As the spotlight on skin cancer continues to increase, dermatologists have raised the alarm about the high levels of melanoma in South Africa and have cautioned the public to exercise increased caution when exposed to the sun.

Melanoma is a particularly dangerous form of skin cancer, and there is a direct correlation between exposure to the sun and a heightened risk of developing it.

Skin cancers are the most common group of cancers diagnosed worldwide (1) and, of these, melanoma is particularly prevalent among fair-skinned people. (2)

In fact, says Dr Jeremy D. O’Kennedy, a dermatologist at Morningside Mediclinic in Sandton, the incidence of melanoma in South Africa is so high that it could be said to have reached epidemic proportions.

“In my practice alone, I’m diagnosing up to 30 cases a week,” he says, “which is exceptionally high by international standards. Unfortunately, official statistics are unreliable, but anecdotal evidence suggests that the incidence of melanoma in South Africa is the highest in the world; far higher than in traditionally high-risk countries like Australia and New Zealand.”

What is melanoma and why should we worry about it?

Melanoma presents as either a single lesion (abnormal mark or growth) or as multiple lesions – and can occur on any part of the body. These lesions are potentially life-threatening malignant tumours that develop in the cells that produce the pigment melanin, which gives skin its colour. And as fair-skinned people have lower levels of melanin in their skin, they are more vulnerable to damage caused by the sun.

This should not, however, lull people with darker skins into a sense of complacency, says O’Kennedy, who is not only in private practice but is on the Executive Committee of the South African Melanoma Society.

“Many people with darker skins feel they have natural protection against the sun,” he says, “and, as a result, they’re careless about protecting themselves from exposure, reluctant to have regular baseline screening, and slow to seek treatment when they notice an unusual mark on their skin. By the time they present with a visible lesion or, worse still, multiple lesions, their chances of a favourable outcome are significantly decreased.

“That’s why we emphasise prevention, baseline screening and early detection as the three-pronged approach to managing the risk associated with melanoma.”

The importance of prevention

Prevention is, of course, the best course of action and what this means is that all of us should be using protective sunscreen every single day, especially on exposed areas of the body.

“You don’t need to be lying on the beach to be exposed to the sun; you’re exposed to it all the time while you’re doing everyday things like going shopping. And, of course, when you’re on the beach or at the pool, your exposure increases dramatically.”

To minimise exposure, it is important to keep out of the sun completely between 10am and 2pm. Even before and after these ‘smart hours’, one should always wear sunscreen and seek shade whenever possible.

Sunscreen should be re-applied every two hours or immediately after swimming, especially to the face, neck, hands, and ears. And, of course, we should not forget that protective clothing and bathing wear that covers the most vulnerable areas of the body – including the neck and the upper arms and legs – is still the best protection of all.

Baseline screening

The next line of defence is baseline screening, a routine procedure conducted using a hand held device called a dermatoscope to determine whether you have any early warning signs of melanoma.

Everyone over the age of 18 should visit a dermatologist to have this done, says O’Kennedy, because early detection vastly improves treatment outcomes, and the earliest signs of melanoma are not necessarily visible to the naked eye.

How to spot melanoma

It is, however, equally important to check for any visible changes to your skin as these might indicate the presence of melanoma. Although lesions can occur anywhere on the body, they are more common on the trunk in men and on the legs in women (3). Signs to look for are a change in the appearance of an existing mole or the development of a pigmented or unusual-looking mark or growth on your skin (4).

A simple way to do this is to follow the ABCDE rule:

• Asymmetrical: Is the mole or growth uneven in appearance? Melanomas are usually uneven in appearance.
• Border: Are the edges irregular? They usually have irregular borders.
• Colour: Does the colour vary? They usually vary in colour.
• Diameter: Is it larger than 6mm in diameter? They are usually larger than 6mm in diameter.
• Evolving: Is it changing in size, shape, or colour? Evolving melanomas usually change appearance over time.

If you notice any changes to the appearance of an existing mole or any irregular and evolving marks on your skin, you should see a GP or dermatologist as soon as possible to have these checked.

What is the treatment for melanoma?

There are several ways to treat melanoma and immunotherapy drugs are a promising option. They are used to help the immune system recognise and attack cancer cells, helping to prevent them from evading the body’s natural defences.

“While the first line of defence is always prevention,” says O’Kennedy,” the effectiveness of immunotherapy means there is hope today, for those affected by even the most advanced forms of this very common cancer.”