifetime of sun exposure plus excessive use of tanning beds most likely caused that mole to change and become cancerous. "It would have killed her if it hadn’t been found and treated," Weinkle said.
Contact Irene Maher at [email protected]