Those who are overwhelmed by tanning and claim that people used to spend even more time in the sun but did not get skin cancer do not understand that with the depletion of the ozone layer, the sun’s ultraviolet radiation has become more intense. The number of melanoma patients continues to grow every year, but by educating the public and promoting early diagnosis, we could change these harsh statistics, dermatologist Raimonds Karl is convinced.
How common is melanoma in Latvia?
The number of melanoma patients has increased significantly in recent decades. For example, in 1985, when the collection of statistics was started in Latvia, melanoma was detected in 85 patients, but in 2017 it was diagnosed in 230 patients. In addition, the fact that the population of Latvia has decreased by at least half a million should be taken into account, therefore, comparing the number of melanoma cases compared to the population, the percentage increase in the number of cases is even higher.
Do you think people are getting sick more, or have diagnostic options improved and melanoma just being detected more often?
The increase in morbidity is observed not only in Latvia, but also in other countries, where the population with light skin color dominates. There are several reasons for this. First, there have been global changes in nature. With a 10% decrease in the ozone layer, the amount of UVB rays reaching the earth’s surface increases by 20% and as a result the number of melanoma cases increases by 40%. Secondly, melanoma is currently being diagnosed in the generation that actively used the first tanning beds 20-30 years ago. Third, people have begun to travel more, including to the mountains and southern countries, where solar activity is higher. But, of course, the diagnosis has also improved, so melanoma is detected more often.
What methods are used to diagnose melanoma?
It all starts with a conversation. When a person comes to the dermatologist, the doctor listens to the patient and asks how he has gone through his life – whether there have been sunburns, how much he is currently in the sun, whether he uses sunscreen, etc.
The patient is then examined. As the skin is an organ of direct examination, much can also be seen with the naked eye. The next step is dermatoscopy. A dermatoscope is a device that allows you to see skin formations under magnification.
If, during dermatoscopy, a doctor finds a formulation suspicious, it is selected for further diagnosis, and the doctor sends the patient for a biopsy or sample of the formulation. Tissue samples are submitted for laboratory examination, where specialists determine whether they are malignant or benign.
What is the difference between optical and digital dermatoscopy?
The primary diagnostic method is optical dermatoscopy. Digital dermatoscopy allows you to save data on skin formations and compare the next time a patient comes to the doctor to see if they have changed. However, digital dermatoscopy is not a better diagnosis of melanoma and should be performed in all patients. It is rather a useful method if you need to observe birthmarks or other formations over a long period of time. Digital dermatoscopy can be successfully used for so-called birthmark mapping.
Are diagnostic options in the regions of Latvia as accessible as in Riga?
Quality diagnostics is available throughout Latvia. Dermatoscopy equipment may differ slightly from each other, but the differences are not so large as to have a significant effect on diagnosis. Probably, in those dermatologist practices that are visited by more patients on a daily basis, the professionalism and experience of doctors is slightly higher, but I cannot say that there are worse doctors in the regions than in Riga.
The biggest problem in Latvia is that people do little preventive testing. Unfortunately, in many cases, the patient does not see a doctor until the melanoma has progressed significantly and the skin has begun to bleed, wet or visibly change.
In what cases and how often should people visit a dermatologist?
We may want patients to see a dermatologist, like a dentist or gynecologist, once a year, but even if a person comes to the dermatologist at least once, it will be a lot, because experience shows that many people have never checked their birthmarks in their lifetime. .
When coming for a preventive visit, the dermatologist will examine and interview the patient and tell them how often they should see in the future. Not all people need regular visits. However, those with multiple birthmarks, those with a family history of melanoma or other risk factors may also need to see a doctor several times a year. Regular visits to a dermatologist can help detect melanoma while it is still very thin and relatively easy to treat.
You should definitely see a doctor if you notice a new formation that is slightly different from the others, or if any of the existing formations have changed, for example, become asymmetrical, changed color, increased in diameter.
In your practice, have you experienced that a person was encouraged to go to a dermatologist, for example, by a masseur, cosmetologist or any other specialist who sees their clients’ skin on a daily basis?
There are specialists who have ever been to one of the skin health lectures and pay attention to the skin of their clients, but there are few of them. Unfortunately, most do not respond in any way. Passivity is observed among masseurs, beauticians, hairdressers and other specialists. The situation is slightly better with podiatrists, but there has already been educational work with these specialists.
I am pleased that the step “Step ahead of melanoma” is working to educate those who see the skin of their clients on a daily basis. In fact, there are many professions whose representatives may notice suspicious formations in the body of others, such as swimming and fitness coaches, but they need to be talked to and told what to look for and why it is so important.
Or would GPs be more involved in the diagnosis of melanoma?
There is so much burden on GPs, especially the administrative burden, that they sometimes do not have the physical time to undress patients and look at their skin. However, in cases where patients themselves complain of skin formations, GPs could speed up the diagnosis by performing a dermatoscopy themselves and sending the picture to a dermatologist. In Latvia, family doctors have additional funding if they detect a malignancy, and some family doctors use it, also actively involved in the diagnosis of melanoma.
Why do you think people do not go to the doctor and tend to delay the visit even if there is a suspicion? Is it related to economic or psychological factors?
If we talk about preventive visits, then they have a big connection with the economic situation in the country. When the economic situation is good, people visit a doctor more often, and melanoma is also detected early. If the economic situation is bad, as it was in 2008-2009, people save money, including preventive visits.
On the other hand, if we talk about cases when a person has already noticed a suspicious formation, the reasons for postponing the visit are rather psychological. Some people do not want to know anything about their diagnosis and hope that by pushing this information out of their lives, the possible problems will disappear. However, patients should understand that procrastination can only make matters worse.
The moment a person hears the diagnosis of “melanoma”, he is ready to give a lot of money to turn back time and change his decisions.
What should we strive for to improve the diagnosis and treatment of melanoma?
The simplest and by no means the most expensive solution would be information campaigns. Just as we are reminded every year that you do not have to jump on your head in unknown bodies of water or drive under the influence, you should be reminded every year about the negative effects of sunbathing and the need to protect your skin. Or, for example, place reminiscent information posters on the paths towards the beach. On sunny days you can see crazy things on the beaches. In my opinion, organizing an information campaign is cheaper than treating one patient with metastatic melanoma, which costs over 100,000 euros a year.
The second thing to introduce is to teach at school that ultraviolet radiation is harmful, and tanning is not a sign of beauty, but a protective reaction of the skin that you should not be happy about, but rather worry about, as sunburn may have unwanted effects in the future.
Education should also be provided to beauty and other professionals who come into contact with human skin, for example by introducing the need for re-certification to confirm knowledge of skin health and skin malignancies.
On the other hand, if we talk about changes in the medical field, it would be good if people who are at risk of getting melanoma or who have already had melanoma could have free access to a dermatologist and the state would pay for it.
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