Aid Cancer Detection Posted Thursday, August 12, 2004 by arjuna
Aid Cancer Detection

July 27, 2004

BY LINDA H. LAMB KNIGHT RIDDER NEWSPAPERS

Judy Poarch hadn't noticed anything different about that spot above her knee.

ABOUT MELANOMA

Melanoma, which is diagnosed in about 53,600 Americans each year, is the most serious type of skin cancer.

A 2002 study found melanoma death rates were declining somewhat in younger patients -- who might be getting the message about sunscreen -- but increasing in older men and women.

Close to 8,000 Americans are expected to die from melanoma this year.

Melanoma is 10- to 15-times more common in white people than in black or Hispanic people.

A change in a mole's appearance might be an early sign of melanoma. However, half of melanomas develop in skin that previously appeared normal.

Risk factors include having fair skin, personal or family history of skin cancer, having many moles (more than 50), sun exposure, having at least one severe, blistering sunburn as a child or teenager and a weakened immune system.

Things to watch for in moles: asymmetrical shape (not perfectly round), irregular border, uneven color (may include black, brown, tan, white, gray, red, pink or blue), increase in size.

Prevention: Protect skin by avoiding sun from 10 a.m. to 4 p.m., use sunscreen, cover up, protect eyes with UV ray-absorbing sunglasses and wear a wide-brimmed hat.

On the Web: Melanoma Patients' Information Page is www.mpip.org. The National Cancer Institute site is www.cancer.gov (then search for "melanoma"). "It was just a little bitty freckle on my leg," said Poarch, 56. "I'd had it for years and years."

But when her daughter said she thought the spot was changing, Poarch sensed fear. A cousin had been diagnosed with skin cancer. Poarch looked at the freckle more closely.

"It was a little bit raised and a little bit darker."

She had melanoma, the deadliest of skin malignancies -- accounting for only 4 percent of skin cancers but 79 percent of skin cancer deaths.

"The doctor didn't think it looked cancerous, but then he said, 'Well, we're just going to take that off.' When it came back as melanoma, I was totally in shock. . . . I had 10 million questions."

Tops on her list was how to spot future melanomas. Recently, she embarked on what she hopes will be a solution.

Poarch, a Georgia resident, went to South Carolina to have a MoleMapCD made. The MoleMap is a photographic map of her body that will help her keep track of every mole, scar and freckle.

Developed by James Grichnik, a dermatologist and researcher at Duke University, it involved posing for pictures by a medical photographer who focused on 33 sections of her body. The photos are processed and 33 images are loaded onto two CDs.

Her dermatologist gets one to use for comparison during checkups. Poarch gets the other to use at home. Clicking on a thumbnail photo on her computer screen, she'll get an up-close look at her skin, section by section.

Poarch admitted she had been a little panicky about a recurrence of cancer. She finds the MoleMap concept reassuring.

"You know exactly where the moles are on your body. You know what they look like, and every few months, you can look and see if anything's changing."

When patients such as Poarch face a disease as deadly as melanoma, naturally they're worried about moles that might pop up where the sun doesn't shine.

But as in her case, sun exposure is precisely what causes most melanomas, doctors say.

"Years ago I was out in the sun a lot," Poarch said. "Didn't use sunscreen; didn't think much about it."

Just one severe, blistering sunburn in your youth makes you more likely to develop skin cancer. Melanoma numbers have been stable in recent years, but they've crept up in older Americans. And an indoor tan is no safer than one you get at the beach.

Having a lot of moles is a risk factor and the larger the mole, the greater the risk that melanoma will develop. But melanoma also develops in normal skin. Half of melanoma cases will materialize not in a mole, but in skin that previously looked perfectly normal.

Cost of the MoleMapCD procedure is about $400, which insurance may cover. (Ask your doctor for information, or visit www.digitalderm.com).

Grichnik has been working with the system for about 10 years, trying to make it more user-friendly for doctors and consumers. Melanoma, like less serious skin cancers, usually is curable when found early, according to the American Cancer Society.
Dermatologists using MoleMap say it's most useful for dealing with two

problems: high risk and high anxiety. Those two things can go together, of course. Having just one melanoma can be so nerve-racking that some patients rush to the doctor to have every new freckle surgically removed -- which means more anxiety, expense and scars.

Grichnik followed 526 patients using MoleMapCD for an average of 2.4 years each. Tracking their skin condition with the CD photos, he found that an average of 1.5 skin biopsies were performed per patient, per year. He said that number was significant because previously, the patients had been having an average of six biopsies a year.
Removing every new mole just isn't necessary, Grichnik said.