Melanoma affects around 12,000 people a year in France. Of the two types of skin cancer – there are also malignant tumors called carcinomas – it is the rarest, but also the most dangerous. While its incidence is increasing more than that of all other cancers, Professor Gaëlle Quéreux, head of the dermatology department at the University Hospital of Nantes and president of the French society of dermatology, gives us all the keys to spot it.
Le Point: Why do you think melanoma cases are on the rise?
Pr Gaëlle Quéreux: The aging of the population is of course involved, as in many cancers. But it is not the only reason. The other factor is our exposure to the sun, whose responsibility in the appearance of melanoma is perfectly established. For fifty years, the population has been more exposed to the sun than previously, either voluntarily to obtain a tan, or during sports or leisure activities. This change in habit probably explains part of the increased incidence of melanoma. Having a lot of “sunbathing” and having had severe sunburn, especially in childhood, is a real risk factor for melanoma.
Aside from our sun “consumption”, which we can try to reduce, are we all equal when it comes to melanoma?
No. Already, having cases in your family or having already had one yourself increases the likelihood of being affected. And there are also physique types – we’re talking phototypes – that are more at risk. Some people are “unlucky” to have skin that is less able to defend itself from the sun. They are those with light skin, especially with freckles, with light eyes and light hair. Another thing: having a lot of moles on the body – more than 50, to give an idea – is also correlated with a higher likelihood of developing melanoma.
They also say that you have to watch your moles, especially if you have a lot of them…
Yes, but not necessarily because these moles – which are quite common and benign – can turn into cancer. It is possible, but most of the time, the melanoma occurs on an area without previous lesion. It arises, as its name suggests, from melanocytes, the cells that produce melanin and are responsible for tanning. Melanoma, when it begins, can take on the appearance of a mole. That’s why we watch them: to detect a possible malignant lesion among benign pigmented lesions. Keep in mind what we call the “ugly duckling” rule.
Are patients slow to worry?
You see all kinds of reactions. But let’s say it happens. Some people, despite awareness campaigns, delay seeing their doctor, fooled by the lack of pain or by this idea – wrong! – that the skin lesions remain superficial. Melanoma is treacherous, that’s what I tell them. Other people, on the contrary, are so worried that they do not consult either. However, we must play down: in 85% of cases, melanomas are caught in time and do not metastasize.
The right reflex, therefore: be attentive to any changes, on the skin of the whole body. For some reason, lesions can appear anywhere, not just on the parts of the body that “see the sun the most”. And for people with a predisposing phototype, do not hesitate to show your skin regularly to your general practitioner, trained in screening for suspicious lesions.
It is an undeniable reality, dermatological demography has dropped enormously. In France, ten years ago, we were 4,000 dermatologists. Now we are 3,000. This is equivalent to 3.5 practitioners per 100,000 inhabitants. Blame it on non-replaced retirements. The number of posts allocated to dermatology is not sufficient. Each year, 100 new dermatologists enter practice. It is estimated that 25 more are needed. As a result, depending on the region, it takes six to nine months to obtain an appointment. It is obviously absolutely unthinkable to wait such a delay in the face of a suspicion of melanoma.
So, is there a possible loss of opportunity for patients?
Hard to say. I would say that the care organization in France tries to reduce this loss of opportunity as much as possible. In the case of a suspicious lesion, the consultation of the general practitioner as a first resort takes on its full meaning. He can get in touch directly with the dermatologist and get a quick appointment. In some regions, tele-expertise systems are also set up so that the general practitioner can have a rapid response to a suspicion of melanoma. But there are territorial inequalities and in the most rural territories, less provided with dermatologists, one can probably fear that there is a small loss of chance, compared to the city.
