Risk of Melanoma in PD in Women especially those of a Darker Hue. By Maria De León

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“The summer knows….”

In many parts of the world the heat index is beginning to rise making it feel like summer although summer is officially a few weeks away. Summer means freedom, happiness, ocean breeze, long days and sand between my toes. However, it also reminds me of the ways we must take care of ourselves to enjoy life to the fullest. Even though having sunshine is a great thing we must have balance like everything in our lives. Especially for those of us who have PD and are women are at higher risk by simple fact that not only PD increases risk of melanoma but melanoma is the second – most common form of cancer in women ages 15-29. Plus, according to some surveys it is increasing faster in our gender than in men of same age.

My very first experience as an intern of having to comfort someone with cancer diagnosis in their terminal stage was a young Hispanic man who was about to lose fiancée to metastatic melanoma. This was a devastating moment in my life as well since I had to pronounce dead someone who not only was Hispanic but of my same young age.
Little did I know then that over the next few decades I would be diagnosed with melanoma a few times already? Fortunately, all 3 times have been caught in first stages where resection was all that was required. However, as a doctor I know that having a history of certain cancers like melanoma are always something to consider when new symptoms arise for these cancers re highly malignant and can spread to almost any part of the body particularly the nervous system.
Now that I have PD, the risk of developing melanoma is greater for me and all people with PD. but, especially for those who have family and personal history of the same. Sadly, for those of us who are Hispanic (who by the way have higher risk of PD) have a higher rate of developing melanoma than two decades ago. Apparently, those of us who have darker skin tone need better sunscreens or perhaps need to begin applying sunscreen. There might be a misconception in our culture that not having pale skin somehow protects us from skin cancers but nothing is further from the truth. Melanin does offer some protection but not nearly enough. IMG_0818

I for instance I don’t tan, I simply burn with minimal exposure to UV rays. I discovered this purely by serendipity one summer at the beach. I had applied sunscreen to my shoulders and face primarily, as most Hispanic women tend to do, but never reapplied by that evening I was swollen like a big toad primarily in my face with glistening puffy water filled bags under my eyes and swollen lips almost disfiguring. Never mind the pain, I was glowing like I had received some form of radiation where even my hair was three shades lighter with only a few hours of sun exposure. This is when I remembered how my grandfather always insisted I wear gloves, hat and long sleeves in the sun…why had I not listened this time? Too busy being young and carefree. For weeks later I simply peeled.
Now even though I love the sun and beach I make sure I use the necessary protection. However, many minority women have not taken heed of the dangers of sun exposure. Plus the fact that among Hispanics, blacks and Indian women melanomas tend to occur in inconspicuous places not usually exposed to the sun. As was my case 2 out of three were not in sun exposed regions of my body. I also lost an Indian friend at young age due to metastatic melanoma which had started in her groin area. Thus by time of detection it had already spread.

Subsequently according to the Journal of the American academy of Dermatology nearly half of black women and a third of Hispanics are diagnosed with this disease in late stages compare to less than a third in white women. Thus fatality is higher in these groups. The question remains is there a biological difference in genetics causing greater risk? Perhaps! But the presentation in soles, palms, and nail beds make it harder to detect, diagnose, and treat appropriately for many doctors might not think melanoma since not directly exposed to sun. Here again the question of healthcare disparity comes into play. Are they going longer without diagnosis because of poor access to care or physician bias? Much more research is needed in this area.

The truth is that we all need to remember to use sunscreen to protect our skin from harmful UV rays especially if you are in the minority groups.Perhaps using sunscreens that leave our skins white and pasty might not be an appealing thing rather serve as a deterrent to many since it is aesthetically unpleasing; especially for those of us who have darker skin. Of course the best sunscreen is one that is used regularly!
Fortunately, the cosmetic industry has taken notice of the need for diverse products which can be used by various groups. Besides sunscreens many cosmetics now have an SPF protection.

How to protect yourself and diminish risk of melanoma:

We may not be able to do anything to avoid getting PD or other chronic illnesses but we sure can do something to prevent skin cancer.IMG_0857

• Use Cosmetics with SPF protection
• Frequent skin checkups especially in winter and in the nude – whole body, if no insurance visit aad.org for list of free SPOTme skin cancer screenings in your state.
• Self-inspection especially of inconspicuous areas – ask partner to help
• Wear gloves if driving in sun
• Use SPF protective garments like bathing suits/hats
• Avoid shellac use of nails routinely because this is applying UV light
• Avoid sun tanning (tanning booths) use instead bronzers than can be sprayed or applied. Many cosmetic brand s offer great products
• Don’t forget your eyes? Wear shades with UV protection
• Apply sunscreen vigorously multiple times don’t forget toes, hands and feet. Must have one with zinc oxide, also avobenzone and oxybenzone but these can be greasy. Look at screen stars which can be friendlier to women of darker skin color
1. Apply one ounce of SPF 45or higher (minimum 30) enough to fill shot glass or golf ball size at least 30minutes before going outside or in the water
2. Reapply every 2 hours or immediately after heavy perspiration or swimming

• Use moisturizers like oil of Olay (my favorite) or Neutrogena both which have SPF.
• If you are a woman with dark skin watch out for sore that won’t heal, patches of rough and dry skin (sounds like I have to go to dermatologist asap), watch for dark lines around finger and toe nails, look for spots on hands, feet, lower legs, groin, mouth, lips buttocks and scalp.
• Hydrate, hydrate, hydrate
After being in sun use some aloe Vera sap all over the exposed body this is soothing and healing.

Have a lovely summer! Soak up the sunshine but don’t forget to be good to yourself and your skin…you will be grateful you did.

Douglas Deborah. (S.O.S) the Oprah magazine June 2018 9(6):109-113

@copyright 2018
All rights reserved by Maria De Leon