Frighten the Black Death away

That year he went on vacation for the first time. They chose Brazil as a place for rest. They went not for 10 days but for the entire month with its full value as earlier. It is wrong to say that he did not go anywhere else before. There were business trips to European capitals and weeklong naps on Turkish, Spanish, Greek, and Italian beaches. There were no financial problems but only craving for new impressions, fresh warm see, unsoiled wind and sun. Sun, which remained in memory as a picture from childhood when even Baltic cool coast allowed turning black like a firebrand. Skin on the shoulders still remembers facilitating coolness of sour cream that grandma used to heal sunburns. In memory of that, star-shaped curve of moles remained on the back. But today there are sun protection means – sunscreen and it is safe to spend the whole day on the beach without any unpleasant feelings.

They called her “death-cup” in school. Although, in reality she was picturesque – blond reddish hair, huge blue eyes, and a see of freckles. But fashion magazine suggested her a new image of swarthy brunette, which she naturally wanted to try on. That is why, straight after she passed exams in institute she dyed her hair black and started to visit solarium two times a week. Finally, she started getting attention but what is more important she started liking herself. The last thing to do was to put away a dark, big mole on her neck, which hitched up the small chain and blouse collar.

In future both of these stories were connected by one diagnosis – melanoma. Accidentally? We would like to think so, but most likely not. As for the majority of oncological illnesses for melanoma exists the basic rule of emergence of malignant neoplasms: predisposition + risk factors. Predisposition to more frequent melanoma occurrence is connected to phenes of human’s body (color of skin and skin etc.) and barely noticeable or completely hidden genetic defects, that is to say, genetic characteristics that can be hereditary. Basic characteristics of predisposition researched in International Agency of Cancer Studies (IACS) are present in the table. 
1. As it can be noticed, the presence of one or another characteristic increases one’s personal risk of melanoma related sickness from 1,4 to 4,1 times. 
1.The characteristics of predisposition to melanoma
Characteristics – Frequency of emergence of melanoma 
Pale white skin – 1,4-2,7 
Blue eyes – 1,6 
Light reddish hair – 1,8-2,4 
Freckles – 2,3 
A big amount of moles – 2,4-4,1 
Close relative having melanoma – 2,2

A combination of such characteristics as blue eyes, pale skin, red hair and easiness of getting sunburns increases a probability of malignant melanoma emergence to 5 times. A large amount of moles (nevuses) on one’s body has a definite meaning, exactly more than 50 pigment spots covering all of the skin. Close relative of those, who have melanoma should be especially careful. 9-12% of all cases are concentrated within the boundaries of one family.

Nowadays there are at least three known risk factors that cause melanoma: ultraviolet radiation, trauma, and hormonal rearrangement of an organism.
There are no doubts that people who live in southern regions suffer from melanoma more frequently. Data illustrating this point is provided by IACS and is available in Table 2. 
2. Index – Risk 
Residence in sunny country for more than 1 year – 2,72 
Actively acquiring a tan in sunny country - 4,72 
Residence in sunny country from birth – 6,56 
…From 10 years of age – 4,31 
…From 10 to 22 years of age – 2,38 
…After 22 years of age – 1,52

These datasets are pieces of a specific interest because they are connected to extremely increased migration rates in the entire world. It is known, that people drift not only from the East to the West but also from the North to the South. A search for a place under the sun has a significant effect on health. According to the results of the research that was done in Israel and Australia, countries having high sickness rate, migrants risk to get the disease in two cases. First, when drifters start to use the sun in the new country and second, when they are brought to the new country while being little children. “Melanoma mines the skin in childhood”, claims the leading expert of IACS Zan Francua Dore. An amount of nevuses (birthmarks) is an indicator of solar radiation that was received in young age (look at the table 1). Careful attitude to the sun during childhood decreases melanoma related risk in adult age by 2 times.

What does it mean “careful”?

