- André Biernath – @andre_biernath
- From BBC News Brazil in London
Credit, Getty Images
Stains and blemishes that appear on the scalp may be signs of melanoma
When you go for a haircut, the conversation in the salon is expected to revolve around light and mundane topics, such as the football game, celebrity gossip or current news. In 2018, though, I almost jumped out of the chair when my hairdresser said to me, “You may have cancer.”
While messing with and cutting my hair, he noticed a suspicious spot (similar to the picture that opens this article) under some strands of hair, near the right ear. In his assessment, it was a typical sign of melanoma, a tumor that affects the skin and is usually aggressive.
As a well-prepared health journalist accustomed to reading and writing a lot on the subject, I decided to schedule a dermatological consultation the same week. In fact, the warning made sense: that spot on my head could actually be a tumor. There was even an indication to remove it during surgery and send the material for biopsy.
I went through the whole procedure of anesthesia and hospitalization, and luckily the result of the laboratory analysis showed that it was a benign change that was not related to anything more serious. Still, the doctors suggested that I have a follow-up every year to measure the size of other spots and birthmarks I have all over my body – if they grow, they may need to be removed as well.
Almost four years after this episode, I still think about the irony of skin cancer. After all, we are talking about a disease that is characterized by an apparent lesion, visible to the naked eye. Yet it is not uncommon for it to be discovered only at an advanced stage after several years of development. To make matters worse, the tumor germinates in a small proportion of patients in areas that we simply cannot see.
That could be my case, with the appearance of the stain on the scalp. Or someone who lives alone and cannot see in detail the genital area or the entire back, buttocks and back of the thighs.
Late diagnosis of melanoma is worrying. When this happens, there is a high risk of metastases, a stage in which the disease has spread to other parts of the body and treatment options have become more scarce.
But when to worry about this type of tumor? And what are the strategies that doctors, patients themselves and other professionals who are not necessarily linked to the health field can put into practice in order to detect the disease as soon as possible?
Less often, more severe
Skin cancer is extremely common. It accounts for about 30% of all tumors diagnosed.
Overall, there are three subtypes of the disease that affect the outer layer of our body: basal cell carcinoma, squamous cell carcinoma, and melanoma.
The first two are the most common and represent about 97% of cases of the disease. The good news is that they are usually much simpler and easier to deal with. In this context, it is possible to talk about healing most of the time.
The remaining 3% belong to melanomas. And here the situation becomes a little more serious: It is an aggressive tumor that, if not detected in the early stages, complicates and can spread through the body.
“Melanoma originates from melanocytes, a type of cell that produces the pigment that determines the color of the skin,” explains Dr. Renato Marchiori Bakos, coordinator of the Department of Cutaneous Oncology at the Brazilian Society of Dermatology.
The National Cancer Institute (Inca) estimates that 8,450 Brazilians are diagnosed with melanoma each year – 1,923 of whom die from the disease.
The main risk factors for the development of this disease are frequent exposure to the sun without any protection, the use of artificial tanning chambers, light skin or eyes and family history (when a close relative was diagnosed with the same problem in the past).
So close and so far out of sight
Oncologist João Duprat, head of the reference center for cutaneous tumors at the ACCamargo Cancer Center in São Paulo, also sees with some irony the barriers to the early diagnosis of melanoma.
“On the one hand, it is a cancer that sits in the skin and can be seen with the naked eye, without the need for complex imaging tests for the diagnosis,” he says.
“On the other hand, people can not visualize well, or it often takes years to think that the sign on the skin could be a tumor,” he adds.
In general, experts understand that there is a lack of information about the signs that indicate melanoma and when it is necessary to seek professional assessment.
To this end, they created the “ABCDE rule”, which summarizes the five main characteristics of a possible skin tumor:
- Asymmetry: shapeless spots or spots where one side is different from the other;
- Edge B: their margins are irregular and blurred;
- Color C: there is more than one tone there, which can vary between white, black, gray and brown;
- Diameter D: moles and spots with a length of more than 5 millimeters;
- And evolution: changes in size, color, shape, or appearance over time.
Credit, Getty Images
Malformed spots and spots that are more than one color and that grow over time turn on the warning sign
“In the presence of one or more of these characteristics, it is important to seek out a dermatologist,” Duprat advises.
“In addition, spots or wounds on the skin that do not have these properties but do not heal after a month should be carefully analyzed,” he adds.
In the office itself, the doctor uses simple equipment (such as a dermatoscope) to monitor what is happening and indicate the most appropriate procedure.
