Aug. 19, 1998 CHAPEL HILL - Like successful defensive players on a football field, physicians at the University of North Carolina at Chapel Hill are gang-tackling a tough opponent - skin cancer.
And, like aerial reconnaissance experts studying enemy ground movements, they also are using new digital photography technology to track changes in skin so that moles don't turn into a mountain of problems for patients.
"This is a UNC School of Medicine-wide initiative that involves dermatology, surgical oncology, medical oncology, pathology and other groups," said Dr. Robert A. Briggaman, chairman of dermatology. "It's people with different forms of expertise putting their heads together to identify melanoma as early as possible and manage it in the most appropriate fashion.
"We collaborate more than ever because this cancer is a very complicated disease that is probably the most rapidly increasing form of cancer humans face. Each member of our team at our new multidisciplinary melanoma clinic does what he or she does best."
Sometimes, treating melanoma is as simple as cutting away a small mole or other lesion that has become cancerous, Briggaman said. Cases not caught as early may involve tracking cancer cells from the original tumor to lymph nodes with weak radioactive tracers and a hand-held Geiger counter. Surgery, chemotherapy, immunotherapy or radiation therapy may follow.
Excessive exposure to the sun through working out outdoors or sunbathing can cause melanoma or the other two major forms of skin cancer -- basal cell and squamous cell carcinoma - which usually are not as deadly. Clearly, some melanomas have nothing to do with sunlight, however, and may have more to do with genetic inheritance or environmental exposures, he said.
Others involved in the new pigment lesion clinic - and members of the UNC Lineberger Comprehensive Cancer Center -- include Drs. Lisa May of dermatology, Benjamin F. Calvo and Michael Zenn of surgery and Mark L. Graham II of medical oncology. To learn whether tumors have spread there, Calvo biopsies sentinel nodes -- structures draining lymph from particular parts of the body. Graham treats patients with more extensive disease with interferon and other promising agents.
"With help from our School of Medicine photography department, we take a series of images with a digital camera and store those images via computer on compact discs for use when patients return for future appointments," May said. "One of the hardest things for dermatologists is to know is whether a lesion is new since the last visit or whether it has changed in some significant way.
"This technology, which is being used like this in only a few medical centers in the United States, also helps calm anxiety in patients who may have hundreds of moles or who have a family or personal history of melanoma," she said.
Technicians store 36 different pictures of each patient covering most of the body, and the resulting CD, which will last at least several decades, becomes part of patients' permanent medical record, May said. Unlike with conventional photographs, diagnosticians can zoom in on any given area to examine it more closely.
Pigmented lesions are chiefly moles, but also include freckles, sun and age spots and keratoses, she said.
"Criteria for suspecting skin cancer have been called the 'ABCD' of melanoma,'" May said. "'A' stands for asymmetry, meaning half a mole, for example, does not look like the other half. 'B' stands for a border that is notched or that has pigment extending beyond it."
"C" represents color; doctors become suspicious of variations of color and particularly dark browns, blacks, reds and whites. "D" is diameter, and any lesions larger in diameter than a pencil eraser also raise concern.
"All of those warrant having a dermatologist evaluate the lesion," she said. "The other big thing not part of the ABCD idea is change. If a mole is itching or bleeding, growing darker, raising up or just growing, we want to take a look at it."
People need to be not worried, but should be vigilant about melanoma, May said. In 1935, the lifetime risk of the illness was one in 1,500, while by 1960, it was one in 600.
"The lifetime risk is projected to be one in 75 by the year 2000, and it already is the most common cancer among women ages 25 to 29."
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