Melanoma- The Social Perspective

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“The idea of preventative medicine is faintly un-American. It means, first, recognizing that the enemy is us.”

– Chicago Tribune, 1975.

“Growth for the sake of growth is the ideology of the cancer cell.”

– Edward Abbey

No one should ever die of skin cancer. You can see it and touch it. It is not lurking deep in the dark moist recesses of your body waiting to declare itself as your silent angel of death. The exception, of course, is melanoma and melanoma is increasing at a rate faster than any other cancer. In the last 60 years melanoma has increased 10 fold in countries such as Australia, South Africa and New Zealand. The USA is not exempt from this statistic, nor is Canada. One in 100 Canadians will get a melanoma.

I grew up in the generation of the burn. Sunscreen was unknown, and we knew that a good burn led to a tan anyway. As a kid in Australia, my sisters would compete to see who could peel the blistered skin from my back in one complete layer. At the beach, my mother told me to stay in the water so I would not get a burn. As teenagers in Vancouver B.C., we drove to Mt Baker in Washington State to dig a snow pit, slather on baby oil and spend the day seeing how much we could cook our bodies. In spring, it was the best way to start your tan early. You can see where this is going. The next generation has more information, but they are just as foolish. The risk of melanoma increases 75% when sun beds are used before 30 years of age and the number of young people I see coming into my medical office with a permanent tan has increased dramatically. My office staff (who help me cut out skin cancer all day) are tanned all year round because they look better. In society, the denial and disconnect between cause and effect is astounding.

I live in Canada, not exactly the tropics. Despite this, I diagnose a large number of melanomas every year. Many are in the over 50-age group, but not all. The youngest patient I have seen in my career was 15 years old. I have looked after patients who have died of melanoma. I have friends who have died of melanoma, in some cases as late as 20 years after the original diagnosis. Bob Marley and Burgess Meredith (The Penguin from Batman) succumbed to melanoma. Celebrities such as Anderson Cooper, Cybil Shepherd, Ewan McGregor and even John McCain have survived melanoma.

So what gives? Melanoma comes from intense UV exposure. UV radiation is a carcinogen. All of the UV radiation from childhood is saved in your UV bank account and accrues interest. Each year, in daily life, you make additional deposits. Driving your car (professional truck drivers have more skin cancer on their left face), shopping, sitting in the back yard, going on holiday to lower latitudes or higher altitudes, adds to the principle deposit. Depending on how diligently you invest over a lifetime the carcinogenic effect accumulates and starts to manifest as skin cancer, usually in the 40’s to 60’s. Add to the UV exposure the physical characteristics of being white skinned, red or blonde haired, blue eyed, freckled, having had a previous skin cancer or a large number of moles, a family history of melanoma or a higher income and you are set to visit melanoma land.

Melanoma is a social issue. Before 1920 purposeful tanning did not occur. The working classes were tanned because they had to labor. For them there was no status involved, only poverty and hard work. Now, older people tan because they have the disposable income to afford leisure in warm places. Tanning signals to others that one has free time and is less bound to the daily grind of employment. Youth tans because current fashion shows more skin, and tanned skin is synonymous with sex.  Women tan because unsightly cellulite, veins and imperfections are said to appear less obvious. Men tan because they feel they look more “cut” or muscular. Tanning is a social signal, plain and simple, and because it is I predict melanoma incidence will continue to rise.

” What is not brought to us as consciousness comes to us as fate

-Karl Jung

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