Melanoma
Melanoma kills about 10,130 Americans a year, per the American Cancer Society. Caught early, your five-year survival rate is roughly 92 percent. Caught late, it's a coin flip at best. That gap is everything.
The risk factors that actually matter
UV exposure does most of the damage. Sun, tanning beds, doesn't matter — your skin doesn't distinguish. The Journal of the American Academy of Dermatology pegged the risk bump at 59 percent for anyone who used a tanning bed before 30. That number alone should end the conversation about tanning beds.
Genetics matter too. Fair skin, blue or green eyes, more than 50 moles, a family history of melanoma — any of those and you're playing on harder mode. The Skin Cancer Foundation notes men get melanoma most often on the back; women on the legs. Worth knowing because those are the places you can't see without a mirror or a partner.
Check yourself once a month. ABCDE: Asymmetry, Border (ragged or blurred), Color (more than one shade), Diameter (anything bigger than a pencil eraser), Evolving (changing shape, size, color). Any of those and you book a dermatologist. Don't wait six months.
Types — and why this matters for prognosis
Superficial spreading melanoma is the most common, around 70 percent of cases. Flat, discolored patch, usually slow to invade. Catch this one early and the outlook is genuinely good.
Nodular melanoma is the bad one. About 15 percent of cases but a disproportionate share of the deaths, because it grows downward fast instead of spreading out across the skin. By the time you notice it, it may already be deep. This is why monthly checks beat annual ones.
Treatment depends on stage. Stage I or II is usually surgical excision and done. Stage III and IV bring in immunotherapy (Keytruda, Opdivo), targeted therapy for BRAF mutations, and sometimes radiation. The shift to immunotherapy over the last decade is the single biggest survival jump in modern oncology — but it's not magic, and it's not cheap.
What I actually use for sun protection
Sunscreen first. Broad-spectrum, SPF 30 or higher, reapply every two hours. I keep a stick in the car and a tube in the beach bag. Two products I'd buy: a daily face SPF like EltaMD UV Clear SPF 46 for under-makeup wear, and a body sunscreen like La Roche-Posay Anthelios Melt-in Milk SPF 60 for everywhere else.
Sunscreen alone is not enough. A UPF 50 wide-brim hat shields the scalp, ears, and neck — three places people forget. A UPF 50 long-sleeve sun shirt beats sunscreen on bare arms for an all-day hike or boat day. And UV400 polarized sunglasses matter because eyelid melanoma is a thing nobody talks about.
Want a tan? Use a self-tanner. Skip the beds. The risk math is brutal and the look is identical.
Common mistakes
Skipping the self-exam because "nothing's changed." You don't know that until you look. Pick the first of the month and just do it.
Treating sunscreen like a force field. SPF 30 properly applied to the whole body needs about an ounce — most people use a quarter of that and wonder why they burned. Reapply after swimming or sweating. Period.
Ignoring a spot because it doesn't hurt. Melanoma almost never hurts in the early stages. Pain is a late sign.
If you've got a mole that's changing — book the appointment this week. The five-year curve falls off a cliff once it gets past stage II.
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