Brittany Arthur tries not to be “the crazy person who scolds people about their sunscreen use.” But the 35-year-old can’t help it.
“I was 27 when I was diagnosed with melanoma. I was always the one in the sun and the tanning bed—all throughout high school, extra visits before the prom, all during the summer, and then all throughout college. Even the apartments I lived in had free tanning. It was a bonus that one of my friends worked at a tanning salon. She would just let me just drop in whenever and tan.”
Arthur says she stopped her self-described “constant tanning routine” after college, but had admittedly slacked off with her dermatology visits for a few years, even though she had a lot of moles. “There was one that popped up on my right shin that I hadn’t really noticed before, and it didn’t really look like any of the other ones. It just really stood out. I knew I had to get it checked out.”
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The mole came back as melanoma. “I was referred to a surgical oncologist, and based on the depth it had already reached and the mitotic rate, she thought it would be best to remove it and also do a lymph-node biopsy to make sure that it hadn’t started spreading anywhere else. It had—they found some microscopic melanoma cells in one of the lymph nodes they had tested, so I had to go back and have a lymph-node dissection of my right groin. The doctors ended up removing about half of those, which—thank goodness—all came back as clear.”
“It was a lot, and it still is,” Arthur admits, eight years after her diagnosis. “I didn’t do any chemo or radiation because of my age, but I had to—and still have to—play what I call a very serious ‘watching game.’ I ended up doing CT scans of my chest, abdomen and pelvis for the next five years, and they always came back clean, which was great.” Now, Arthur says, she’s in a bit of a holding pattern. “I see the oncologist once a year, and my dermatologist every six months—I see one in December and the other in July, so every six months, I’m seeing one of them. This year, they want me to do a chest X-ray just to make sure we’re still in the clear.”
“My friends and family all know my story. My family doesn’t tan anymore, but I have a couple of friends who still do. I always give them the eye! Now, I apply a broad-spectrum sunscreen every day and I have an 18-month-old who has it on all the time, too. I’ve learned my lesson; I’m not taking any chances.”
While Arthur’s story is scary, it’s not all that surprising: Skin cancer is the most common cancer in the U.S. and—as New York dermatologist Michelle Henry, MD stresses—it doesn’t discriminate. “There is still a misconception that skin cancer only affects older, fair-skinned individuals. I see it in patients in their early 20s. I also see it in patients with very dark skin. Although it is somewhat rarer in those populations, the outcomes can be worse because of delays in diagnosis.”
Besides the religious use of sunscreen, Dr. Henry recommends what she refers to as “regular structured surveillance,” including monthly skin self-checks at home (about half of melanomas are self-detected) and annual full-body skin checks with a derm.
Dr. Henry says she’s also seen an uptick in the use of one device in particular: “Recently, the use of dermatoscopes has become more common. There is also a new device called Nevisense that is designed to detect malignant melanoma. It can detect the relative risk of a mole in the office in few minutes—potentially helping doctors diagnose melanoma early before the classic clinical features arise.”
Studio City, CA dermatologist Gene Rubinstein, MD is also partial to dermatoscopes, mainly because they allow for better identification of skin cancers, and differentiating them from benign conditions. “There’s also a new device called the DermoScan, which we use for full-body mole mapping. It allows uniform, standardized pictures to be taken of the entire body, and the ability to compare pictures taken at different times. The software allows us to see which moles are changing, and this is extremely helpful to us. On patients with multiple moles, it allows us to flag the changing moles, and view them side by side on the monitor in order to decide if a mole needs further examination.”
Another addition to the field is VivaScope, a newly FDA-approved imaging device that allows doctors to obtain “virtual biopsies” of the skin, with microscopic detail, and without cutting. “This device only takes a few minutes to acquire images, allows for instant diagnosis and is pain-free,” says Dr. Rubinstein. “The future of skin diagnosis is definitely noninvasive.”