May 20, 2008 Even couples that have been together for years may be embarrassed to let a spouse or partner see their less than perfect bodies naked in bright light. That shyness can hamper a couple's willingness to do total body skin exams on each other to check for a new or recurring melanoma. Melanoma, the most deadly form of skin cancer, can appear in more than one spot so these checks are important.
"I had a woman tell me, 'I don't want my husband seeing all my cellulite and fat rolls'," said June K. Robinson, M.D., a professor of clinical dermatology at Northwestern University's Feinberg School of Medicine. "Some women have issues about their spouses seeing their bodies."
In new research, Robinson found couples with close, supportive relationships were able to leap the self-conscious hurdle and perform regular, thorough skin checks on each other. Her findings are published in the May issue of the Journal of the American Academy of Dermatology.
Couples who perform these skin self-examinations increase their chances of finding a new melanoma earlier. "When they're treated at an earlier stage in the disease, they have a much lower mortality from melanoma," Robinson said.
Melanoma causes 8,000 deaths a year in the U.S. An estimated 62,000 new cases of melanoma are diagnosed each year.
The study participants included 130 melanoma survivors who had learned how to do skin self-exams either alone or with their partners. Couples with close bonds were about three times more likely to perform the skin exams than those who didn't have strong bonds. Patients who reported the quality of their relationships with their partners as below average were the least likely to perform routine skin self-exams.
Robinson's findings build on a previous study last year in which she reported melanoma survivors who learned skin self-exams with their partners were more likely to consistently perform the exams. The new study explains why certain couples were more successful than others at this.
In a total body exam, a person is asked to lie on a bed while a partner checks areas commonly covered by a bathing suit. "Melanoma can appear places where the sun never shined," Robinson said. "There's a fear of lying there naked and vulnerable when someone you care about is seeing you in not the most flattering light."
"A couple that is in sync with each other is going to take this new experience and support and reassure each other and get over the modesty issues," Robinson said. "A couple that isn't in sync won't have the ability to support each other as they take on this novel assignment. They are going to find it stressful and are going to start to fight. I've seen it in happen in front of me."
She encourages people to open up and communicate about the exam in a moment when it's not threatening. "Talk to each other over a glass of wine and explain your concerns to your partner," Robinson said. It also helps when each spouse or partner does it for the other, so both are having the same experience.
The exam can have an unexpected benefit. "This may rev up the marriage," Robinson said. "You are spending more time in intimate contact with each other, touching each other, looking at each other and reassuring each other."
Robinson suggests dermatologists consider discussing the quality of melanoma patients' relationship with a spouse or partner to see if the partner is able to offer adequate help with the skin self-exams. If not, the doctor could suggest the patient recruit a family member or a friend for assistance. If that isn't possible, a person would need more frequent checks by a dermatologist.
As the U.S. population of adults 65 and older grows by an estimated 20 percent in the next decade, the mortality from melanoma also is expected to rise because the incidence of the cancer increases with age.
Men who are 70 and older have the highest mortality from melanoma. They are less likely to do self-exams and their melanoma metastasizes faster than in females. The spots men tend to develop melanoma -- like the scalp -- are also harder to see and have a better blood supply than places women get it (their legs.) So, it's easier for melanoma to gain access to the blood stream and lymphatic system in men.
"Deaths from melanoma could be lowered by as much as 60 per cent if the general public performed monthly skin self-examinations," Robinson said.
Each mole should be checked monthly for the warning signs of melanoma. The signs include: A for asymmetry of shape, B for border irregularity, C for color variation, D for diameter of 6 millimeters or more and E for evolution or change of one or more features. (These are known as the ABCDE rules of early detection.) A mole with three of these signs or a mole with change in one or more of these needs to be checked by your doctor.
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