Skip to comments.Dermatologist challenges sun-melanoma link
Posted on 08/14/2004 5:58:16 AM PDT by dennisw
Posted on Fri, Jul. 23, 2004 Dermatologist challenges sun-melanoma link
By Gina Kolata
NEW YORK TIMES
Dr. A. Bernard Ackerman, a dermatologist, spends much of his time diagnosing the potentially deadly cancer melanoma and other skin diseases.
But when he returned from a recent trip to Israel, he was, well, deeply tanned.
Burnished brown, in fact.
Ackerman did not use sunscreen on his trip. He did not give any thought to the hundreds of moles that speckle his body. He did not even put a hat on his bald head.
Other dermatologists may worry about getting melanoma from exposure to ultraviolet rays. But Ackerman, 67, a renowned expert in the field and the emeritus director of the Ackerman Academy of Dermatopathology in New York, said the link between melanoma and sun exposure was "not proven."
He has scrutinized, one by one, the widely held precepts about melanoma and the sun and found the evidence wanting. "The field is just replete with nonsense," he said.
For example, it is commonly assumed that painful or blistering sunburns early in life set the stage for melanoma later on. But while some studies show a small association, Ackerman says, others show none. And even studies that do show an effect disagree on when the danger period for sunburns is supposed to be.
Taken as a whole, Ackerman argues, the research is inconsistent and fails to make the case.
Common wisdom also has it that sunscreens protect against melanoma. But Ackerman points to a recent editorial in the journal Archives of Dermatology concluding that there was no evidence to support that idea.
Finally, many people assert that the more intense a person's sun exposure, the greater the risk of melanoma.
For example, Darrell Rigel, a New York dermatologist, points out that the incidence of melanoma increases as distance to the equator decreases. Rigel, a past president of the American Academy of Dermatology and the lead editor of "Cancer of the Skin," a major textbook in the field, cites this as a compelling reason to conclude that sun exposure causes melanoma.
But it is not compelling to Ackerman. Epidemiological data on melanoma, he says, are imprecise and inaccurate. In searching for the causes of other cancers, he argues, epidemiological data have led researchers astray, and by their nature, they cannot demonstrate cause and effect.
Stay out of the sun, Ackerman advises, but do it to avoid premature aging of the skin. If you are very fair, avoiding sunlight will also help prevent squamous cell carcinoma, a less dangerous cancer. But it would be a mistake, he says, to assume that avoiding sunlight or using sunscreens will offer protection from melanoma.
Ackerman has been enamored of skin and its diseases since his earliest days as a resident at Columbia. Studying dermatology, to him, was like taking courses in art history. "If you know a certain artist, you can recognize him again," he said. "So it is with lesions in the skin. A lesion is like a painting or a piece of sculpture."
He has spent most of his career in academia and has published 625 research papers. His list of honors and awards includes this year's Master Award, given to one person a year by the American Academy of Dermatology.
In 1999, he started his own academy, supported by AmeriPath, a company that owns pathology laboratories. "I had nothing to sell -- I was always in university life," Ackerman said. "If you'll excuse the expression and not think I'm a tart, they bought me."
His academy, he says, is now the world's largest training center for dermatopathology.
Ackerman, who is paid a flat salary, and his six associates examine more than 100,000 specimens and have done more than 4,000 consultations each year. Ackerman continues to teach, write, ask for data and question his field's conventional wisdom.
Challenging the link between sun and melanoma is part of this pattern.
Ackerman even questions whether the "epidemic" of melanoma proclaimed by many dermatologists exists. The definition of the cancer, he says, has changed over time, leading doctors to diagnose, remove and cure cancerous growths that once would not have been called melanoma.
"The criteria today, clinically and histopathologically, are diametrically different from those 30 years ago," he said. In medical school, he continued, "we were taught that melanoma is a big, black, fungating tumor that kills. Who would have believed then that you can recognize melanoma for what it is when it is small and flat and the size of the fingernail on your pinky? You would have said they were insane."
Anyone who argues that sun exposure causes melanoma, Ackerman says, needs to explain why blacks and Asians get melanoma almost exclusively on skin that is not exposed to sunlight: the palms, soles, nails and mucous membranes. Even in Caucasians, the most common melanoma sites -- the leg in women, the trunk in men -- are hardly the most sun-exposed body parts.
It is not a popular argument. Rigel, reached by telephone in Hawaii, where he was vacationing, said it was perverse of Ackerman to pick the data apart.
Melanoma, Rigel said, can occur "where the sun doesn't shine." But that is because sunlight suppresses immune cells in the skin's surface that ordinarily hold cancer at bay, he said.
He himself stays pale, even in Hawaii, that land of intense sunlight.
"I'm a dermatologist," he explained.
Ackerman does not buy the immune-system argument. It is a hypothesis to support the hypothesis that sun exposure causes melanoma, he says. But it is not evidence.
Of course, Ackerman adds, he could be wrong.
"If the evidence were compelling, I'd be the first to capitulate," he said. "I'd say, 'I tip my hat to you. Well done.'"
It seems as if everything we believe about health and nutritition eventually is disproved. I am going to have three slices of pizza (sausage and extra cheese), a six-pack of Sam Adams and a quart of Rocky Road ice cream for dessert. Just staying ahead of the information curve. (I'll pass on the unprotected homosexual sex, thank you very much.)
There was a report not long ago that nurses who work night shifts have more colon cancer. The reports I heard mentioned this may be because they didn't get enough sunlight and "melatonin has a well known strong anti-cancer effect." So I think it is fair to say the medical establishment doesn't know what it's talking about on sun exposure. (I'm not saying it's overall good or bad, just that they don't really know).
I wish I had time to see what Australian dermatologists say about this.
There is an extra health advantage if you consume those things while sitting in the sun. :~)
Yes --- you get Vitamin D from the sun and your bones need it Vitamin D also --- and there is an increase in osteoporosis now.
Also getting some tan is good because it's nature's way of protecting your skin from UV damage.
As I recall, one of the strongest epidemiological clues to the sun-melanoma connection was a study of American and Australian truck drivers.
American drivers supposedly get many more melanomas on their left arms (which are hanging out the window as they drive) than on the right.
For Aussie drivers, of course, it's the reverse.
However, the sun still causes basel and squamous skins cancern. I know because I am a victim of the first.
These are not life-threatening though. But if on the face, surgery can be a problem.
Very interesting . . . thanks.
Me too, but I wonder if Basel cell cancer has been shown to be the caused of excess sun or is it purely conjecture.
Of course, Ackerman adds, he could be wrong.
While the cause is still a matter of debate, there is a strong association between sun exposure and melanoma in certain groups. To be safe, young persons, fair skinned one in particular, should place a high priority on protection against being sunburnt.
Because a fair amount of data suggests sunscreens may be ineffective in preventing melanoma and possibly cause more harm than good, young fair skinned persons should avoid sun exposure levels that would result in burning had they not been wearing sunscreen.
It's appearing on the most sun-exposed parts of me, particularly on the face. I really have no doubt that for me, at least, the sun is the cause. (But I've gotten some pretty bad burns...I don't believe occasional sun will cause it.)
What is our poor intrepid dermatologist to do? How can he reverse this trend and return his business to profitable levels?
I think the good doctor falls into this category.
I'm using a medication called "Aldara" which may help you.
When I detect a new spot, I apply it. So far I have had success.
It beats surgery.
Hmmm it is a fact that people who get too much sun end up looking like leather suitcases
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.