Once burned, twice shy

Not all melanoma is caused by sun exposure, but that doesn’t make it any easier for me to be outside on a sunny day without thinking about wearing a hat, sunglasses, sun block, and/or SPF clothing—and noticing how high the sun is in the sky. When the weather turns nice, as it did this week in western Oregon, I begin to think strategically about when, how and why I’m in the sun. I begin to ration my exposure.

It makes perfect sense. There likely wouldn’t be an epidemic of melanoma if baby boomers like myself had limited our fun in the sun when we were younger. My vice was not sunbathing, per se, but mostly playing golf—sometimes 36 holes a day—without hat or shades. I loved the bronzed look it gave me, even if it meant keeping my shirt on and ending up with a farmer tan. I may have been vain, but not supremely stupid like some of the people I saw floating down the Sandy River on 90-degree days on inner tubes wearing nothing but swimsuits (and sometimes not even that).

There was one occasion I remember distinctly, however, when I burned badly enough to blister. That’s a second-degree burn and, as it turns out, a major risk factor for melanoma. After a couple of days I could peel off long strips of dead skin. I was a naive 19-year-old college student at the time. I don’t ever recall burning that badly again. When I did go into the sun after that, I made sure to cover up after an hour or so. That doesn’t mean I avoided the sun. I just figured I was being wise by not burning.

When I was first diagnosed with melanoma in 2006, I beat myself up emotionally replaying that blistering sunburn episode. I figured my cancer was self-induced and that I was not just the victim of a random genetic accident. My conclusion was that I was just as dumb as someone who smokes a pack a day, and who’s later diagnosed with lung cancer. I’m over the trauma of that realization now, and figure that my behavior was pretty typical for my generation. It’s unknowable that one severe sunburn led to my melanoma. My cumulative sun exposure, however, certainly upped the ante.

The progression from serious sun exposure to skin cancer can take decades to unspool in our DNA. The increased rate of melanoma we’re seeing now is from what many people did 30+ years ago. Suntan lotion in the ‘70s (for those who used it) had an SPF of 2. Some people applied baby oil, which can make a burn worse by sealing in the heat. The first SPF 15 sun block wasn’t introduced until 1986. I don't bother applying anything today that isn’t at least SPF 30. Sun block is greatly overrated, regardless of its SPF, but I figure it’s better than nothing when I can’t otherwise avoid mid-day rays.

Our understanding of melanoma, while still pretty primitive, was downright Neanderthal back when I was pumping up my melanocytes. As late as the ‘80s, there were no good studies on how big a margin was needed when removing a melanoma, and surgical incisions often stretched to 8 to 10 inches. That was an improvement over earlier decades, when doctors sometimes amputated limbs to stop its spread. If you go back far enough, you find reports of branding irons being used to burn out skin cancers.

Not that I volunteered for the job, but I’m pleased to know that my diagnosis has played a role in the decisions made by several people I know to have their moles checked. As I hope everyone knows by now, early detection is crucial. If a melanoma is removed while still confined to the skin, the five-year survival rate is 99 percent; if it’s spread to the lymph system or blood, the survival rate drops to 65 percent; if it’s reached the organs, 15 percent.

My primary cancer, which was located on the side of my left knee, was about the size of a dime and itchy when I finally saw my GP about it. I ended up with a wide excision and, because I was stage two, had a sentinel lymph node biopsy. That exam was a false-negative—meaning it showed no spread of cancer to the lymph nodes in my groin, while that was exactly what eventually happened. Surgery, radiation and immunotherapy all followed. For me, cancer is now like that crazy uncle who comes to your house for a visit and won’t take the hint to leave.

I can look back now and accept the fact that I was reckless about my sun exposure. Whether it caused my melanoma or not doesn’t matter at this point. Epidemiologists can predict that others of my generation are destined to travel the same road. I'm not alone in my temporary insanity.

That doesn’t mean there aren't easy ways to reduce your odds of developing melanoma and skin cancer in general. We know how to do it. I don’t preach on this subject because it appears to be so obvious. Our culture has turned cigarette smokers into social pariahs. We may some day soon do the same to those foolish enough to believe that, given sufficient opportunity, ultraviolet rays can't scramble their DNA and turn good cells into bad characters.