When you are going to get your hair cut, the salon conversation is expected to revolve around light and common topics such as football games, celebrity gossip, or current news.
In 2018, however, I almost jumped out of my chair when my hairdresser told me, “It could be cancer.”
As he was touching and cutting my hair, he noticed a suspicious stain (similar to the image that opens this article) under some threads, near his right ear. In his assessment, this was a typical sign of melanoma, a tumor that usually affects the skin and is usually aggressive.
Since a well-trained health journalist used to read and write a lot about the subject, I decided to schedule a dermatological consultation that week. In fact, the warning made sense: the place in my head could have been a tumor. There was also evidence that he was removed from surgery and sent for biopsy.
- Woman with terminal cancer in Caesarean section
I underwent the entire procedure, under anesthesia and hospitalization, and thankfully the results of the lab tests revealed that it was a benign alteration that had nothing to do with anything more serious. However, the doctors suggested that I follow up every year to measure the size of other spots and moles I have all over my body; if they grow, you may need to remove them as well.
Almost four years after this episode, I still think about the irony of skin cancer. After all, we are talking about one a disease marked by an apparent injury, which is seen with the naked eye. However, it is not uncommon to detect it only in the advanced stage, after years of development. To top it all off, a small portion of patients grow in areas where we simply don’t see the tumor.
It could be my case, with the appearance of a stain on the skin. Or someone who lives alone and can’t see the sexual area or the back, buttocks and back of the thigh in detail.
Late diagnosis of melanoma is worrisome. When this happens, there is a high risk of metastasis, spreading the disease to other parts of the body and at a stage where treatment options are scarce.
But when to worry about this type of tumor? And what are the strategies that doctors, patients themselves, and other professionals who are not related to health care can put into practice to detect the disease as soon as possible?
Less, more serious
Skin cancer is very common. It accounts for about 30% of all tumors diagnosed.
In general, there are three subtypes of the disease that affect the outer layer of our body: forest cell carcinoma, stem cell carcinoma, and melanoma.
The first two are the most common and account for about 97% of cases of the disease. The good news is that they are usually much easier and easier to treat. In this context, one can talk about healing most of the time.
The remaining 3% is melanoma. And here the situation is a little more serious: it is an aggressive tumor that, if not detected in the early stages, can be complicated and spread throughout the body.
“Melanoma originates in melanocytes, a type of cell that produces a pigment that determines skin color,” said Dr. Renato Marchiori Bakos, coordinator of the Department of Skin Oncology at the Brazilian Dermatological Society.
The National Cancer Institute (Inca) estimates that 8,450 Brazilians are diagnosed with melanoma each year, 1,923 of whom die from the disease.
These are the main risk factors for developing this disease Frequent sun exposure without any protection, the use of artificial tanning beds, light skin or eyes, and family history. (when a close relative has been diagnosed with the same problem in the past).
So close and so far without sight
Oncologist João Duprat, head of the Skin Tumor Reference Center at the ACCamar Cancer Center in São Paulo, also ironically sees the obstacles to early diagnosis of melanoma.
“On the one hand, it’s skin cancer that can be seen with the naked eye, without the need for a complex diagnostic imaging test,” he says.
“On the other hand, people can’t see well or it often takes years to think that this superficial sign can be a tumor,” he added.
In general, experts understand that there is a lack of information on the signs that suggest melanoma and when to seek professional evaluation.
They created it for that “The ABCDE Standard “summarizes the five main features of a possible skin tumor:
- asymmetry: shapeless spots or stains where one side is different from the other;
- edge b: their edges are irregular and blurred;
- Color C: there is more than one shade, which can vary between white, black, gray and brown;
- Diameter D: Moles and stains over 5 millimeters;
- and evolution: Changes in size, color, shape, or appearance over time.
Deformed stains and stains, which are more than one color and grow over time, trigger a warning signal – Photo: Getty Images via BBC
“If you have one or more of these characteristics, it’s important to look for a dermatologist,” Duprat leads.
“In addition, skin blemishes or wounds that do not have these characteristics, but do not heal after a month, should be carefully examined,” he added.
