The beauty queen and the mole

Preparing to vie for the crown of Miss Maryland while working toward her nursing degree kept 21-year-old Brittany Lietz of Edgewater, Md., on a tight timetable. But time threatened to run out for Lietz last year when she noticed that a long-standing, brownish-red mole on her back bled when it was irritated.

“I remember a mark, the size of a pencil eraser, being on my back since I was 10 years old,” says Lietz. “But my mother noticed that the mark started growing after I started tanning religiously during my junior and senior years of high school. I would visit the tanning salons often and sunbathe for hours in the summer. After the mole grew to the size of a nickel, my family encouraged me to see a doctor.”A consult with a dermatologist showed that the mole, which resembled a large freckle, was melanoma, a deadly form of skin cancer that both Lietz and her physician attribute to years of sun bathing and tanning booth visits.”In my mind I thought that tanning made me look great and for this reason tanning for me became very addictive,” says Lietz. “What I didn’t notice was that my skin started to have a ‘leathery’ complexion and I also started to develop wrinkles on my face.” Since her surgery in May 2005, which left a 14-inch scar on her back, Lietz has had multiple visits with dermatologists and some two dozen suspect and potentially precancerous moles removed from her body. “I am still healing,” she says. “But this experience, more than anything else, has taught me some important lessons.”Dermatologists at Johns Hopkins are exploring new ways of distinguishing between dangerous skin lesions and ones that are not so worrisome, but prevention remains the mainstay of the melanoma fight. “Parents should not only encourage their children to use sunscreen for protection and warn them about the dangers of artificial tanning beds and sun lamps, which increase an individuals’ risk of melanoma, but should also advise them to periodically examine themselves for changes in their skin, especially on places that are difficult to see, such as the scalp and back,” says Nanette Liegeois, M.D., assistant professor of dermatology and director of the Division of Dermatologic Surgery at Johns Hopkins. “People should have a friend, spouse or physician examine hard to see areas carefully. This is especially important for those who, like Lietz, are fair skinned and display many freckles and moles.” According to the American Cancer Society, malignant melanoma cases linked to UVB exposure are rising in the United States, with an estimated 61,000 new cases of melanoma expected to be diagnosed this year and nearly 8,000 deaths anticipated this year. Early diagnosis and detection are essential to cure and contain the disease. Researchers at the Johns Hopkins Kimmel Cancer Center are also in the early stages of developing a blood test for melanoma that depends on the detection of molecules in the blood called chemokines, which are proteins that guide cell movement. “We believe cancer cells may be using chemokines to grow, invade tissues and move to other parts of the body,” says Rhoda Alani, associate professor of oncology and dermatology in the Johns Hopkins Kimmel Cancer Center, “acting as an early-warning system for cancer.” Human studies in a small group of patients with widespread disease are currently under way and enrolling patients.Alani and her colleagues are working with biomedical engineers, for example, to develop a skin cream that will produce a fluorescent light when exposed to a radiologic scanner. The cream would react with pigmented cells on the skin that are dividing at a faster rate than normal cells, pinpointing lesions for further examination and biopsy. Later this month, Lietz will participate in the American Cancer Society’s South County Relay for Life in Anne Arundel County and will use her own personal survivor story during the Miss Maryland competition to increase skin cancer awareness among children and young adults. “This is very important to me because life is truly precious,” she says. “Now that I am cancer free, there’s nothing better that I would want to do with my time than helping to save a life.”(Source: Johns Hopkins Medicine: June 2006.)