FIGHTING MELANOMA

July 18, 2000
		Ray Suarez discusses melanoma with Dr. Darrell Rigel, professor of dermatology at NYU Medical Center. Senator John McCain confirmed this week that spots detected on his face and arm were a recurrence of the potentially dangerous skin cancer. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

July 3, 2000: The Quiet Killer May 13, 1999: Bone marrow transplants and breast cancer Feb. 18, 1999: Preventative Mastectomies Sept. 25, 1998: The Cancer March May 27, 1998: Sorting out cancer research April 13, 1998: New drugs to treat breast cancer March 18, 1998: Is Vitamin E a cancer fighter? March 12, 1998: Some cancers are declining. May 30, 1996: Lawsuits against breast implant manufacturers. Nov. 25, 1996: More news about Prostate Cancer The NewsHour's Health Spotlight. Browse the NewsHour's coverage of Health	RAY SUAREZ: Senator McCain's office confirmed this week that spots detected on his face and arm were a recurrence of the potentially dangerous skin cancer melanoma. After a series of tests, the Senator's doctors today said the cancer does not appear to have spread to other parts of his body. McCain is scheduled to undergo surgery tomorrow to remove the two melanomas as well as surrounding skin and lymph nodes. At a news conference in Arizona, the Senator was upbeat about his surgery and said he expected a full recovery. SEN. JOHN McCAIN: I'm confident. The doctors are very confident, and that we'll have this thing done very quickly and in a very short period of time i'll be back on the straight talk express campaigning for our candidates around the country as well as for Governor Bush. We expect it to be relatively short, relatively simple, and as I say, I'm very confident. I've been in a number of fights in my life and this is just another one. I'm sure we'll be able to prevail. I hope that anyone who has any discoloration or any marking on their body that looks unusual would go see a doctor about it. Most Americans should be confident that early detection means a very, very high probability that everything's fine. I've had... I had another malignant melanoma taken off my shoulder and it's been fine. The whole key is early detection. It's like any other cancer: Early detection.
	Moving quickly
	RAY SUAREZ: Nearly 50,000 Americans are expected to be diagnosed with melanoma this year. And while the disease accounts for just 4% of all skin cancer cases, it is responsible for nearly 80% of the deaths. Joining me to explain more about the risks, prevention, and treatment of melanoma is Dr. Darrell Rigel, professor of dermatology at New York University Medical Center. Dr. Rigel, when a patch has been identified as melanoma, what's going on in that bit of the surface of the body that's different from what's happening in the skin that's covering the rest of your body? DR. DARRELL RIGEL: Well, Ray, melanoma is a cancer of the pigment cells in the skin. And what happens as with any cancer, these cells don't know when to stop growing and they grow very rapidly. What's really bad about melanoma compared to most other cancers is that melanoma tends to spread early in its course. And that's what makes it more lethal than the average cancer. RAY SUAREZ: And when you say spread, that's not only to adjacent areas but to other totally separate parts of the body? DR. DARRELL RIGEL: Melanoma spreads through the blood, through the lymph nodes and through other things, through the body. And it actually doesn't kill you by what's on the skin but it kills you as it goes to your internal organs and causes them not to function well. RAY SUAREZ: Is that ability to spread around the body what makes it different and much more dangerous than carcinoma, the other main type of skin cancer? DR. DARRELL RIGEL: Basically that's right. The more common types of skin cancer -- such as basil cell cancer or scrama cell cancer -- tend not to spread, not to metastasize. They have to be removed because they can locally destroy thing on the body but melanoma spreads throughout the body early on. A melanoma the size of a dime on your skin has a 50% chance of already having spread. RAY SUAREZ: Is this something that is often detected late in the game, been percolating perhaps underneath the surface and makes itself apparent only when it's started to do its deadly work? DR. DARRELL RIGEL: Well, as the Senator said, early detection is critical with melanoma. Melanoma is probably the most clear-cut case of a cancer, if you catch it early and you treat it early, it's not that big a deal. But once it has spread, there's really no effective treatment for it. And that's why it has to be caught early.