Just as the majority of physical phenomenons and chemical agents that are around us, ultraviolet radiation can be measured in doses of influence on human organism or biodoses. Biodose is a minimal time of radiation leading to a minimal reaction of skin reddening or erythematous reaction. This reaction is unique for every individual, it can differ in many times and gives information about safe exposition or duration of contact with the sun: 3 minutes, 10 minutes, half an hour or 1 hour. In most cases people who got melanoma did not limit themselves not only to their own biodose but they broke all possible limits even for the strongest human skin. In table 3 it is possible to compare the risk of melanoma emergence depending on duration of the contact with sun.
Data presented in Table 3 needs to be explained on the basis of molecular mechanisms of melanoma’s photobiology. When ultraviolet rays (UV) reach the skin surface its cells start to fight against radiation. A complicated mechanism, perfected by millions of years of evolution, gives a signal to melanocytes, which start to produce a specific substance – melanin pigment. Exactly melanin working like fire extinguisher blows out a stream of solar radiation, which may bring a danger of deformation of hereditary cell apparatus – DNS molecule. From deep layers of skin melanocytes are rising higher and give melanin to keratinocytes, creating skin pigmentation or tan. It is determined that keratinocytes can just dye from an excess of solar energy if melanocytes did not have enough time to send melanin, melanocytes themselves are able to mutate, they are good at surviving and procreating. But as it is fixed, the complete skin phitoprotection from ultraviolet radiation is comes only in three days. Before this time, melanocytes only redistribute their resources and melanin pigment is not produced. Higher skin layers are preparing at the cost of extending of the network of tiny blood capillary. Then appears so-called eritema or reddishness of the skin. That is why it is so important to remember that first contact with the sun should be short – stimulation and preparation of melanocytes for a very serious work is necessary – to protect the skin from ultraviolet radiation. Pigment layer or tan, as it was mentioned above, protects the skin from ultraviolet. A person who is working under the sun on a daily basis usually forms and supports this protection for quite a long time. That is the reason why risk in this category is even lower than average (0,86<1). People who tense their melanocytes at full power only 1-2-3 times a year have totally different situation. What it is and what is the danger of it can be seen from results of observation of sunburns consequences. And if eritema is a sign of individual biodose then sunburn is a sign of danger. It speaks, that probability to get a malignant melanoma heightened.
According to the data provided by IACS mankind can become a victim of malignant melanoma. Sickness rate is heightened by 5% annually. Even now melanoma is on the second place after breast cancer. Experts in IACS claim that one of reasons of this epidemic can be a wide spread use of sunburn protective means. Sun protective factor (SPF) of human skin melanin is 1,8 but of sunscreen it is 4-8-15 and higher. A human, who is not seeing eritema and is not feeling sunburn on the skin tends to prolong the time spent under the sun. Only few northerners having only 10 days to spend in Turkey will use 3 days gradually raising the amount of time spent in the sun. Thus, skin preparation does not occur and natural photobiological mechanism is distorted: there is not enough melanin in keratinocytes and ultraviolet radiation may cause mutations in melanocytes. However, the most often melanocytes being overstimulated by the sun and having produced a portion of melanin interflow in dotty formations, which are called nevuses or moles. Moles as little defects of melanocytes development are also formed straight after birth and during hormonal rearrangements of an organism, but in general nevus is a result of solar radiation.

Melanoma usually emerges from nevuses. The most often it is revealed on it’s own. Thus, from all the melanomas that are revealed like that 71% is counted for women and 26% is counted for men. Unfortunately, women suffer from this illness 3 times more often. The most susceptible age is ranging from 30 to 44 years. Women and men before age of 50 have back as the most sensible and susceptible body part. After 50 – face, shank, and forearm. A provocative moment for overheated moles can be a trauma, prolonged irritation caused by clothes or cut caused by shaving. Relatively often malignant degeneration of moles occurs due to the unjustified cosmetic intervention – cauterization, excision, and racking of nevus. Signs of mole change from normal, unruffled birthmark into atypical stadium or degeneration are darkening of pigment spot with a predominance of black-blue gradations or the gaining of saturated black color: around the mole emerge inflammatory phenomenons, aureole of reddish color, appear itch and burning. It is especially typical is mole’s growth – its enlargement and emergence of daughter cells around. Disappearance of skin picture and emergence of smooth surface on the mole are also considered to be the distinctive features of melanoma. While growing it can become friable and very vulnerable. Light friction with cloth can destroy its surface and lead to bleeding. Although, it is impossible to distinguish between a mole without any obvious characteristics of degeneration and malignant melanoma it is inadmissible to eliminate it independently or make a biopsy in order to define the diagnosis.

Melanoma is the most aggressive, rapidly metastazing and practically incurable malignant tumor, which is called by geophysical factor the sun that is a part of surrounding nature and space. But nature is not at all cruel and archly as fatalists may think. Nature is constantly trying to predict us about how dangerous it is to break its biological laws. Medical science that is not perfect in surgical and therapeutic ways of treating melanoma knows biological risk markers and prophylactic means. Melanoma is one of the few malignant tumors for which prophylactic may bring an effect that is close to 99%, but spendings on prevention are 5-10 times less in comparison to spendings on ineffective yet treatment.

3. Melanoma Risk and Exposition to the Sun 
Exposition type – Risk 
Professional Contact (regular job in the sun) – 0,86 
Periodical Contact with the sun - 1,71 
Sunburn in adult age – 1,73 
Sunburn in childhood – 1,95

Besides signs of predisposition and risk factors that are mentioned in the tables, in arsenal of doctors and scientific medical laboratories are tests on markers for predisposition and sensibility, ranging from determination of tyrosinases pherment in urine to counting the amount, size, and disposition of moles on the body and epiluminzecentic microscopy of nevuses. Therefore, consult a doctor before you decide to visit solarium, to use sunscreen on the beach, to plan your vacation on sunny sea resort, to decide to bring a small child out to the beach or to move to the South.