Being on the lookout for signs of skin cancer, the only spot Jay Silverman could see was on his upper right arm, about half the size of a dime. “I had always heard that if a spot changes shape or color, see a dermatologist,” he says. Lucky for him, he did.
The change Jay noticed led him to make an appointment with a dermatologist, who found two other pink spots in areas he couldn’t readily see, and biopsied all three. Two of the biopsy reports came back with a diagnosis of melanoma.
Jay, who grew up outside of Boston, describes himself as an “outdoors kid.” He spent summers on the beach and doesn’t remember being sunburned as a child, but he also doesn’t remember being slathered with sunscreen.
After reviewing the doctors in their insurance network and doing some research online, he and his wife, Dale, found Curtis Wray, M.D., listed among the surgical oncologists who specialize in melanoma and other skin cancers. Dr. Wray is affiliated with Memorial Hermann-Texas Medical Center and a member of the faculty at UTHealth’s McGovern Medical School.
Melanoma is the most common skin cancer – and the deadliest.
“When I first talked with Dr. Wray, the thing that surprised me most was hearing the word ‘survivability.’ I had never heard the term related to my medical care and I said, ‘Whoa! Why are we talking about survivability?’ He went through a clinical synopsis of what melanoma is and the potential consequences of non-treatment, which made it very clear to me how serious this cancer really is.”
Among skin cancers, the most common form of cancer in the United States, melanoma is the deadliest. Every hour of every day one American dies from melanoma, a toll that adds up to 10,000 deaths annually.
Jay was 63 when he was diagnosed, but melanoma can strike at any age and is the leading cause of cancer death in young women ages 25 to 30 and the second leading cause of cancer death in women ages 30 to 35, according to the Melanoma Research Foundation. The lifetime risk of getting melanoma is about 1 in 40 for Caucasians, 1 in 20 for Hispanics and 1 in 1,000 for African-Americans. About 90 percent of melanomas are thought to be caused by exposure to UV light and sunlight. One bad sunburn at a young age can more than double a person’s chance of developing melanoma later in life.
Melanomas like Jay’s can spread to other parts of the body.
“Melanoma is unique among skin cancers in that it can spread anywhere in the body,” Dr. Wray says. “Its thickness is a very important prognostic factor and determines whether we need to do a sentinel lymph node biopsy. If the lymph node biopsy is positive, it can significantly affect survival.”
In a surgery performed under general anesthesia at Memorial Hermann-Texas Medical Center, Dr. Wray removed the spots with a wide local excision. He sent Jay for a sentinel lymph node biopsy, the removal of one or two lymph nodes from each arm. The pathology report came back negative. Because of the small number of lymph nodes removed, he was not at risk for lymphedema, which can cause swelling and pain, usually in the arms, and require rehabilitative treatment.
“Everything about the process was impressive,” Jay says. “My professional career has led me to become an operations expert. My role has always been to make a process better, but I couldn’t find any way to improve on my experience. I was really very pleased. I tend to complain a lot when things go wrong, but I also give compliments when things are done well and efficiently.”
“Mr. Silverman did all the right things,” Dr. Wray says. “He saw a dermatologist and had the spots biopsied. The melanoma was clinically localized, and the negative sentinel node report indicated very early stage disease with an excellent prognosis. The takeaways are that if you have a mole that’s growing, changing colors or itching or bleeding, you need to see a dermatologist.”
The rule of thumb for melanoma is ABCDE: Asymmetry (the shape of one half doesn’t match the other), Border (the edges are ragged, blurred or irregular); Color (the color is uneven and may include shades of black, brown and tan); Diameter (a change in size, usually an increase); Evolving (the mole has changed over the past few weeks or months).
Melanomas are not always brown or black. They can be pink and almost invisible as they were in Jay’s case.
Two months later, his dermatologist found another spot and biopsied it along with two more. Only one came back positive, and he went back to Dr. Wray to have it removed. “The surgery went well and was not as big an excision as the first one, so we’re done with them,” Silverman says. “Because these spots were located in the same lymphatic zones, another lymph node biopsy wasn’t necessary, so it was much simpler.”
Dr. Wray’s prescription for life for his patient is simple: regular checkups with a dermatologist, sunscreen, hat and long-sleeved shirts. “I tell patients like Jay to be very careful. The risk of developing another melanoma is about 500 percent greater if you’ve been previously diagnosed.”
Memorial Hermann Cancer Center at the Texas Medical Center is offering free skin cancer screenings on May 13 as part of National Skin Cancer Detection and Prevention Month. Screenings do not require an appointment and are available on a first-come, first-served basis.