	The ABCD rule
	RAY SUAREZ: How is it recognized? DR. DARRELL RIGEL: The best way to recognize melanoma is to remember the ABCD Rule. And "a" stands for asymmetry. Early melanomas tend to be uneven. You can't draw a line down the center. They tend to have an irregular border. That's the "b." They tend to have uneven colors. That's the "c." We have another picture of that. There we go. Where we can see that the color is uneven. Most moles tend to be light in color. They tend to be dark in color but they tend to be uniform in color. And finally, if you have a mole on your skin that is asymmetric, irregular border or uneven color and the size of a pencil eraser or larger, have it checked by your dermatologist because that's the kind of suspicious thing that should be checked. RAY SUAREZ: Should people be doing periodic self-exam to their skin and have somebody take a look at the parts of the skin you can't see, your back, shoulder? DR. DARRELL RIGEL: We as dermatologists are seeing more and more of this because melanoma rates are skyrocketing. One of the things we recommend, on your birthday, have your birthday suit examined. If you do that on a regular basis once a year, you'll catch most of these when it's still early and basically treatable. RAY SUAREZ: Now, you say the rates have been skyrocketing. What could be some of the push factors that are making that rate grow so quickly? DR. DARRELL RIGEL: Well, we're not really sure why they're expanding so rapidly. Melanoma is increasing faster than any other cancer in the United States right now. In fact it's one of the few cancers that's still increasing. We do know that the fairer skinned you are, the lighter your eyes, the lighter your hair the more easily you sunburn, the greater your risk for melanoma but anybody with any skin type can get it. The sun you get when you're younger, as a child, teenager, adolescent or adult increases your risk especially if you've been sunburned. There is recently a study that has come out that suggested our servicemen who served in the South Pacific in World W II, if they were POW's had three 1/2 times of chance of getting melanoma later in life compared to if they served there and were not POW's. We wonder if with Senator McCain that might have contributed to some of his risk. RAY SUAREZ: Let's talk specifically about the treatment of senator McCain. In the diagnostic workup, he had various body scans and x-rays looking for evidence that the melanoma had spread. Are these usually conclusive? DR. DARRELL RIGEL: Well, as with any test, having a negative result is better than ape positive result. The problem with these types of scans with melanoma, especially when it's relatively early is the tumor could have spread but not yet been detected. I'm sure we all hope that the test in fact is negative but all we can say at this point is that nothing was detected by the test. RAY SUAREZ: So what kind of follow-up would be done in a case of this kind? DR. DARRELL RIGEL: Well, it appears from the report today that he had two new melanomas. It wasn't the one from his back that had spread. The one on his arm was basically what's called an insitu melanoma in place meaning it has not spread. The one on his temple, they mentioned he has to have his lymph nodes examined nearby on his neck. That is the sign that it is not an early melanoma and has a chance of having spread. So I think we really have to wait to see when the results are in on the lymph nodes as to what his chances will be. RAY SUAREZ: When you use surgical intervention for melanoma as opposed to carcinoma, do doctors err on the side of caution, take a larger area, go deeper to get further under the growth just to be sure? DR. DARRELL RIGEL: Well, I think that's critical with melanoma. You must get the tumor out. In fact, if you don't catch it early enough, what happens is it has spread. The horse is out of the barn, so to speak. So the trick is to take enough around it to try to get it all out hoping it has not spread beyond the area that you're cutting out. RAY SUAREZ: So when someone like the Senator and perhaps of a similar age in his 60s has had a diagnosis, had the surgical intervention, what kind of follow-up should be done down the road? DR. DARRELL RIGEL: Well, the first thing is to make sure that this tumor has not spread. And he needs regular scans and follow-ups to check that out. But even more importantly, once you've had one melanoma, the chance of getting a second one, not the first one spreading but a second one sometime in your life is about 5%, one in 20. So therefore you need to be followed for life roughly every six to 12 months, to make sure that there's not a second one that pops up. Or if it does, it can be caught early enough. RAY SUAREZ: You're a dermatologist. Do you expect that a highly publicized case like this may send some of your patients heading for your doors for that birthday suit check-up who might not have otherwise come in? DR. DARRELL RIGEL: Senator McCain said it well. He said prevention is important, early detection is important. We as dermatologists are concerned because we are seeing more and more of this problem as melanoma rates rise. The risk of an American getting skin cancer of some sort right now is one in five. One in five Americans will get skin cancer and even worse, one American dies every hour of skin cancer. That's a startling statistic. And since most skin cancers are preventable, we hope that people will change their behaviors. RAY SUAREZ: So the kind of publicity that companies this case is nothing but help for you. DR. DARRELL RIGEL: Well, it's certainly unfortunate for senator McCain, but I think if it gets the word out to the public where others will seek treatment for a suspicious mole they have on their body and seek treatment early, hopefully it will be beneficial overall. RAY SUAREZ: Dr. Darrell Rigel, thanks a lot. DR. DARRELL RIGEL: My pleasure.