IGNORANCE about skin cancer — particularly melanoma — among Jamaicans has led to many patients being diagnosed with the disease at later stages, resulting in expensive treatment options and even death, says Dr Guyann Arscott, the chief plastic surgeon at three of the country’s main hospitals.

Widely regarded as the most dangerous type of skin cancer, melanoma develops from melanocytes — the cells that give skin its colour. It is formed due to excess exposure to ultraviolet light or immunological factors. Melanoma often presents itself as an irregular mole on the skin.

Over the last 12 years, Dr Arscott said that plastic surgeons at the Kingston Public Hospital, University Hospital of the West Indies, and Bustamante Hospital for Children have directly managed about 130 cases related to the disease.

He said data reveals that the 40 to 70 age group accounted for 79 of the 130 patients. Additionally, 85 of the 130 patients presented at an advanced stage that often led to the cancer spreading to the lungs, liver and brain, in some instances resulting in death.

He was speaking to the Jamaica Observer ahead of World Cancer Day, which is observed annually on February 4. This year, it is being observed under the theme ‘United by Unique’.

According to Dr Arscott, the relatively high number of patients presenting at a late stage is due to ignorance about the disease and myths that melanoma does not occur in people of colour.

“Interestingly, white and black skin have roughly the same amount of melanocytes. It’s an important factor that most people don’t know. The number of melanocytes is roughly the same in the black skin as it is in the white skin, but the melanocytes in the black skin produce more melanin,” Dr Arscott explained.

“The pigment melanin provides protection. It protects the skin to some extent from photo radiation or ultraviolet radiation damage, and that is why the incidence of melanoma is much higher in the white skin than the black skin. We have much melanin protecting our skin…It does protect us and, in fact, the melanin in the skin is about a 13 per cent skin protector,” he told the Sunday Observer.

However, he said it does not provide full protection, so people of colour are still vulnerable.

He further noted that the disease presents itself in different ways within the black population, and because many people are unaware of this, they cannot easily detect if something is wrong.

“In our [Jamaican] population, that is predominantly people of colour, the [most common] sight for melanoma is not in the sun-exposed areas of the body as [it is in] the Caucasian population. A subtype of melanoma that is considered uncommon in the Caucasian population is the [most common] one we see [in people of colour], and that is the subtype called acral lentiginous melanoma (ALM).

“This occurs [in moles] on the soles of the feet, the palms of the hands, and under the nails of fingers and toes. That is where we see most of the melanoma in our population. That is interesting and important, and it is why we want the population to know about it, and it’s why we want the general health-care worker to be aware,” he explained.

Dr Arscott shared that the cancer often presents itself in the form of an irregular mole.

“If a mole is greater than five millimetres, if there is recent growth, if there is an increase in pigmentation, if the pigmentation has an irregular pattern and produces an irregular outline, if it itches, if it is oozing and crusting, if it has inflammation like redness and tenderness — that’s eight features. Any four of those features that a patient presents with means that there is likely melanoma in that mole and it must be dealt with, it must be biopsied, and biopsy should remove it completely,” he said.

The plastic surgeon noted that despite its deadly nature, melanoma can be cured if caught early.

“When melanoma is presented to us in a more advanced case, the treatment becomes much more complicated. We will have to look at the lymph nodes, we’ll have to look at scans and imaging to see how far it has gone, if it is found to have spread, and the treatment that is available.

“In recent years, dramatic changes have taken place in terms of treating advanced melanoma. This has resulted from two main discoveries where chemotherapy that used to be practised is now replaced by immunotherapy and targeted therapy. But, it is extremely expensive and virtually unavailable in Jamaica to the average Jamaican, so when they come with advanced disease, they are going to be driven into [bankruptcy] to afford it. This is heart-rending because if this disease that is so lethal is caught early, it is curable by a relatively simple surgical procedure,” he explained.

Dr Arscott stressed the importance of self-examination, noting that it leads to the majority of early cancer diagnoses. He also encouraged the use of sunscreen to protect the skin and called for more plastic surgeons to be stationed in hospitals as they are very familiar with melanoma and can help with early detection.