About the Author
Catherine M. Poole is president and founder of the Melanoma International Foundation and has been a melanoma survivor and patient advocate for fifteen years. DuPont Guerry, IV, M.D., is director of the Melanoma Program and professor of medicine at the Abrahamson Cancer Center, University of Pennsylvania.
Read an Excerpt
Books about cancer seem always to begin with scary stories about people whose deaths could have been averted by its early detection and with statistics that describe the growing menace of the disease to the population. The accounts move on to grapple with the "causes" of lung or breast or colon or prostate cancer and eventually deal with related issues of prevention. The authors of such books may talk about genes as if they were fate (breast cancer is "caused" by one broken gene in some families) and about environmental factors as if they were inevitable executioners (a standard Western diet "causes" colon cancer).
Such books conclude with the promise that new research is about to deliver a novel and effective preventative strategy, a better diagnostic test, or a cure that does not involve surgery, radiation, and toxic chemicals. This new approach may rely on gene therapy or something "natural" and "biological".
These books do provide useful information smoking really is bad for you and is a potent cause of lung cancer; mammography is a modestly effective tool in decreasing breast cancer mortality and should be widely and regularly used. But they usually promise too much, at least for the real world of the here and now; and they often get it wrong. They miss a number of cancer's features its many forms, its multifactorial causality, its multiple mechanisms of growth and spread, and its complex interactions with the immune system and other systems that defend bodily integrity. The authors neglect to point out that targets on cancer cells and that agents tobe used in prevention and therapy not only are intrinsically weak but also have side-effects.
Writers make these mistakes because they oversimplify, and often they oversimplify because they fail to recognize the subtlety and complexity of the causation and evolution of the disease. Cancer is best viewed as a diverse family of chronic diseases whose early manifestations gestate for years and are usually hidden from view under the skin, in a duct of the breast, or in a segment of the bowel.
With help from me and colleagues, Catherine Poole has written a different book or a book different in substance. She has adopted the sensible format of the generic cancer book. But because melanoma is unlike other malignancies in two specific ways, her discussion makes for a guide that has real utility now. Melanoma is different from other cancers because it is pigmented and because it arises in the top layer of the skin. Hence, it is distinctive and visible apparently to our best-developed sense (sight) and "on" and organ of great psychosocial importance.
Melanoma is a book that delivers on the promise to teach information that will save lives. At its core, it is about how to detect melanoma when biologically it is still early cancer. By this I mean cancer at the first step in its evolution, when it is potentially detectable but still incapable of spreading to distant sites. It is such a colonization of tissues away from the tumor's point of origin, called metastasis, that is potentially death-dealing. Biologically early cancer is not to be underestimated, however. If left alone, it is liable to take the next step, at which metastasis becomes ever more likely with time.
Most cancers of all types begin with that first step, but in most it is invisible. In melanoma, however, it is east to see as a distinctive, flat, brown or black pigmented spot on the skin, one that is often slowly but perceptively changing or that can be detected as change within a mole.
Melanomas discovered in this flat phase of their evolution are invariably cured, usually with simple, inexpensive, cosmetically uncomplicated outpatient surgery. And even the next step, the lumpy phase, is cured more often than not (70 percent of patients with melanoma that has reached this later step are cured with comparable surgery).
The trick, of course, is for you to learn to see early melanoma and to figure out who needs particular and professional observation. Once you have mastered the routine of really looking at your skin (and that of people close to you), the chance of developing the potentially lethal step in melanoma will go from small to vanishingly small. Hence, you should be fearless about pointing out suspicious spots in others and about having your own evaluated and managed. Chapter 5 tells you how to do this.
Chapter 6 deals with disease that has escaped beyond the place of its origin (the primary site), a step in melanoma that will happen to some small but irreducible fraction of patients, no matter how good we all get at taking care of and watching our skin. This chapter conveys the important information that there is an initial step in metastasis when the disease has spread only to nearby lymph glands. At this step, cure is still a reasonable liklihood.
We also remind you that even serious disease can turn out well in some patients and that at least incremental advances are at hand in the "biological" therapy of disease that is at high risk of being metastatic. We can now see the glimmer of a promise of useful therapy for some patients with widespread disease.
Catherine closes with an important chapter on matters of the heart and soul and one on eradication of melanoma in what should be the best sense the prevention of the disease rather than its removal. Chapter 8 is about the avoidance of excessive sun exposure, particularly in childhood. It argues that with exposure to sunshine, moderation makes sense it will promote healthier skin, will retard many of the changes in skin thought to reflect aging, and will greatly diminish the number on nonmelanoma skin cancers. It is also very likely to control the melanoma epidemic.
Catherine Poole is a practical, no-nonsense person. It is no surprise that she has written a practical, no-nonsense guide to how to deal with melanoma in the real world. She has had the disease herself, and this perspective lends her book authenticity and spirit.
DuPont Guerry IV, M.D.
Director, Melanoma Program
University of Pennsylvania
Comprehensive Cancer Center