A lesion that is difficult to visualize
Bakos explains that melanoma tends to appear more frequently in the face, body and limbs.
“Most of the time, they are associated with lifelong sunburn,” points out the dermatologist, who is also a professor at the Federal University of Rio Grande do Sul.
Over time, the radiation coming from the sun – ultraviolet A (UVA) or B (UVB) rays – can damage the genetic material in skin cells. Damaged DNA generates cancer cells, which begin to replicate wildly and cause serious damage to health.
In a small proportion of patients with melanoma, it is even more complicated to make an early diagnosis: the lesions develop in places that are difficult to see by themselves, such as the scalp itself, mentioned at the beginning of the report, in the genital region or on the back. Melanoma can even appear under the nail.
This is where other professionals come into the picture, not necessarily related to health, but who are very helpful with early detection.
“Hairdressers, barbers, podiatrists and manicurists help a lot in this regard. They can be guided to detect injuries and warn customers”, Duprat exemplifies.
In older people who have gray hair, melanoma can also attract attention after the sudden birth of a band of dark hair on the head.
This happens because the diseased melanocytes that are at the root of these strands end up producing more pigment than normal, which even changes the color of the specific stretch of hair.
“Tattooists also contribute a lot because we have cases of people getting tattoos to hide stains or stains they are ashamed of,” the doctor adds.
Credit, Getty Images
Dermatologists use equipment called a dermatoscope to check the skin.
The Brazilian Melanoma Group even has a project that provides instruction and lectures on the detection of suspected cases at vocational schools or events that bring together workers in these areas who deal directly with the skin.
Barkos adds that other medical specialties have a role to play in this context. “At periodic consultations, the gynecologist or urologist may notice a stain in the intimate area, which often goes unnoticed or is covered with hair.”
Duprat, on the other hand, is reminiscent of yet another difficulty in the early diagnosis of melanoma: the cases in which the disease occurs in blacks or Asians who are not part of the classic risk group for this type of tumor.
“Because this cancer is less common in these groups, many do not even think about the possibility that the black or Asian patient has melanoma,” he laments.
“In them, it is more common for the lesion to occur on the soles of the feet or on the palms of the hands,” he describes.
Therefore, the recommendation remains the same regardless of individual characteristics: spots, blemishes or wounds that have any of these characteristics of ABCDE or do not heal after 30 days should be assessed by a healthcare professional.
good news therapies
If the biopsy confirms that the mole or spot is actually a tumor, the doctor may prescribe a number of therapeutic approaches.
In the first cases, where the lesion is not yet very deep, the most common way is surgery. In most of these cases, it is enough to remove the affected piece of skin with the scalpel.
Early detection of this tumor is important precisely for this reason: in the early stages of the disease, surgical removal usually solves the problem once and for all without the need for other complementary therapies.
“Now, if the lesion is already a little more extensive, we need to evaluate the lymph nodes to see if metastases have already occurred,” Duprat says.
As explained above, metastasis is the process by which cancer spreads to other parts of the body.
Credit, Getty Images
Covering the skin and applying sunscreen throughout life are the basic attitudes to reduce the risk of melanoma.
But even in these more advanced cases, the treatment of melanoma has undergone a real revolution in the last decade with the advent of immunotherapy. It is a new class of drugs that stimulate the patient’s own immune system to attack and eliminate cancer cells.
“In the past, you either made an early diagnosis of melanoma, or the house fell apart and there was not much else to do. Chemotherapy was extremely ineffective in treating this metastatic cancer,” Duprat recalls.
“Today, immunotherapy can prolong the patient’s life expectancy with very few side effects. The only barrier to this treatment is the price, which remains very high,” the oncologist compares.
If the resources against this type of cancer have evolved significantly in recent years, the recommendations for preventing the disease remain the same.
“Sunburn is one of the most important factors leading to the development of skin cancer in the future. Therefore, when you are outdoors, it is ideal to wear a shirt, sunglasses and a hat to cover the most sensitive areas”, lists Bakos.
“In parts of the skin that are unprotected, it is important to apply sunscreen and reapply from time to time,” the dermatologist concludes.
For those with fair skin who have many birthmarks or have a family history of melanoma, periodic consultations with a dermatologist are also indicated.
Asking your hairdresser, barber, podiatrist, tattoo artist or any other professional who deals with aesthetics to warn you about stains and blemishes in “hidden” areas is also an excellent idea – which I have learned and noticed myself. the skin not long ago.
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