Skin cancer: Danger under the sun
By Mehru Jaffer
JAKARTA (JP): On retirement Ridwan, 63, looked forward to being at home and enjoying time with his family.
All his working life he was a busy telecommunications engineer, but now he was happy helping his wife make cookies, which they sold in the markets of Padang, West Sumatra. He spent the rest of the day playing with his grandchild.
That is until he was told he suffered from melanoma, the most deadly type of skin cancer.
Ridwan's problem started as a swelling in the groin, accompanied by a dull ache. A medical examination last August showed that a nodule was infected with melanoma. He was immediately sent for treatment to Dharmais Cancer Hospital in West Jakarta.
"I was devastated when I first heard the news," Ridwan told The Jakarta Post from his bed at the hospital. But today he is feeling better as he has responded well to chemotherapy and is looking forward to returning home after a month of treatment.
Skin cancer is increasingly recognized as a potential health hazard, and melanoma is the number three cancer killer in the country. The key to its treatment is catching it early, and particularly being alert if a mole on any part of the body changes shape or color or begins to bleed.
"In most cases if the disease is treated early enough it can be cured," says Dr. Aida SD Suriadiredja.
She said basal cell carcinoma was the most common of all cancers in humans.
Among Aida's other patients is a 35-year-old man with a rarer form of skin cancer, merkel cell carcinoma, who is afraid of chemotherapy and is being treated instead with radiotheraphy. Unfortunately, he is not responding well to the treatment.
Most patients are men, and the last woman treated by Aida was a 27 year old with squamous cell carcinomas that were successfully treated. There is a social basis for the difference in incidence among the sexes. As light complexions are sought- after in Asian societies, particularly among women, people tend to avoid direct sunlight. And ultraviolet radiation, apart from its role in premature aging, also causes at least 90 percent of all skin cancers.
Like other Asians, Indonesians forced by circumstance to work in the sun, such as construction workers and farmers, have long known the importance of keeping their bodies covered. Even those working in the early morning hours keep their heads swathed in cloth.
According to dermatologist Dr. Lily Soepardiman from the School of Medicine at the University of Indonesia, anyone can get skin cancer regardless of gender, race or age. However those with fair skin and a northern European heritage, especially blonds or those with red or light brown hair and blue, green or gray eyes, are most susceptible as they tend to burn easily.
Pigmentation
Dark-skinned people have the advantage of pigmentation that acts as a natural sunblock, but if there is a history of skin cancer in the family the risk is higher. Lily advises that direct sunlight should be avoided at all times by using a hat, umbrella or protective clothing and sunscreen cream enriched with a high sun protecting factor (SPF).
It is the trend among Caucasian women to tan themselves in the sun, which only began in the 1930s, and with tanning beds that has increased their chances of getting skin cancer.
There is a debate among many in the medical profession whether the traditional all-covering dress in many Asian countries which is being replaced by more revealing western styles will cause a rise in the incidence of melanoma.
One serious sunburn, especially in childhood, is said to increase the risk by as much as 50 percent. Nearly a million new cases of skin cancer are reported annually, mostly in western countries. Of that number about 42,000 Americans develop melanoma, with more than 7,500 patients dying of the disease every year (it is the leading cancer killer in women between the ages of 25 and 30 in the United States). Melanoma spreads quickly to other parts of the body through the lymph system or through the blood. Although it usually strikes adults, it may occasionally be found in children and adolescents.
Melanoma generally begins with a change in the shape, color or some other feature of a pigmented area of the skin. Because men and women with melanoma may be relatively young at onset (less than 48 years old), it has become one of the leading causes of lost productivity in the U.S.
Aida said the incidence of skin cancer in the country has not increased in recent years, and the maximum number of patients she treats has remained constant at about two to three every month.
She added that overexposure to ultraviolet light was not the lone cause of skin cancer; chemical agents and viral causes are also responsible. However, it is difficult to tell what actually causes the disease in different individuals.
What is most important to remember, Lily said, is to get to a doctor as soon as any change on the skin is noticed.