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Oncology: Saving Your Skin from the Sun

With warm weather comes outdoor activities and spending more time in the sun. Hatem El Halabi, MD, FACS gives advice about how to protect yourself from the dangers of melanoma, a serious form of skin cancer. “Melanoma is an aggressive skin cancer that can metastasize,” says Dr. El Halabi, a surgical oncologist who has a special interest in treating melanoma and other skin cancers. “If left untreated, it can spread to lymph nodes, the liver, the lung and the brain.”
Melanoma is the sixth most common cancer and the number of cases diagnosed each year is increasing faster than any other cancer. Excessive sun exposure, a blistering sunburn as a child, and using a tanning bed increase the chances of developing melanoma. People who burn but don’t tan and have very fair skin are at higher risk of melanoma. So are people who have a family history of melanoma, a large number of moles, or a suppressed immune system. When going outside, Dr. El Halabi recommends using a sunscreen of at least 30 SPF and covering up — even on cloudy days. Ultraviolet rays that cause sunburn pass through clouds and can be reflected off bright surfaces such as concrete, sand, snow and water. Children need a higher SPF sunscreen than adults and should not stay in the sun for long periods of time.
“Don’t think that you are fully protected by just using sunscreen,” he says. “Cover up with clothes. If you’re swimming, cover up when you come out of the water.” For those at higher risk of melanoma, Dr. El Halabi advises avoiding the sun as much as possible between 10:00 am and 4:00 pm when the sun’s rays are the strongest. He also cautions against using indoor tanning beds, which have been linked to increased risk of melanoma. Sunscreen becomes less effective over time and should be thrown out after its expiration date. If there isn’t an expiration date, it should be discarded after three years — sooner if it has been left in a hot car, because high temperatures speed up the process.
Moles that could turn into melanoma may or may not be raised, and may bleed, itch or crust over. They can develop anywhere on the skin, including the back, chest, the palms of the hands, and even under toenails or soles of the feet. Alexandria resident Lynn Gallagher found melanoma on the bottom of her right foot. Since she had had a kidney transplant and takes anti-rejection drugs that suppress her immune system, she knew she was susceptible. Her family also is fair-skinned and has a history of skin cancer, so she had it checked.
“It looked like a bruise on the bottom of my foot between two toes,” Lynn says. “It wasn’t raised and there was no pain. It didn’t look like anything you would think of as a skin cancer.”
Lynn’s treatment included a skin graft, so Dr. El Halabi worked with Mazen Bedri, MD, a plastic and reconstructive surgeon. Both physicians are members of the Virginia Hospital Center Physician Group. When Dr. El Halabi operated to remove the cancerous tissue, Dr. Bedri put a graft in the wound to encourage capillary growth for good tissue and blood supply. Lynn now is “back to normal,” she says. Doing regular self-examinations of your skin will make you more aware when changes in moles occur, Dr. El Halabi notes. Have your significant other or family member check areas of your body that you can’t see. See your doctor if you notice any changes that concern you.
“There’s always a much better chance of curing melanoma with early detection. It’s important to know what to look for,” he says.

THE ALPHABET OF MELANOMA

Moles are very common and the chance of a mole becoming a melanoma is very small. Just to be on the safe side, check any moles for these five warning signs.
A is for asymmetry. One half of the mole is different from the other half.
B is for borders. They may be ragged or irregular.
C is for color variation. Melanoma moles may be black with brown
discoloration.
D is for diameter. Anything bigger than a pencil eraser is concerning.
E is for evolution. If you’ve had a mole for a long time and it changes in color or shape, get it checked.

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