Not Just Skin Deep: Update on Melanoma
By Nadine Salmon, MSN, BSN, IBCLC, Clinical Content Manager AMN Healthcare
If you were paying attention to your calendar, you may have noticed that May 5 was Melanoma Monday, designed to increase public awareness and remind us of the importance of early detection.
Dr. Michael Shapiro, a renowned dermatologist in New York, uses a simple mnemonic for determining when a mole should be evaluated by a medical professional: ABCDE. The “A” represents symmetry. In a malignant mole, the shape of the mole may be asymmetrical. The “B” stands for border irregularity, where a malignant growth may have borders that are not crisp or well-defined. The “C” represents the variety of color that a malignant mole may have, and the “D” stands for diameter. Malignant moles are generally larger than 5mm in diameter. The “E” represents evolution, which would include changes in any of the other characteristics in the mnemonic.
According to the National Cancer Institute (NCI), UV radiation increases the risk of developing skin cancer. Melanoma, the deadliest form of skin cancer, is linked to severe sunburns, especially at a young age. As the summer months loom ahead, it is particularly important for nurses to protect themselves and educate others on the importance of sun-protection. Experts in the field recommend the use of a sun protection factor (SPF) 30 or higher, water-resistant sunscreen, on all exposed body parts when outside, even on cloudy days (NCI, 2014). It is advisable to seek shade when the sun’s rays are strongest, between 10 a.m. and 2 p.m.; and to wear sunglasses, a wide-brimmed hat, long sleeves and pants whenever possible (dark colors and tightly-woven fabrics work best).
It is also advisable to avoid tanning beds at all costs. The FDA estimates that about 30 million Americans still use indoor tanning beds each year, including 2.3 million teens (FDA, 2014a). According to the Skin Cancer Foundation (2014), indoor ultraviolet (UV) tanners are 74% more likely to develop melanoma than non-tanners, and the more time a person has spent tanning indoors, the higher the odds of developing the disease. UVA penetrates the skin more deeply than UVB; it ages skin cells to cause wrinkles, and damages their DNA, which contributes to skin-cancer risk. In July 2009, the International Agency for Research on Cancer (IARC), part of the World Health Organization, concluded that tanning devices that emit UV radiation are more dangerous than previously thought, and moved these devices into the highest cancer risk category: “carcinogenic to humans.” The IARC has also recommended banning commercial indoor tanning for those younger than 18 years to protect them from the increased risk for melanoma and other skin cancers.
This year, the Food and Drug Administration (FDA) also approved the first combination drug treatment for certain patients with advanced melanoma. A clinical trial found that patients who used both Mekinist (trametinib) and Tafinlar (dabrafenib) experienced a reduction in size or disappearance of their melanoma for a longer period of time than those who treated with Tafinlar alone (FDA, 2014b). More research is needed to see whether the combination improves survival rates.
Some treatment centers across the USA are also now offering adoptive cell therapy (ACT), in which a patient's disease-fighting T-cells (Tumor-Infiltrating Lymphocytes or TILs) are retrieved surgically, grown in a lab and the expanded supply of cells are then transferred back to the patient to help the immune system fight melanoma (Phan & Rosenberg, 2013).
To learn more about caring for a patient with cancer, review RN.com’s Oncology 101: When Your Patient Also has Cancer course to get an overview of important concepts related to the care of the oncology patient. This will promote a deeper understanding of the disease process, and allow you to better care for and educate your oncology patients.
Federal Drug Administration [FDA], (2014a). Indoor Tanning: The Risks of Ultraviolet Rays. Retrieved from http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm186687.htm
Federal Drug Administration [FDA], (2014b). FDA approves Mekinist in combination with Tafinlar for advanced melanoma. Retrieved from http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm381159.htm
Glynn, M. (2014). Melanoma Monday: What You Need To Know. The Daily Apple. Retrieved from http://www.newsday.com/news/health/the-daily-apple-1.4760551/melanoma-monday-what-you-need-to-know-1.7899963
International Agency for Research on Cancer [IARC], (2014). Exposure to Artificial UV Radiation & Skin Cancer. Retrieved from http://www.iarc.fr/en/publications/pdfs-online/wrk/wrk1/ArtificialUVRad&SkinCancer.pdf
National Cancer Institute [NCI], (2014). Melanoma: Risk Factors & Prevention. Retrieved from http://www.cancer.net/cancer-types/melanoma/risk-factors-and-prevention
Phan, G. & Rosenberg, S. (2013). Adoptive Cell Transfer for Patients with Metastatic Melanoma: The Potential and Promise of Cancer Immunotherapy. Cancer Control 20 (4), 289 – 297.
Skin Cancer Foundation (2014). Indoor Tanners May Have More than Four Times the Risk of Melanoma. Retrieved from http://www.skincancer.org/publications/sun-and-skin-news/summer-2010-27-2/indoor-tanners
© 2014. AMN Healthcare, Inc. All Rights Reserved.