No Big Deal?

When Cathy Jenkins' doctor called to tell her that the sore on her neck was melanoma, her first thought was, "Thank God, it's only skin cancer." Like many people, Jenkins, 49, assumed that melanoma was no big deal, a nuisance her dermatologist could remove with a quick flick of the scalpel. In fact, she waited six months to see her doctor after she noticed the mole, chalking it up to irritation caused by a heavy new necklace she'd been wearing. Even after the diagnosis, taking care of the problem didn't seem like a life-or-death situation. But when Jenkins tried to give it the brush-off, the doctor told her, "This is very, very serious. You need to come in now." It was only then she realized what a battle she was facing.

Jenkins, who has survived for eight years, isn't the only one who underestimates melanoma, a cancer of the pigment-producing cells in the skin. The least common of all skin cancers -- basal-cell and squamous-cell types are diagnosed far more frequently -- it's often lumped together with those rarely fatal varieties. But there's a big difference: Although it is 99 percent curable if caught at the earliest stage, once it has spread deep into the body, melanoma is very hard to treat. "In medical school, they told us you never wanted your patients to get melanoma, because they die," says Casey Culbertson, MD, chair of the Melanoma Research Foundation. While not everyone with melanoma faces such a dire prognosis -- as Culbertson, a seven-year survivor himself, can attest -- the statistics aren't great. The American Cancer Society estimates that of 59,580 melanoma cases diagnosed this year, the disease will kill nearly 7,800 people. Incidence of the disease is rising faster than that of any other cancer -- both in the U.S. and worldwide -- and it's one of the fastest-moving. According to Howard L. Kaufman, MD, author of The Melanoma Book, "Melanoma can double in a matter of a few weeks." The deeper the lesion, the greater the chance that it has metastasized.

Part of the reason so many of us think that melanoma is no big deal is because we believe that avoiding it is simply a matter of wearing sunscreen and avoiding excessive sun exposure. Certainly, Cathy Jenkins thought she was safe. She was never a sun worshiper, had no family history of the disease and had few moles. Plus, she has dark hair and eyes, not the fair skin, freckles, and light eyes that can put you at risk for the disease. But sunlight is not the whole story. Even if everyone eliminated their sun exposure, we still wouldn't be rid of melanoma. "Melanomas occasionally develop on parts of the body, such as the feet or buttocks, not commonly exposed to sun," says Kaufman. "We think that other factors must play a role." That's another reason to alert your doctor if you see or feel a suspicious lesion in a spot found where the sun doesn't shine. UV light is clearly an important component, but it's not the only one. About 10 percent of melanomas are thought to have genetic links, but as scientists learn more about the disease they may uncover other factors, says Kaufman.

At the time of her diagnosis, Jenkins' melanoma was in an early stage, but had penetrated many layers of her skin, and one doctor suggested she may only have five years to live. (Melanoma is generally broken into stages 0 through IV, depending on how deeply the cancer has infiltrated the skin and how widely it has spread through the body.) "If you're diagnosed with melanoma, your treatment options are limited," says Hester Hill Schnipper, chief, oncology social work at Beth Israel Deaconess Medical Center in Boston. "Chemo and radiation aren't known to work on melanoma, so you're basically left with two drugs, interferon and interleukin-2."

After surgery to remove the lesion, Jenkins began a 12-month regimen of the drug interferon alpha. This treatment is based on a substance produced by the body to fight viral infections; in patients with melanoma, it stimulates the body to attack the cancerous pigment cells. For her melanoma, it offered a possible 10 to 15 percent better chance of survival -- a rather meager hope. (For melanoma at other stages, interferon also may help, but studies have not yet proven that it's effective across the board.)

The year of treatment was grueling. Interferon's side effects range from exhaustion and flu-like symptoms to depression. For Jenkins, the fatigue was overwhelming: "Walking up the stairs or putting detergent powder in the dishwasher would take all my energy." And once her treatment was over, she found herself obsessing over the future, fixating on her doctor's suggestion that she could be dead in three to five years. "I made it through that third year and thought I had two more to go," she says. "I felt doom every morning when I woke up. I thought, 'Today's the day.'" When she reached the five-year mark, her boyfriend took her on a vacation to celebrate.

Now that she has almost reached the eight-year mark, is she cured? Not necessarily. Melanoma is notorious for paying its victims a second visit, so Jenkins' happiness is tempered with fear. "It can return, at any time and in any place," says Michael Gold, MD, a dermatologist in Nashville and Skin Cancer Foundation spokesperson. "There's almost nowhere in the body I haven't seen it come back to."

"About five months ago I was really dizzy," says Jenkins. She feared the worst and immediately made an appointment with her doctor. "As they performed a CAT scan, all I thought was 'Oh, my God, it's in my brain!' Luckily, it was an inner-ear problem." She still meticulously checks her skin for bumps and moles every day in the shower, fearful that she'll find something. The superficial checking is smart, to a point: While melanoma can recur on the skin, typically, when it returns, it's in the lungs, liver, bones, or brain. "Once you're diagnosed [with a deep melanoma], you're basically a patient for life," says Culbertson. "There are regular blood tests, plus they scan you everywhere, CAT scans, PET scans, MRIs."

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