By Ed Edelson
MONDAY, April 20 (HealthDay News) -- A new study delivers a lifesaving message to older men about the potentially deadly skin cancer known as melanoma: If you can't examine your own back, have a loved one take a look, and if there's something suspicious, see a doctor.
"We were trying to understand why it is that when a doctor finds a melanoma, it usually is thinner compared to a person finding it by himself," said Alan C. Geller, a senior research scientist at the Harvard School of Public Health, and a co-author of one of two reports on melanoma in older men that appears in the April issue of the Archives of Dermatology.
Detecting a melanoma early, while it is thin, is an essential first step in surviving the skin cancer, said Dr. June K. Robinson, editor of the journal and a professor of clinical dermatology at the Northwestern University Feinberg School of Medicine, who wrote an accompanying editorial.
"The numbers are startling," she said. "If it is diagnosed at an early stage, the chance of survival is 90 percent. At a later stage, it is 20 percent."
There will be more than 62,000 cases of melanoma diagnosed in the United States this year, the U.S. National Cancer Institute estimates, and 8,420 Americans will die of the cancer. Half of those deaths will be in white men over the age of 50.
So, a group led by Dr. Susan M. Swetter of Stanford University interviewed 227 men aged 40 and older within three months after they had been diagnosed with melanoma. A quarter of them had tumors more that two millimeters thick -- about a third of the thickness of a pencil eraser, but enough to mark a dangerous borderline for effective treatment.
Analysis of the data by a group led by Geller found that men whose melanomas were detected by physicians tended to be older, and that 46 percent of the physician-detected melanomas were on the back.
"The back is the place that should be examined by a doctor and by the person himself," Geller said. "We found that one of the major reasons for doctors finding thinner melanomas was that they were more carefully examining the back. If you do it yourself and see something unusual, go to a doctor and say, 'Give me a referral to a dermatologist.' "
Dermatologists are trying to publicize that message because "of cancers in general in the United States, the only one in which the mortality rate is not dropping is melanoma," Geller said.
This is one appropriate occasion for a man to turn his back on his wife, Robinson said. "Most men in Western society depend on the women in their lives to mediate medical care -- nagging, scolding, reminding," she said. "And the places where melanoma occur more readily are hard for the man to see -- the back, the top of a bald head, behind the ears. With women, melanoma is more likely to occur on the lower leg."
When the inspection is made, "they should be asking the spouse to check for moles with border irregularity, color variation over the surface and with greater than six millimeter diameter," Robinson said. "You don't have to run to a doctor immediately. They grow at their own rate of speed. If you think you see suspicious features, come back in a month, and if it changes, go to the doctor."
One reason why doctors found the melanomas earlier was that they looked for them, said Dr. Steven Wang, director of dermatologic surgery and dermatology at Memorial Sloan-Kettering Cancer Center in Basking Ridge, N.J.
"It's very important for middle-aged and older men to see a physician for a total body examination," Wang said. "We don't have any effective cure for late-stage melanoma. Only early diagnosis followed by complete removal can improve the prognosis."
The study "highlighted what we suspected," Wang said. "This population, middle-aged and older men who might be more cavalier about their medical care, needs to be more aware of the danger associated with undiagnosed and untreated melanoma."
The complete story on melanoma is told by the U.S. National Cancer Institute.
SOURCES: Alan C. Geller, R.N., senior research scientist, Harvard School of Public Health, Boston; June K. Robinson, M.D., professor, clinical dermatology, Northwestern University Feinberg School of Medicine, Chicago; Steven Wang, M.D., director, dermatologic surgery and dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, N.J.; April 2009, Archives of Dermatology
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