Melanoma: Prevention, Detection, and Treatment (cont.)

GUERRY:
Absolutely not -- happily.

When we will re-excise, when we go back and take a very narrow border around an abnormal mole, is when the pathologist tells us two things; one, there is architectural abnormality, and cytological atypia that is severe. So I'm not quite sure what this pathology note means because it only talks about the architecture and doesn't talk about the bricks, whether or not the cells are severely atypical. It would be that that would make us do a narrow re-excision.

So what your daughter is not supposed to have is a cancer operation because she did not have a malignancy. You might consider getting the pathology reviewed by an expert in melanoma and funny moles.

"In families in which something like four or five first-degree relatives -- brothers, sisters, parents and children -- have melanoma, then it's relatively likely that you have a gene or high susceptibility to melanoma."

MEMBER QUESTION:
Since I have had melanomas, I now use a self-tanner. Is this safe for someone who has had melanoma?

GUERRY:
Yes, self tanners are safe and effective. They're not very good sunblocks, so I would continue to use a good sunblock.

MEMBER QUESTION:
I heard that SPF 50 was not any better than SPF 30. Is this true?

GUERRY:
It's not true if you happen to be a very, very fair red-headed freckler. The SPF 50s turn out to be good for the very, very sun sensitive. For the average person you can't really find an appreciable difference between the 50s and the 30s, except they're more expensive.

MEMBER QUESTION:
Can one ever get a safe and healthy tan from the sun or should I just realize that the only safe tan is one from the bottle?

GUERRY:
This is actually a hard question. We evolved on a sunny planet, and the natural response of the skin of sun exposure is to tan.

A tan actually does protect the top layers of the skins from further sun damage, so mild to moderate sun exposure so that at end of the summer you've got some tan, probably means you're a white person who lives on a sunny planet, and does not mean that you've done something stupid. So, being moderate about sun exposure, staying out of the sun between 10 a.m. and 4 p.m., wearing a broad brimmed hat and using a sunblock with a high SPF when you're going to be out in the sun for some time, is prudent.

Living in the basement so you never see a ray of sun isn't good for you, so a little bit of sun exposure is, in fact, just fine.

MEMBER QUESTION:
My father and his mother were both diagnosed with a melanoma that stemmed from a mole. With a strong family history what are my chances of being diagnosed with a melanoma?

GUERRY:
Hard to know. In families in which something like four or five first-degree relatives -- brothers, sisters, parents and children -- have melanoma, then it's relatively likely that you have a gene or high susceptibility to melanoma. It isn't fate; it means you are more likely to get melanoma with a 50-50 chance by age 50.

You only have two relatives with melanoma which is compelling from a human perspective but no so compelling from a genetic perspective. Take care of your skin -- don't get sunburned, see a dermatologist and tell him about your family history, get a thorough skin examination, talk about having photographs of the skin which you get a copy of to help you with self-examination and go from there. You should protect your children from getting sunburned and you should tell your brothers and sisters that they should be screened by a dermatologist to have their skin looked at top to bottom.

There's a test for a gene that explains susceptibility to melanoma. I don't think it's worth it, because if you find you have the gene you would do what I just told you; if you find out you don't have the gene you would do what I just told you. It isn't going to change how you manage yourself.

MEMBER QUESTION:
Are new cream treatments available to treat melanoma that work by enhancing the immune system? How successful have they been in early melanoma?

GUERRY:
There are some very interesting cream treatments that probably enhance the response of the immune system and may kill melanoma cells directly. They're still very much under test and I don't advise their use except in the context of a real hard-nosed clinical trial.

It's still best to make the diagnosis with a biopsy and get all the melanoma out with surgery. For the present, my advice is to stay tuned.

MEMBER QUESTION:
What is the latest news on vaccine trials? Are there any new drugs in clinics that seem to be promising?

GUERRY:
There is promise in vaccines. One of the more prominent vaccines, called Canvaxin, is still under testing in people who have had their lymph nodes involved with melanoma. We hope it will turn out to be beneficial but we don't know. In testing of people who had a more advanced stage, stage IV, a piece of melanoma made its way to the lung, was removed and then they received Canvaxin. We know that people who did or did not get the vaccine did just as well, or just as badly -- so we're troubled that in more advanced disease the vaccine seemed not to work. Vaccines are probably going to work in people who have not so much disease, so it might work in stage III, but we just don't know yet.

"The critical thing is to keep an eye on your skin and look for abnormal spots and see the ones that matter and take them to the doctor to make a diagnosis, often by doing a cheap, easy, outpatient biopsy."