Fall 2010

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Shining Light on Melanoma

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Fifteen years ago June Robinson sat down with Northwestern’s North Beach lifeguards to talk about tanning. Not surprisingly, every one of them said they looked healthier, “more macho,” if they had a tan, says Robinson, a dermatologist at the Feinberg School of Medicine. “I remember the quote to this day. They say to me, ‘I don’t bother putting on sunscreen until I FEEL it.’ And I’m sitting there thinking, ‘That’s exactly the opposite. By the time you feel it, you’ve already sustained the damage.’

“I would hope that things have improved during that period of time, but I wouldn’t say that they necessarily have.”

Unfortunately, her intuition is probably correct. Skin cancer is the most prevalent form of cancer in the United States, with more than 1 million new cases of non-melanoma skin cancer and more than 60,000 new cases of melanoma estimated each year.

Melanoma, the deadliest and most aggressive form of skin cancer, is one of the fastest-growing cancers — incidence tripled over the past 30 years. It is the most common cancer among 26- to 30-year-olds and the second–most common among 20- to 25-year-olds.

If melanoma is diagnosed early, it can be treated effectively. But it spreads easily, and once it metastasizes, it’s nearly impossible to stop.

One person in the United States dies from melanoma every hour — more than 8,000 victims every year. “We have our work cut out for us for people to understand that melanoma can be very deadly,” says Wendy Selig (GJ87), president and CEO of the Washington, D.C.–based Melanoma Research Alliance, which funds research that will lead to more effective prevention, detection and treatment options — $22 million in grants in the organization’s first three years.

Ultraviolet radiation primarily through sun exposure is the chief environmental cause of melanoma (inherited genetic mutations likely account for less than 10 percent of all cases). “We are all at risk,” Selig adds, “and if you have been a regular user of tanning beds, your risk is about 75 percent higher for melanoma.”

Among women ages 15 to 39 — the primary group targeted by tanning salons — incidence of melanoma increased dramatically (50 percent) between 1980 and 2004. The World Health Organization recently reclassified indoor tanning beds to its highest cancer risk category.

Back in 1995 Robinson’s research team was one of the first to document that 20 percent of high school and college students, ages 16 to 21, were going to indoor tanning salons. Robinson began to explore the reasons why young women in particular go to tanning salons — to change their appearance, relax and socialize, and, in some cases, because they’re addicted to the feel-good hormones (endorphins) that come with the experience. She’s also looked for ways to address and affect attitudes and behaviors about tanning.

Warnings about the risks of deadly skin cancer haven’t been effective, but she might have finally found a deterrent — wrinkles. “You have to do something that gets their attention,” Robinson says of young indoor tanners. “If you say, ‘You’re going to have wrinkles when you’re 40,’ none of them ever think they’re going to be 40. But the idea of getting wrinkles at 25, ah-ha!

“It is so hard for me as a physician to say that,” she adds. “I would really hope that the possibility of developing melanoma skin cancer would be a motivator, but it’s not.”

Robinson served as senior author of a paper in the Archives of Dermatology that reported on a study on the best strategies to wean college-age women who are considered addicted or pathological tanners from tanning salons.

The research showed warning them about the effects on their appearance caused a 35 percent drop in their indoor tanning visits. “The fear of looking horrible trumped everything else,” says Robinson, a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “It was the most persuasive intervention, regardless of why they were going to tan.”

Selig says with better skin-care products on the market, including sunscreen and UV-resistant clothing, people should find it easier than ever to reduce skin cancer risk.

There are signs of hope on the research side, too. At the annual meeting of the American Society of Clinical Oncology in Chicago in June, doctors shared the successful results of treatment with a drug that helps the immune system fight tumors. Important progress was also reported in developing drugs that target molecular pathways driving melanoma formation, progression and metastasis. These findings offer new opportunities for melanoma therapy and prevention.

Illustration by David Plunkert