Dr. Michael Rich talks about melanoma in Australia

Presenter: Katherine
Guest: Dr. Michael Rich
Guest Bio: Dr. Michael Rich is the Founding President of the Skin and Cancer Foundation of Victoria.  It is a Centre of Dermatology Training and is closely affiliated with the University of Melbourne and St. Vincent’s Hospital.  Dr. Rich heads the High-Risk Melanoma unit at the Skin and Cancer Foundation, which is associated with the Victorian Melanoma Unit, and also heads the laser clinic there.

Segment Overview: The amount of skin exposure under the sun in the first 16 years of one’s life has an effect in later years and this could lead to melanoma. Dr. Michael Rich elaborates on this topic as he shares his knowledge in this segment.


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Katherine: Today joining us is Dr. Michael Rich. Dr. Michael Rich is the Founding President of the Skin and Cancer Foundation of Victoria. It is a Centre of Dermatology Training and is closely affiliated with the University of Melbourne and St. Vincent’s Hospital. Dr. Rich heads the High-Risk Melanoma unit at the Skin and Cancer Foundation, which is associated with the Victorian Melanoma Unit, and also heads the laser clinic there. Welcome, Dr. Michael Rich.

Dr. Michael Rich: Thank you, Katherine, nice to be on.

Katherine: Can you explain to us what melanoma is?

Dr. Rich: Well, melanoma is the malignancy of pigment-producing cells, the melanocyte.  Basically, any cell in our body can undergo a malignant change and that cell becomes a rogue cell and duplicates itself.  And some cancers are nastier than others.  And in this particular case, it’s a pigment-producing cell, the melanocyte, which becomes a rogue cell and copies itself and multiplies and then spreads beyond its primary area, which could be anywhere on the skin and sometimes not.  Occasionally, you can even get a melanoma in the eye and it spreads and it can have dire consequences.

Katherine: Oh, I didn’t know that you could.  Because in the past, let’s say, if they showed a melanoma with skin cancer, and it’s interesting to know that it could appear in other parts of the body as well.

Dr. Rich: Oh, yeah, absolutely, less common but certainly there’s many people who lose their eyes as a result of melanoma in the eye.

Katherine: Right.  I was reading that one in 17 Australians will be diagnosed with melanoma before the age of 85.  And Australia actually has the highest rate of skin cancer in the world.  Melanoma is also the third most common form of cancer in Australian men and women.  It doesn’t seem to discriminate as well.  It doesn’t really matter what age group you’re in, men or women, you can get melanoma.  Is this correct?

Dr. Rich: Yeah, look, absolutely.  I mean, there is a certain group who’re more prone, but, the bottom line is, the natural inhabitant of this country is an Aboriginal and everyone else is not.  And even if you’ve got darker skin, olive skin, whether it is from Italy and so on, you are not bred to cook as we all do, as we used to.  And therefore, the sun damage that we expose ourselves to throughout life, it’s a plus, plus, plus effect. So, the sun damage at from one year onwards that plays a part in what develops later on. We have the highest incidence of melanoma and other skin cancers in the world, yes.

Katherine: And it’s also commonly diagnosed in adolescents, and between the years 2003 and 2007, it accounted for more than one-quarter of cancer in this age group.  Why do you think young adults are prone to melanoma?  Is it because at that age their skin is more sensitive?

Dr. Rich: No, not because it is more sensitive, because they spend too much time in the sun.  And you’re right, studies have shown that sun exposure in the first sixteen years of life, first sixteen, is very significant in regards to the advent of melanoma in later life.

And that’s a message I would give the parents, to be honest, that while they’re under our control … after sixteen, we often can’t get them to wear the sun-smart outfits and the sunblock.  But, at least, in those first sixteen years, which are significant, we as parents can insist that they protect themselves.  And that protects them to some extent for the rest of their lives.  Obviously not totally, but it’s a help.

Katherine: Right, because that’s another thing with the Australians’ love for the sun and outdoor activities, we have grown up with quite good education, like we all know the ‘Slip Slop Slap’ slogan and especially in schools, very young children, they have to wear sun cream before they go out in the school yard.  But things like education, it is accessible, but yet skin cancer is still so prevalent in our society.

Dr. Rich: As I said, the ‘Slip Slop Slap’ campaign has been groundbreaking, Australia’s been at its forefront.  It was developed by Robert Marks [sp], a dermatologist, and that’s really not a country … Other countries have tried to emulate it.  So, we have succeeded to a great extent with that but it’s not enough because my son lives near the beach in [indecipherable 0:04:31] and I go out there.  On a summer day, it’s full of people sitting there, like lame ducks, cooking themselves so it needs [indecipherable 04:38] education.

 People are still burning.  And they think putting on a 15-plus sunblock once in the morning is adequate.  Well, it’s not, it’s not.  So, we’re going to have … the incidence of skin cancer is still on the rise but with the campaigns that have been lodged, it’s not as bad as it would have been without it.

Katherine: Right, yeah.  Is melanoma, in your opinion, a preventable disease?  Or, is it like some other types of cancers, hereditary?

Dr. Rich: Well, there’s two components.  There’s two major factors that play a part and, look, people with darker skin who are not prone can occasionally get a melanoma and will get melanoma in non-sun exposed areas because any cells in our body can undergo malignant change and there are many factors that play a part.

