As a surgical oncologist, I'm usually the one delivering the bad news. But this time I was the recipient.
Nine days earlier, my dermatologist had taken a biopsy from a small pink dot on my back, and now the results were available. It was, he told me, malignant melanoma, the most deadly form of skin cancer.
I envisioned the irony of my obituary: "Melanoma surgeon dies of melanoma."
Specializing in the care of melanoma patients makes me all too aware of the facts. I know that melanoma is one of only a few cancers whose incidence is increasing. The chance of developing it during a lifetime is 1 in 50. And while melanoma accounts for less than 5% of skin cancer cases, it causes 75% of skin cancer deaths. This year alone there will be more than 76,000 new cases of melanoma diagnosed in the United States, causing 9,000 deaths.
But in the moment of receiving bad news, statistics became meaningless. At age 36, with two young children, I had a potentially deadly cancer, and all I could think was, "Why me?"
Soon, the scientist in me took over, and I arrived at "Here's why."
Like lots of kids, I'd enjoyed family vacations on the beach. Could it have been that? Maybe. But I also spent time in tanning beds before the age of 18. My mother used one to help treat her psoriasis, and I used it because we believed it could give me a "healthy tan," a base that would prevent me from burning.
I also had a family history of melanoma, which increased my odds. Because of that, I had been faithful about being screened every six months. Melanoma that is discovered in its earliest stages — as mine was — is highly treatable. By contrast, the five-year survival rate for melanoma that has traveled to distant organs is only 15%.
This summer, the FDA is considering new regulations for tanning beds. Currently they are regulated by the FDA as Class I medical devices, the same designation given Band-Aids and tongue depressors. Under the proposed regulations, tanning beds would have to add labels warning young people not to use them and to encourage those who do to undergo skin cancer screening.
In addition, suppliers of tanning bed products would be required to demonstrate to the FDA that the electrical systems are safe, the lamps emit the right amount of energy and timers are working properly. Responses to this proposal are due this month.
Those regulations are a start. But people have to understand that there is no such thing as a healthy tan, particularly one that comes from a tanning bed. Research has shown that just one indoor tanning session increases the user's chances of developing melanoma by 20%, and each additional session during the same year boosts the risk almost another 2%. One study found that when people first used a tanning bed before the age of 35, they increased their risk for melanoma by 75%.
It used to be uncommon to see melanoma in patients younger than 40. Now, possibly because of tanning beds, I have removed melanomas from people in their 20s.
A week after my diagnosis, I found myself as the patient on an operating table I have often used as a surgeon. A wide ellipse of normal skin was removed from around the tumor to prevent future local recurrences, leaving a 7-inch-long "reminder" of my cancer.
The surgery went well, but given the characteristics of my melanoma, my age and gender, there was a 15% chance the malignancy had traveled to the lymph nodes underneath my arm. A lymph node with metastatic melanoma would change my Stage I cancer to Stage III, thus cutting my survival rate by almost half.
I waited an agonizing four days for the pathology results before receiving a simple text message from my surgeon: "Nodes are negative, have a margarita for me." Greatly relieved, I looked up from the phone. "I am going to be OK," I told my husband.
On my first day back at work, I saw four new patients with melanoma who were under the age of 46. My job as a doctor is to do everything possible to cure them. But as a survivor, I also feel a huge responsibility to help prevent new cases.
The FDA's proposed regulations on indoor tanning are an important first step. Warning labels on cigarettes have helped influence children not to start smoking, the leading cause of cancer. The same kind of simple warnings also should apply to tanning beds.
We need to get the word out: Tanning kills.