A Win for Your Skin
Melanoma is the most serious type of skin cancer, but it can often be prevented. Here, a surgical oncologist at Saint Barnabas Medical Center explains its risk factors and the multidisciplinary approach used for patients.
Skin cancer is the most common cancer in the United States and the seventh-most common in New Jersey, according to new statistics from the NJ Department of Health. This is why it’s so important to have regular checkups with your general practitioner and/or dermatologist, who can monitor potential lesions on your skin. “Now that dermatology offices are opening up following the pandemic, we encourage people to get their skin cancer screenings,” says Franz O. Smith, M.D., FACS, section chief of surgical oncology and director of the surgical residency program at Saint Barnabas Medical Center (SBMC). Here, Dr. Smith explains the risk factors for melanoma (the most serious type of skin cancer), how to identify an abnormal growth, treatment plans and more.
Q: What are some of the biggest risk factors for melanoma?
A: Some of the major risk factors are ultraviolet (UV) light exposure—people who have had severe sunburns in the past, especially blistering sunburns. The use of tanning beds is associated with melanoma too. About 10 percent of melanomas run in families. We also have some syndromes that are associated with melanoma, and the patient’s doctor would be able to take a history from the patient and identify if they need further testing and have features associated with those syndromes. People with blonde hair and blue eyes and those with red hair and freckles are also at an increased risk. Lastly, if you have a prior melanoma, you’re at risk of developing a new one in the future.
Q: As we head into the cooler weather, how do you recommend patients protect themselves from melanoma?
A: The winter sun can be just as damaging as the summer sun. Avoid the sun during its peak hours between 10 a.m. and 2 p.m. and use a minimum of SPF 30 sunscreen and reapply every two hours. We also encourage people to wear sunglasses and a broad-rimmed hat. Those who are outdoors a lot for recreational activities or for work, such as landscapers and construction workers, should invest in UV-protective clothing.
Q: Is melanoma more common in older adults?
A: There is a greater risk of melanoma in the older population; the majority of people who are diagnosed tend to be in their 60s. But we’ve seen that it’s a number one increasing cancer in young women between ages 20 and 29 [because of tanning].
Q: How can someone identify an abnormal growth?
A: Regardless of age, generally what you’re looking for is an unusually appearing mole, what we refer to as ABCDE. ASYMMETRY, if one half of the mole doesn’t look the other half; if the BORDERS around the melanoma are irregular, notched or crooked; COLOR variation in the mole; DIAMETER, which is if the mole is greater than 6 millimeters in size; and EVOLVING. If the mole is changing, growing rapidly in size or appearance, then bring it to your doctor’s attention.
Q: When do you recommend a patient come to see you and your practice?
A: What we recommend is that a patient see their dermatologist and have a full-body exam where the dermatologist can inspect the body from head to toe. If the dermatologist is concerned about a lesion, he or she may biopsy one of the lesions. If there is a mole that is cancerous or precancerous, then they’ll refer their patient to me, the surgical oncologist.
Q: What is the process when you start seeing a new patient?
A: At the [initial] consultation, we review the pathology from the biopsy, discuss risk factors, their family history and any other things that may influence how we treat the patient, like if they have a history of heart disease, diabetes or hypertension. Then we examine the patient to help us to determine the size of the lesion, confirm its location and pay attention to lymph nodes because melanoma can spread to lymph nodes. Then we discuss how best to remove the mole surgically and if the patient will need evaluation of their lymph nodes.
Q: What do the surgeries to treat melanoma typically entail?
A: Most melanoma surgeries are outpatient, so the patient would come in, have the surgery and go home the same day. Most patients will need some kind of anesthesia, whether it’s sedation or general, but that’s determined on a case-by-case basis.
Q: Do you offer immunotherapy as a treatment option?
A: The primary treatment for a localized melanoma is surgery: Surgery is the gold standard for patients with early stage melanoma. We consider immunotherapy for people who have melanoma that has spread to lymph nodes, people who have stage 4 disease.
Immunotherapy is for patients who are high risk of the disease coming back or for whom it’s already spread.
Q: How do you work with other physicians at SBMC to treat patients with melanoma?
A: We work very closely with the patient’s dermatologist and primary care doctor. Patients are referred to us or they’re self-referred, and we evaluate them and review their pathology to confirm the findings [from their doctor], and then we discuss the treatment options with the patient. For patients with more complex problems, we have a tumor board discussion with medical oncologists, radiation oncologists, pathologists and social workers to come up with the best treatment for that particular patient. We focus on providing high-quality, individualized and multidisciplinary care.
Q: Is there anything else that’s important to know?
A: It’s important that everyone is aware of the risk factors, especially the things that they can modify to reduce the risk, such as sun exposure and the use of tanning beds. If diagnosed, it’s important that a patient see a surgeon as soon as possible so they can be evaluated comprehensively and determine whether to do surgery first or consider another form of treatment.
To schedule an appointment with Franz O. Smith, M.D., at Saint Barnabas Medical Center, call 973.322.5126.