SKIN CANCER HITS MANY, BUT IT CAN BE CURABLE

Sally Loring, 70, a retired volunteer for the historical society in Manchester-by-the-Sea, Mass., is one lucky lady.

Seven years ago, while on vacation in Australia and New Zealand, Loring knocked the head off a mole that she'd had for decades but that hadn't been checked by a doctor for four years. The headless mole wouldn't heal.

When she got home, she saw a doctor, who gave her the grim news on Good Friday: Stage 4 melanoma, "as bad as it can get..." That night, she says, "I was in a choral group singing the Mozart Requiem. I couldn't even croak it."

She had surgery and other treatments, but the melanoma spread to her breast. Finally, in 1992, she tried interleukin-2, a then-experimental treatment, which helps significantly in about 20 percent of patients with advanced melanoma. Loring was one of them, and now has "almost forgotten it happened to me."

Skin cancer—which includes melanoma and the far less aggressive basal and squamous cell carcinomas—is one of the most common and curable of all cancers—but only if it's caught early.

Even melanoma, which will account for 7,300 of the 9,200 skin cancer deaths among Americans this year, is highly curable—more than 90 percent survival after five years—if detected while the tumor is still thin and localized.

The message is obvious: Have your skin checked regularly by a health care professional, preferably a dermatologist. It's especially important if you have fair skin, lots of moles or a family history of skin cancer. If you call 1-800-227-2345 this week, you can get a free skin check, thanks to a combined effort of the American Cancer Society and the American Academy of Dermatology.

You can keep a watchful eye on your own skin, too. Basal and squamous cell cancers, which together will strike 1 million Americans this year, usually start out looking like pale, waxlike, pearly nodules or red, scaly, sharply outlined patches.

Melanomas often start out as small, mole-like growths that grow in size and may change color. They can be hard to see yourself because they often appear on the back—and sometimes pop up even on areas of the body never touched by sunlight.

In fact, dangerous moles, or atypical nevi, can fool all but the most trained eyes, says Dr. Richard J. Sharpe,a dermatologist with a practice in eastern Massachusetts.

Last fall, Dottie Lucas, a woman in her mid-50s, asked her nurse practitioner to look at a "pimple-like thing" on her calf. The nurse thought it was nothing.

Last month, when Lucas went to see Sharpe for something else, he offered a skin check. The "pimple-like thing" was melanoma.

If you do get diagnosed with skin cancer, don't panic.

If it's basal cell, remember that "basal cells are not lethal," says Dr. Arthur Sober, associate chief of dermatology at Massachusetts General Hospital. Over the last 70 years, a mere 400 people have died from basal cell cancer worldwide. Even so, it pays to get basal cell cancers treated quickly—usually with surgery — because they can destroy tissues such as eyelids, parts of the nose and ears, he says.

Squamous cell cancers are less common than basal cell cancers, but more lethal, causing 1,500 deaths a year in the US. Like basal cell cancers, they are usually treated with surgery. For both basal and squamous cell cancers, cure is "highly likely if detected and treated early," says the cancer society.

But the biggest payoff from regular skin checks is catching melanoma when it, too, is early and curable. Its incidence has been rising sharply, by about 4 percent a year since 1973.

If a melanoma is thin (less than 1/16th of an inch deep) and hasn't spread, it's Stage I and the chances of surviving at least five years are more than 90 percent. If it's Stage II (thicker but still localized), five year survival is 65 percent.

If the melanoma has spread to nearby lymph nodes (Stage III), the survival rate is 25 to 50 percent at five years, though treatment involves not just surgery to remove the tumor but often high doses of a drug called alpha interferon. In 1996, a major study showed that interferon clearly boosts survival for Stage III patients, says Dr. Robert Soiffer, a medical oncologist at Boston's Dana-Farber Cancer Institute.

Even if you, like Sally Loring, are diagnosed with Stage IV melanoma, there are new options. Typically, these melanomas have caused lumps in the skin and have spread to distant lymph nodes or organs like the brain, bone, lungs or liver.

In January, interleukin-2, the treatment Loring had, was approved for Stage IVmelanoma. Unlike chemotherapy, which directly poisons cancer cells, this drug seems to activate the immune system, making the body better able to recognize and fight tumor cells, says Dr. Michael Atkins, director of melanoma program at BethIsrael Deaconess Medical Center in Boston.

Chemotherapy—a drug called DTIC—also helps 20 percent of patients with advanced melanoma. Some patients may be helped by a combination of chemotherapy, interleukin-2 and interferon, which probably acts chiefly by boosting the immune system.

But most exciting, researchers say, are the new, experimental melanoma vaccines. Unlike regular vaccines that prevent disease, these vaccines, under intense study for the last five years, are designed to boost immunity in people who are already sick.

Several of these vaccines use small bits of protein from melanoma cells—sometimes from the patient himself, sometimes from other patients—to boost immune response. Another vaccine, under study at MGH and Dana-Farber, contains a gene for a natural immune-booster called GM-CSF as well. Still other vaccines in combination with interferon and interleukin-2 are being tested at the National Cancer Institute and Beth Israel.

So far, says Soiffer, a number of these vaccines have been shown to boost immune function considerably. But it remains to be seen whether this truly shrinks tumors or prolongs survival.

What is clear is that prevention is the key for skin cancer. Between 85 and 95 percent of basal and squamous cell cancers are linked to sun exposure, says Dr. Howard Koh, the Massachusetts public health commissioner, who is also a dermatologist and a medical oncologist.

That means you should limit sun exposure and use sunscreens with SPF, or sun protection factor, of 15 or higher. Sunscreens with an SPF of 15 block 92.5 percent of ultraviolet B light (the wavelength that causes sunburns); an SPF of 30 increases this slightly, to 96.3 percent. Scientists now think ultraviolet A light may also trigger cancer, and some sunscreens now protect against UV-A as well.

Sunlight may be less tightly linked to melanoma, though it is still thought to cause about 70 percent of cases.Scientists disagree on how well sunscreens protect against melanoma.

Fair-skinned people who burn easily are two to three times more likely than darker people to get melanoma. People with many moles are at 6-to-10 times higher risk.

And since stronger sunscreens—with an SPF of 15 or higher — have only been available since the mid-1980s and melanoma can take years to develop, the protective value of sunscreens may simply have not shown up yet in epidemiological studies.

So dermatologists recommend "safe sun," that is, wearing protective clothing, minimizing sun exposure between 10 a.m .and 3 p.m., using sunscreens and avoiding excess exposure, even with sunscreens. And this may be especially true for kids. Although studies are mixed, some research suggests that bad childhood sunburns are linked to melanoma later in life.

The bottom line, as Koh puts it, is simple: "Melanoma is unique among cancers in that it is visible. This is a cancer where literally everybody can participate in early detection."

FOR A FREE SCREENING

To learn where you can get a free skin cancer screening, call 1-800-227-2345, through May 8. If you are told that a screening is not available in your state, call your state dermatological society or 1-847-330-0101 X394. The free screenings are a joint effort by the American Cancer Society and the American Academy of Dermatology.

(Judy Foreman's e-mail address, via Internet, is: foreman@globe.com. Please keep letters to 200 words or less. Publication Date : 1998-05-05

Copyright 1998 by Simon & Schuster All rights reserved. This copyright material may not be published, broadcast or redistributed in any manner.