In the office itself, the doctor uses simple equipment (such as a dermatoscope) to check what is happening and to indicate what is the most appropriate behavior.
An injury that is hard to see
Bakos explains that melanoma most often appears on the face, torso, and limbs.
“Most of them are related to constant sunburn,” said the dermatologist, who is also a professor at the Federal University of Rio Grande do Sul.
Over time, radiation from the sun — ultraviolet A (UVA) or B (UVB) rays — can damage the genetic material of skin cells. Corrupt DNA creates cancer cells that begin to replicate wildly and cause serious damage to health.
In a smaller proportion of patients with melanoma, it is even more complicated to make an early diagnosis: the lesions develop in places that are difficult to see on their own, on the skin itself, which we mentioned at the beginning of the report. genital region or back. Melanoma can also appear under the nail..
This includes other professionals who are not necessarily related to health, but who are very helpful in early detection.
“Hairdressers, barbers, podiatrists and manicurists help a lot in this. They can be guided to detect injuries and alert customers,” says Duprat.
In older people with gray hair, melanoma can also attract attention in the head after a sudden birth of dark hair bands.
Because this is happening diseased melanocytes at the root of these chains end up making more pigment than usualwhich also changes the color of that particular section of hair.
“Tattoo artists also help a lot because we have cases of those who do embarrassing stains or make tattoos to hide stains,” the doctor added.
The Brazilian Melanoma Group also has a project that includes classes and lectures to detect suspected cases in vocational schools, or events that bring together staff from those areas that work directly on the skin.
Barkos added that other medical specialties play a role in this context. “During regular consultations, a gynecologist or urologist may notice a stain in the intimate area, which often goes unnoticed or is covered in hair.”
Duprat already remembers it Another difficulty in the early diagnosis of melanoma is that cases of the disease appear in blacks or Asians who are not in the classic risk group. of this type of tumor.
“Because this cancer is less common in these groups, many do not think about the possibility of black or Asian patients having melanoma,” he laments.
“In them, it is more common for the lesion to appear on the feet or palms of the hands,” he described.
Therefore, the recommendation remains the same, regardless of individual characteristics: Stains or wounds that have any of these characteristics of ABCDE should be assessed by a health care professional for stains, stains or wounds that do not heal after 30 days.
If the biopsy confirms that the mole or spot is actually a tumor, the doctor may prescribe several therapeutic approaches.
In the initial cases, when the injury is not yet very deep, the most common is surgery. In most of these cases, simply remove the affected part of the skin with a scalpel.
Early detection of this tumor is important for this reason: in the early stages of the disease, surgical removal usually resolves the problem once and for all without the need for additional treatments.
“Now, if the lesion is already a little wider, we need to evaluate the lymph nodes to see if the metastasis has already occurred,” Duprat says.
As explained above, metastasis is the process by which cancer spreads to other parts of the body.
But even in these more advanced cases, the treatment of melanoma has undergone a real revolution in the last decade with the advent of immunotherapies. It is a new class of drugs that stimulate the patient’s immune system to attack and eliminate cancer cells.
“In the past, you either had an early diagnosis of melanoma or the house was broken into and there wasn’t much else to do. Chemotherapy was not very effective in treating that cancer metastasis,” Duprat recalled.
“Nowadays, with immunotherapy, the patient’s life expectancy can be extended with few side effects. The only obstacle to this treatment is the price, which remains very high,” the oncologist compares.
While the resources for this type of cancer have evolved significantly in recent years, the recommendations for the prevention of the disease remain the same.
“Sunburn is one of the main factors that can lead to skin cancer in the future. That’s why when you’re away, it’s a good idea to wear a shirt, sunglasses and a hat to cover the most sensitive areas,” Bakos said.
“On unprotected skin, it is important to apply sunscreen and re-apply it from time to time,” concludes the dermatologist.
For people with clean skin, a lot of moles, or a history of family melanoma, regular consultations with a dermatologist are also recommended.
It’s a great idea to ask your hairdresser, barber, podiatrist, tattoo artist, or any other beauty professional to warn you of stains and stains on “hidden” areas – by the way, because I’ve learned it myself and felt it on my skin. not long ago.