You’ve heard the message: melanoma is deadly. You probably also know that it is the fastest growing cancer in the United States and that one American every hour dies from melanoma. Millimeter for millimeter, it is the deadliest cancer. Rather than bore you with statistics on this horrible disease, let me share some fascinating background information that you may not have heard before.

There are few historical accounts of melanoma. It was not officially recognized as a disease until 1806 in France. Several years earlier, in 1787, a perplexed Scottish surgeon named John Hunter was faced with a large black growth on the jaw of a thirty-five-year-old man. He described it as a “cancerous fungus.” Not knowing what he was, he did what fools do: he cut it off. Amazingly, it wasn’t until 1968 that someone first looked at it under a microscope and confirmed that it was a melanoma. It has been preserved all this time in the Hunterian Museum of the Royal College of Surgeons of England in London and can still be seen today, I am told. The patient evidently sought out Dr. Hunter a few years later for a recurrence of the growth in the same location. In a drunken brawl he had been beaten with a stick and the “soft black mass” returned. The fate of the patient is lost to history. But we know that it was highly unlikely that his melanoma would come back because of the beating he took.

Since then, there has been no shortage of melanoma. It may surprise you to learn that many of the leading melanoma researchers are based in Australia, not the US. In the 1870s, the British government established an Australian penal colony and sentenced criminals to live there for days with kangaroos The forced emigration of pale-white English convicts to the sunny continent has sparked an epidemic of melanoma several generations later. Australia has the distinction of being the melanoma capital of the world. However, we are not left behind. In 1935 it was estimated that only one in 1,500-2,000 Americans would have melanoma. Several bikini and tanning salon decades later, the rate is now 1 in 65 and getting worse every year. Now predictions are being made for 1 in 33 of us in the near future; an amazing increase.

Interestingly, melanoma is one of the few diseases I can name that tends to disproportionately affect people from higher socioeconomic groups. This is believed to be because disposable income drives families to equatorial vacation destinations. Vacations in Cancun and Florida equate to short but intense periods of sun exposure, exactly the same exposure you would get from a tanning bed. All those high school girls tanning for prom in the ’80s and ’90s are thought to represent the skyrocketing rates of melanoma we’re seeing in women under 40 today. Along with breast and thyroid cancer, melanoma is one of the most common cancers in young women. If you watch Grey’s Anatomy, you know that one of the favorite main characters (a blond man in his thirties) died of melanoma a few seasons ago. While I don’t normally pay much attention to those shows, I applaud the writers’ effort to raise awareness on this issue. Governor Brown just banned the use of tanning beds for those under the age of 18 in recognition of the link between ultraviolet light and melanoma.

However, tanning is not the only cause of melanoma. I wish this horrible disease was that simple. Genetics play an equally sinister role in this story. We’ve known for a long time that if you have melanoma, your first-degree relatives are much more likely to have melanoma, too. Many of the new treatments specifically target various genetic mutations and genes associated with melanoma. Shared genes with pancreatic cancer and possibly even some forms of breast cancer are now being studied. But the tan is not out of the woods. If someone’s genetic makeup is dry cornfield, tan is phosphorus and kerosene.

As far as mammalian skin goes, human skin in general is a mess. It offers virtually no protection from the sun. Even very dark African American skin has only a natural SPF of around 13-20. Pigskin is the closest equivalent to human skin in its composition and organization. Surgery trainees usually begin their studies by operating and stitching pig’s feet and sometimes we still use pig skin grafts when necessary. It has been said: “Also like humans, pigs enjoy lying in the sun, tanning in response to the sun, and enjoy drinking copious amounts of beer.”

Now to bore you with a bit of science: the melanocyte is a cell in our skin that produces our color. Melanoma is the uncontrolled growth of melanocytes. One bad mutation begets two. So two beget four. Four beget sixteen, and so on. The normal melanocyte resembles an octopus and produces the pigment in our skin. Its long tentacles deliver the pigment (melanin) to the other skin cells. The purpose is to protect the other skin cells from sun damage by absorbing the sun’s rays. When you tan, melanocytes speed up production to make more of this shield. When you see the tan, you know that there has been damage to the DNA of the skin cells. This is why I like to think of a tan as tears from melanocytes weeping over their neighboring cells.

We are in the midst of a skin cancer epidemic with no end in sight. While most skin cancers are not life-threatening, they can require extensive surgery and cause deformities that need surgical correction. However, melanoma is a different story. Fortunately, the Northern State enjoys a stellar collection of dermatologists and surgeons skilled in these arts. Although almost 100% curable if caught early, melanoma has a dismal survival rate once it spreads beyond the skin and into other organs. There is no known definitive cure. (please read that last statement again)

Until the last few years, we really hadn’t been better at treating advanced melanoma than Dr. Hunter was in 1787. The lack of progress in nearly 225 years is embarrassing to me as a dermatologist. Now, the research pipeline is full of treatments coming our way. A melanoma vaccine led the way and has been widely studied, but has not yet lived up to the hype. A recent breakthrough drug turns the immune system against melanoma cells. Unfortunately for the British, it has just been rejected by England’s national health care panel for not being profitable for their society. The drug boasts a 20% three-year survival rate (or, put another way, 80% of people with metastatic melanoma who take it will die within three years). At $120,000 per patient per year, it certainly raises many philosophical and ethical dilemmas. Fortunately, there are many other promising new treatments on the horizon. Hopefully they can be more reasonably priced.

If you or someone you know has metastatic melanoma, talk to your doctor about enrolling in a study. Gone are the days when you would be randomly selected to receive the study drug or sentenced to unknowingly receive the fake placebo treatment. I have several patients with advanced melanoma who have done quite well in some studies so far. It also gives meaning to his suffering and the opportunity to fight back. While preparing this article, I realized that perhaps no other cell in the body has been responsible for more misery in humanity than the melanocyte. Historically, the functions of your melanocytes could condemn you to a life of slavery, limit your martial prospects, curb your economic potential, or simply make you drink from a different water source.

In conclusion, I would encourage each of you to see a dermatologist for a complete skin exam. You may say to yourself, “My moles look good. Nothing has changed.” To which I would ask, “Would you bet your life on it?”