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Sun Damage is More Than Skin Deep: Fighting Melanoma Once Puts You at Greater Risk in the Future

July 17, 2014



Ron Verhoff and wife Grace

OAKLAND, Calif. — Are you guilty of skimping on your sunscreen? Many Americans don’t take skin cancer seriously, but according to the American Academy of Dermatology, one person dies every hour from melanoma.

When found in its earliest stages, melanoma is highly treatable, but just because it’s easily taken care of the first time doesn’t mean it can’t come back — even decades later.

A cautionary tale: Ron’s story

Ron Verhoff, 71, first heard of melanoma when doctors found an irregularly shaped mole on the back of his ear in 1991.

At the time, Ron’s melanoma didn’t seem to be cause for much alarm.

“They cut it out, did a skin graft, and sent me out the door,” remembered Ron. “I basically forgot about it after that.”

It wasn’t until 2013, more than 20 years later, that Ron felt a lump on the side of his neck while vacationing with his wife, Grace, in Florida.

When the couple returned to their Georgia home, Ron visited his Kaiser Permanente doctor, where he learned that after two decades of minimal health issues, Ron was facing down a second round of skin cancer.

With tears in his eyes, Ron recalled the day he got the news.

“I thought it was over,” he said, holding his wife’s hand. “And I don’t know what we’d do without each other.”

Battling Ron’s recurrence of melanoma wasn’t easy, but it also wasn’t “over.” Removing the cancer entirely meant undergoing surgery that left Ron with 29 staples in his neck.

After his staples were removed, Ron was eager to regain his health and was back on his feet within a month.

A deadly misconception

It is a common misconception that surviving five years after treatment for melanoma means a patient is cured.

Amy Reisenauer, MD, is a dermatologist with Kaiser Permanente in Hawaii. She understands the dangers of skin cancer intimately, having encountered the disease regularly in her practice as well as in her personal life: her father-in-law passed away from a recurrence of melanoma in 2009, 17 years after his initial diagnosis.

“The risk of recurrence never goes down to zero,” she said. “That’s why we track all of our patients who have been diagnosed with melanoma to ensure they are getting regular follow-up exams with their dermatologist.”

Innovations in dermatology have led to increased rates of screenings in some health systems. At Kaiser Permanente, Dr. Reisenauer uses the Melanoma Patient Database, which flags patients in their electronic health record who are overdue for check-ups with their dermatologist.

Dr. Reisenauer also relies on teledermatology, which allows primary physicians to take a picture of a suspicious-looking mole or skin condition, upload the photo into a patient’s electronic health record, and send it to a dermatologist during a check-up appointment. Doctors can expect a timely response from a dermatologist after uploading the photo.

Melanoma: what you should know

One in 50 Americans will develop melanoma skin cancer in their lifetime — and that number is on the rise. Here’s what you should know about melanoma:

  • Melanoma is common. Nearly 140,000 Americans will be diagnosed with melanoma this year. It’s is the most common form of cancer for young adults ages 25-29 years old, and the second most common for young adults from 15-29 years old.
  • Once you’ve been diagnosed, there is always a risk of recurrence. Melanoma can always come back, even after decades of good health.
  • If you have melanoma once, you’re more likely to have it again. Patients who develop melanoma are 4-7 times more likely to have melanoma again in their lifetime.
  • Screening saves lives. You may be able to spot melanoma just by looking in the mirror. Monthly self-exams and a yearly visit to the dermatologist are recommended for those who have never had melanoma; melanoma survivors should visit their dermatologist more frequently.

Screening and Recurrence

Catching melanoma in its earliest stages when it’s most treatable requires vigilant screening.

“Using a handheld mirror in front of a full-length mirror works best to visualize the whole body,” explains Dr. Reisenauer. “Patients with a history of melanoma are looking for signs of melanoma recurrence, but they are also checking for any signs of a new melanoma.”

During your monthly self exam, look for the ABCDs of melanoma:

  • A is for Asymmetry. One half of the mole looks different from the other half.
  •  B is for Border Irregularity. The borders of a mole are notched or scalloped and not smooth.
  •  C is for Color. If there’s more than one color mixed in the mole.
  •  D is for Diameter. Anything bigger than six mm, which is the size of a pencil eraser, should be looked at.

Survivors of melanoma should look for these signs of recurrence:

  •  Discoloration on the skin or a lump on top of, or next to, the previous melanoma scar.
  •  A hard lump under the skin that is larger than a marble and near a lymph node. Most commonly this occurs around the neck, armpits, or groin area.
  • Unexplained fevers, chills, night sweats, and unexplained weight loss can all be signs of recurrence.

If you experience any of these symptoms or have further questions, talk to your doctor immediately.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 9.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.