Young, and Learning Too Late That Sun Safety Matters
The pain Sara Langill felt in her right hip didn't concern her much, until she felt a lump as she massaged tendons near her hip flexors following a soccer game.
"I felt this thing that felt like a rubbery grape," recalls Langill, 33. Thinking it might be a hernia, she went to the doctor.
Within days, Langill was diagnosed with stage 3 melanoma -- an advanced stage of the most serious form of skin cancer.
A "typical Southern California" kid born and raised in San Diego, Langill spent hours and hours soaking up sunshine engaged in outdoor pursuits.
"I've had more sunburns than I can count. I used to come into work on Monday, and if I wasn't sunburned, I didn't have a great weekend," Langill recalls.
May is Skin Cancer Awareness Month, and Langill is now speaking out as part of a campaign to get people to protect themselves from the sun and have their skin checked regularly.
Her melanoma diagnosis came in September 2016. A biopsy found cancer in the lymph nodes near her hip, and doctors eventually tracked the cancer to a "really small mole on the outside of my right calf," Langill said.
She soon underwent surgery to remove the cancerous lymph nodes as well as the original tumor on her calf. Langill now bears a 6-inch scar down the front of her hip bone, from where they took out the lymph nodes.
"They also took about a golf ball out of the side of my calf that looks like I have a shark bite now," Langill said.
It's not unusual for someone to have advanced melanoma without any clue of their cancer, said Dr. Melanie Palm, a dermatologist in San Diego.
"I recently had a three-month period where I had 10 new melanomas, which I think as a solo practitioner is extraordinary," Palm said. "Eight out of these 10 I found, the patient was unaware of them."
Nearly 20 Americans die from melanoma every day, according to the American Academy of Dermatology.
Langill wound up in a clinical trial for Keytruda (pembrolizumab), a new immunology drug that turns the body's immune system against cancer cells.
"What they know about melanoma, once it's migrated in the body it's very aggressive even in microscopic quantities," Langill said. "Chemo is not super-effective on melanoma, so they suggested a clinical trial at the University of California, San Diego Medical Center."
Langill is now cancer-free, but she dreads every follow-up exam.
Palm said people should check their own skin at least once a month, looking for what she calls the "ABCDEs" of melanoma:
- Asymmetry. One half of a spot is unlike the other half.
- Border. The spot has an irregular, scalloped or poorly defined border.
- Color. The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red or blue.
- Diameter. Melanomas are usually greater than 6 millimeters, about the size of a pencil eraser, when diagnosed. However, they can be smaller.
- Evolving. The spot looks different from the rest or is changing in size, shape or color.
Palm considers "E" the most important. "That means anything new or changing," she said. "If a spot is new, if it's itchy, if it's sensitive, if it bleeds or crusts."
People who find one of these warning signs should see a doctor or dermatologist, as should anyone who regularly spends time outdoors, Palm said.
"Weekend warriors or people doing outside activities: really make sure you're going to a board-certified dermatologist and getting your skin checked once a year," Palm said.
Elizabeth Ellestad, 36, has a history of skin cancer in her family and has kept that in mind, slathering on sunscreen and even carrying a parasol while watching her son play soccer.
"Having that history of skin cancer definitely puts me in the high-risk category," said Ellestad, who lives in Chapel Hill, N.C.
But her very fine blond Norwegian hair left her with a part exposed to the sun, she said.
Her hairdresser noticed a little spot on her part. Ellestad had it biopsied on Valentine's Day this year, and the spot turned out to be basal cell skin cancer.
"They declared me cancer-free the day of the surgery, and sent me home with about 12 stitches in my head," Ellestad recalls.
"I've had my share of sunburns through the years, definitely way too much sun exposure," Ellestad said.
Just one sunburn during your lifetime doubles your risk for melanoma, Palm said.
Tanning beds are even worse. "The artificial UV beds are very dangerous. Just one exposure to that doubles your risk for melanoma," Palm said.
To protect your skin, you should seek shade or avoid going outdoors during peak sun times, usually between 10 a.m. and 2 p.m., Palm said.
The American Academy of Dermatology also recommends wearing long-sleeved shirts, pants, a wide-brimmed hat and sunglasses to shield you from harmful rays.
Also advised: a broad-spectrum water-resistant sunscreen with an SPF of 30 or higher. Be sure to reapply every two hours, or after swimming or sweating.
The American Academy of Dermatology has more about skin cancer.
SOURCES: Sara Langill, San Diego, Calif.; Melanie Palm, M.D., M.B.A., dermatologist, San Diego, Calif.; Elizabeth Ellestad, Chapel Hill, N.C.