Seven three-week cycles of cancer-killing drugs combined with interferon and interleukin-2, another immune system-boosting drug.
The treatments worked: Standard tests haven’t detected tumor cells in Szczecina’s body. For now at least, her life is back on track. She plays tennis several times a week and plans to go back to graduate school. Still, she is scared. “It’s difficult to put it behind you,” she says. “I know the statistics, and they’re not on my side.”
With the odds of surviving the advanced stages of melanoma so low, experts focus on the importance of patient education. In sunny Australia, where much of the population is vulnerable to skin cancer because of their fair-skinned, Northern European descent, a massive, ten-year public education campaign is paying off. Today, studies show that 90 percent of Australians know what skin cancer is and that it is a serious disease. Though it’s too early to document a decline in skin cancer, sunscreen sales have increased exponentially, and surveys report fewer sunburns.
In the United States, the National Weather Service, in conjunction with the Environmental Protection Agency, introduced a UV (ultraviolet) Index to 58 cities last year and anticipates expanding it to 160 this year. The UV Index broadcast on radio and television, as well as printed in the newspaper is a prediction of the sun’s skin-damaging potential at noontime the follow ng day. The scale ranges from 0 to 10+, with minimal risk at readings of 0 to 2, moderate at 5 to 6 and very7 high risk at more than 10.
Early detection is critical, but finding a melanoma is not as simple as glancing at your skin every now and then, since the changes heralding a tumor can be subtle. “It is a misconception to think that all melanomas are black, large, ugly and obvious,” says Dr. Bolognia. “They usually start out much more slowly with slight color variations, outline changes and/or a gradual increase in size.”
“If you look at something every day, you may not notice that it’s changing unless you’re looking for a change,” says 26-year-old Amy Jo Parker, a nurse in Greenville, North Carolina, who wras diagnosed with melanoma in May 1994. Parker is a classic melanoma patient: She’s blond, green-eyed, very fair skinned and a veteran of numerous sunburns. She also has dysplas-tic nevi, or oddly shaped or colored moles, which are a marker for melanoma risk. While not malignant, dysplastic nevi can be hard to distinguish from melanoma. It took a young doctor lounging next to Parker poolside to notice that a small mole on her back had uneven borders and colors. An even larger mole-like melanoma tumor was discovered on her stomach when she went for a checkup. “I’d had these moles my entire life,” Parker says. “The surgeon said I had them removed just in time, before they had a chance to spread.”
For the average-risk person, the Skin Cancer Foundation advises an annual exam with a physician and a quarterly, thorough self-body scan (see “How to Scan Your Scan, page 52), with a visit to a dermatologist if anything suspicious is found. People at high risk should check themselves more frequently, according to their doctors’ recommendations. They should also be screened by a dermatologist usually annually but sometimes more often for those with many moles or a strong family history of skin cancer. Any of the following characteristics place you at higher risk for melanoma: fair skin, light eyes and red or blond hair; skin that bums or freckles easily; having had a melanoma or a parent or sibling who has had it; or having numerous or atypical moles. Keep in mind that no one is immune to the cancer Szczecina, for example, has brown hair and eyes, and women of color, who produce more melanin than Caucasians, still get melanoma, though far less frequently.