A hockey fan’s gift of health

A staffer for the Vancouver Canucks had a lifesaving encounter last fall, thanks to an ice hockey fan’s good eyesight and medical knowledge.

Nancy Popovici, who was sitting behind Canucks assistant equipment manager Brian Hamilton during a game against the Seattle Kraken, noticed an irregularly shaped mole on the back of his neck. Worried it might be skin cancer, she typed a message on her phone and held it up to alert him.

It spurred Hamilton to check with the team doctor who was also concerned. Eventually a biopsy confirmed he had stage 2 melanoma that, thanks to Popovici’s actions, could be treated before it became life-threatening.

Popovici’s quick action is an important message for anyone who lives on Cape Cod, where the melanoma diagnosis rate is double the national average, according to Blue Cross Blue Shield. That’s partly due to the amount of time Cape Codders spend outdoors, said Elizabeth Tocci, M.D., a Hyannis dermatologist.

“There are different reasons people get melanoma, but most common is from sun exposure,” she said. “Then there are the genetic predispositions to getting melanoma, such as having fair skin and light colored eyes, or rarely there are cancer syndromes that run in families.

“The Cape has a very high incidence rate of melanoma. Next to Martha’s Vineyard, it is the highest in the state.”

Melanoma is dangerous, she said. “It can readily metastasize, whereas the other types of skin cancer – basal and squamous cell carcinomas – very rarely metastasize. But melanoma has the potential to grow and metastasize to the lymph nodes and spread to other parts of the body.”

How can you recognize melanoma or, better yet, avoid it? Here are Dr. Tocci’s answers to those questions and more. (Her answers have been edited for length.)

What is melanoma?

Melanoma is a malignancy of the melanocytes, which are the cells in our skin that make the pigment. If you have very fair skin, you are more likely to get skin cancer down the line, if you’ve had a lot of sun exposure and sunburns. But here on Cape Cod, all types of skin can get melanoma.

What are some different types of melanoma?

There is lentigo maligna melanoma, which is usually superficial, just in the top layer of skin. There is nodular melanoma – that usually represents a bump that is growing fast – and superficial spreading melanoma, which is usually flat, like a new flat growth or a mole you’ve had that’s flat that’s changing. Then there’s acral melanoma which happens on the hands and feet, which Bob Marley [who died from a melanoma that started under his toenail] made famous. That tends to be genetic and not from sun exposure.

How do I know if a spot is suspicious?

We recommend checking your own skin every few months, looking for spots. I think a lot of patients don't realize, especially on the Cape, most of the skin cancers, the basal and the squamous cell carcinomas and even some melanoma, can be pink. So, it’s also really important to be on the lookout for new pink spots like a pimple that doesn't heal, or a small rash that doesn't go away or a wound that doesn't go away. It's always important to get that checked out.

The A-B-C-D-Es of spotting melanoma are:

• Asymmetry. When one half of the spot doesn’t match the other half.
• Borders. Irregular borders. Either a spot is growing a tail, or its borders are scalloped shaped.
• Color. If there’s more than one color in the spot.
• Diameter. If it’s bigger than about 6 millimeters – about the size of a pencil eraser.
• Evolution. This is the most important criteria. It’s always a good idea to show your primary care provider or your dermatologist anything that is changing, either an existing spot or a new one.

If I or my doctor spot something, what happens next?

Normally what will happen is a biopsy. That's a small procedure: local numbing medicine with a small needle. Then the lesion is either scooped out or cut out and sent to the lab. Then, if it is melanoma, you would need another surgery to clear the margins and maybe need further workup, depending on how deep it is.

Melanoma is staged depending on how deep in the skin it goes. And, depending on how deep, there are guidelines to further treatment. Sometimes we have to check lymph nodes. Sometimes there are scans involved to see if it spread anywhere. There are great drugs available now that weren’t available back in the day, called immunotherapies, such as immune checkpoint inhibitors. It’s like chemotherapy but they’re more targeted and work better.

What’s the best protection against melanoma?

Sunscreen. Broad spectrum UVA/UVB, SPF 30 or higher – really 30 will give you good protection if you’re applying it every hour or two. You do have to reapply. It sweats off; it wears off after time. And put a good amount on. You’re supposed to put at least an ounce on your whole body, which is a lot – the size of a shot glass. When you put it on, it should really be rubbed in.

If patients are worried about chemicals, I say stick to the zinc- or titanium-based sunscreen. Those sit on top of the skin. We call those physical blockers as opposed to the chemical blockers. They make the texture nicer now and they rub in better than the used to.