Interview with Dr. Sommerville


Q. Are there regional differences in the U.S. in terms of level of awareness about the damaging effects of sun exposure as it relates to the developments of skin cancers?

Dr. Sommerville: Yes, in fact Washington, D.C. emerged as the most sun-smart city out of 32 metropolitan regions whose adult residents were recently polled on their knowledge, attitudes and behaviors toward tanning and sun protection according to the survey conducted by the American Academy of Dermatology! New York and Miami took the second and third place respectively.

Q. What is the most deadly form of skin cancer and how common is it?

Dr. Sommerville: Malignant melanoma is the most deadly form of skin cancer. Even though it only accounts for 4% of skin cancers, it is responsible for 80% of all skin cancer deaths. Incidence of melanoma is increasing at a faster rate than any other cancer in the United States. Melanoma is the most commonly occurring cancer in women between ages 25 and 29 and is second only to breast cancer in women between the ages of 30 and 34. The incidence of invasive melanoma has been rising for several decades. Overall, it is currently the sixth most common cancer in both males and females. Age-adjusted incidence nearly tripled between 1973 and 2003. Only if detected at an early stage, melanoma is a curable cancer in the vast majority of cases.

Q. Is excessive exposure to the sun responsible for this alarming increase in the incidence of malignant melanoma?

Dr. Sommerville: Although chronic unprotected sun exposure is definitely harmful, it is primarily the intermittent sunburning that promotes developments of melanoma. This “intermittency” prevents the skin from adapting to the harmful UV rays. Just one severe sunburn in childhood doubles the chances of developing melanomas later in life. Yet more than 40% of white children under age 12 are burned at least once.

Q. Are doctors doing enough to diagnose melanomas at its earliest curable stage?

Dr. Sommerville: American Cancer Society recommends routine professional skin examinations every three years for people ages 20 to 40 and yearly for anyone over 40. Unfortunately, to date, non-dermatologist clinicians do not consistently, routinely examine skin. In the year 2000, only 15% of adults reported having a skin exam conducted by a doctor according to the National Health Interview Surveys. Dermatologists do not boast much better rates of performing full-body skin exams. Only 30% of dermatologists report performing routine full-body skin screening; 49% screen only those at higher risk of skin cancer. Overall only 25% of melanomas are diagnosed by physicians. Therefore, skin self-examination may be the only thorough skin exam that most patients experience. A 1996 study on skin self-examination indicated that it may reduce melanoma mortality by 63%!

Q. How to effectively diagnose an early melanoma?

Dr. Sommerville: The key to early diagnosis of melanoma is the ABCDE acronym representing an analytical method for the evaluation of pigmented lesions. Melanoma often manifests some or all of the ABCDE features, namely asymmetry (A), border irregularity (B), color variability (C), diameter greater than a pencil eraser or 6 mm (D), and evolution of change (E).

Another way of making an early clinical diagnosis is the “Ugly Duckling Concept”- the observation that nevi (moles) in the same individual tend to resemble one another, and that melanoma often deviates from this pattern thus emphasizing the importance of not just evaluating the characteristics of the lesion in question, but also comparing it to that of surrounding lesions, looking for an outlier in the background of similar appearing moles, a lesion that looks and feels different than the patient’s other moles.

Unfortunately, a very dangerous subtype of melanoma, nodular melanoma representing approximately 20% of all melanomas, tends to grow very rapidly, and is notorious for lacking the classic ABCDE signs.