Katherine: Right.

Dr. Rich: Having said that, the major initiating factor is ultraviolet light and sun exposure.  And it’s very interesting.  There’s a really good study done in the United Kingdom with a population of people from there comparing those people in the United Kingdom who never left the United Kingdom to those who went once a year to Spain for a two-week holiday to Majorca.  And that group had a significantly high incidence of melanoma just from their two-week holiday.

So, you don’t need much, to cook yourself often enough, to develop skin cancer and melanoma.  So, yes, there is … a large component of it can be minimised and prevented by sun protection, yes.  And, furthermore, for example …

Katherine: It’s funny, you said that, yeah, about how in Mallorca, how they were trying to maximise their time in the sun, that’s pretty interesting.

Dr. Rich: Oh, yes, for two weeks, you see the Brits, they do cook themselves.

Katherine: And quite amusing.  Yeah.

Dr. Rich: Yeah, they look like lobsters, but, still that two weeks once a year, was significant.  And if I’m on a beach and I see, for example, a child under sixteen without a sun-smart outfit, my first thought is ‘what stupid parents’.

Katherine: Yeah, and like you mentioned before, that if you do, say, significant damage one year, the next year it just builds on top of what damage that you’ve already done.

Dr. Rich: Sun damage is plus, plus, plus throughout our life.  There’s no doubt that a bigger plus is more significant, so that one or two severe sunburns with blisters is a far bigger plus than the same amount of radiation over ten exposures, but it still adds up.  But there’s no … again, someone with fair skin who’s had two or three really severe blistering attacks are really at quite a high-risk of all types of skin cancer.

Katherine: I see.  Speaking of exposure, research shows that using solariums before the age of 35 boosts the risk of melanoma by 59%.  In Australia, many states including New South Wales and Victoria, by December 2014, commercial tanning units will be banned.  Do you think that after this ban takes effect, there will be a significant reduction of melanoma?

Dr. Rich: Well, two factors.  I don’t think there will be a significant reduction but that ban is twenty years too late because the solariums have UVA, and that’s a light that penetrates through glass.  And when they talk about SPF factors, UVB, it’s the light that causes sunburn and blistering.  But UVA is a deeper, it’s like x-rays going deeper, and the solarium, that’s the wavelength they emit.  They emit that deep, penetrating radiation and that is very dangerous.

The fact is that young people have died unnecessarily.  I think that girl Gillespie, she was courageous to come out and bring it out into the public.  Then, when she was dying, it’s really … this is a business that is unjustified.  It should not exist, it should never have existed.

Katherine: I see, yeah.  You actually assisted in developing Australia’s first melanoma computer imaging system.  Can you tell us how the system works?

Dr. Rich: I thought about at the time, and that was many years ago.  I suppose, it’s has its day.  At the time, I thought, the best way to record was take very detailed computerised photography with not a sophisticated system.  The idea is to … because we know if we get melanomas early, people do well.  If we don’t get them early, they do not do well and can die.  So, the whole idea was to image them and get them treated and monitored, but, it was a really primitive computer system in those days.

But these days, they’ve done a very nice systems and Mole Map which is run by some of dermatologists like Professor Kelly from Melanoma Unit and Martin Haskett, who formed this very nice diagnostic tool.  If people have high risk, they can be monitored and changes noted and possibly, they can be diagnosed early.  But we haven’t got an absolutely foolproof system yet.  It will come, but not yet.

Katherine: Right, and how often should people be getting checked … their skin checked for skin cancers?  Is it yearly?

Dr. Rich: Well, it depends on skin type, to be honest with you.  If there’s a family history of melanoma, they should be checked every year or two, depending on their age.  As we get older, the risk increases.  It they’ve had a melanoma in the past, after the first few years of being checked, they should be checked six-monthly for life.

Katherine: Right.

Dr. Rich: But, if someone is, let’s say, if they’ve dark olive skin and they haven’t had much sun exposure, every few years is adequate.  But it’s case-by-case.  Really, you need to look at the person and assess the risk on an individual basis.

Katherine: Right.  My last question is: we are told to either stay out of the sun, or, when you’re in the sun, wear hats and sun protection.  But now, there’s been a lot of warnings about a lot of Australians suffering from vitamin D deficiency, and people are saying to get back out in the sun and it is a bit confusing for people and they don’t know what is moderate.  What, in your opinion, is a healthy medium?

Dr. Rich: It’s actually a difficult problem and I think someone who’s had skin cancer is a high-risk, should avoid it and vitamin D supplements should be taken.  And keep in mind that the normal vitamin D levels, which is 75, has been put up.  It used to be much lower.  So, very few Australians are within the normal range.  In fact, my own level was 22, I [indecipherable 0:11:22] mostly vitaminDs on a regular basis to bring it up.

But, really, if you’ve got low risk, yes.  But a little of sun exposure for five to ten minutes, on not the commonly sun-exposed areas, like the body in sun.  But if you’ve have a history of skin cancers or high risk, I think you’re better off taking the vitamin D orally.

Katherine: Sure, thank you so much for your time today.

Dr. Rich: It’s a pleasure.

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