In the winter of 2018, 59-year-old Alan Norman was leading an active lifestyle as Sheriff of Cleveland County, North Carolina.
To outsiders and colleagues, Sheriff Norman was a shining example of how the right diet and consistent exercise keeps a body in motion. He felt great, ran often, worked out daily, and had little worry that his health could be at risk.
That was until a round, dome-shaped spot on his left arm made an appearance, and wouldn’t go away.
From tanning beds to daily skin cancer prevention
In May 2019, Sheriff Norman visited his Atrium Health dermatologist, Joseph Urash, MD, to have the spot checked. Five days later, Dr. Urash paid a personal visit to the sheriff’s office to deliver the news — and it wasn’t good.
“It was melanoma,” said Sheriff Norman. “I was in a state of shock, and sick to my stomach. It was as if my life fast forwarded past me … and all I could do was plan for the worst, but pray for the best.”
Melanoma, the most deadly form of skin cancer, begins in the melanocytes, or the skin cells responsible for protecting the skin from sun damage. When UV radiation injures those skin cells, a tan or burn develops as the body attempts to repair the damage.
And according to the American Academy of Dermatology, just one blistering sunburn during childhood or adolescence can double a person’s risk for developing melanoma.
Dr. Urash immediately scheduled him to see Richard White, MD, distinguished chair of surgical oncology at Atrium Health’s Levine Cancer Institute and award-winning innovator of Atrium Health’s immunotherapy program.
According to Dr. White, Sheriff Norman appeared healthy upon first impression —until he took a look at his skin.
“It was obvious that Sheriff Norman was a fit, muscular guy, but there was clear evidence of a lot of sun damage,” said Dr. White. “We discussed next steps, including how to remove the melanoma on his arm, tests to determine if the melanoma had spread and what he needed to do to protect his skin from additional damage in the future.”
Just one day after his first appointment at LCI, Sheriff Norman was in surgery for the wide excision and nodal evaluation of what Dr. White refers to as an ‘intermediate thickness melanoma’ — a melanoma between 1 and 4 millimeters in size. Fortunately, the area surrounding the excised melanoma tested negative, and Dr. White determined Sheriff Norman’s lymph nodes remained unaffected by the cancer.
Prevention is key when it comes to melanoma
Reflecting on the years leading up to his melanoma diagnosis, Sheriff Norman says his exposure to sun began at a young age. Growing up, he spent many days outdoors near pools, lakes or oceans, without any sunscreen to protect himself.
“I thought the darker you were, the better you looked,” said Sheriff Norman.
He’d heard that UV rays could be dangerous but always thought the message was intended for someone else. After years of weightlifting, frequent visits to the tanning bed, prolonged time outdoors without sunscreen protection and riding in a patrol car with his left arm exposed to the sun, not even an otherwise healthy lifestyle could prevent the inevitable damage to his skin.
“I can still push 400 pounds on the bench press, but it doesn’t matter how much weight you can press or how far you can run — skin cancer does not discriminate,” says Sheriff Norman. “I am walking proof.”
Dr. White echoes Sheriff Norman’s advice. In fact, of the nearly 700 new people treated last year with melanoma at Levine Cancer Institute, he says ages ranged from childhood to the elderly.
“No one is immune,” says Dr. White. “The good thing is that while melanoma is on the rise, death rates are slowly decreasing thanks, in part, to greater awareness of UV risks and skin health.”
Keeping your skin healthy is about more than wearing sunscreen, he adds. In fact, that should be your last line of defense.
“Just because you wear sunscreen doesn’t mean you won’t get skin cancer,” says Dr. White. “If you’re still spending a lot of time in the sun, tanning or not using other precautions, you’re just delaying the problem.”
Dr. White advises patients to take the following steps to protect their skin from harmful UV rays and to prevent skin cancer:
- Limit sun exposure, when possible.
- Wear brimmed hats and UV-protected sunglasses.
- If exercising outdoors, opt for early morning or late afternoon, when the sun’s rays aren’t as powerful.
- Wear protective clothing that covers large areas of exposed skin.
- Don’t sunbathe, and avoid tanning beds entirely.
- Wear sunscreen, no less than 30 SPF.
- Make sure your primary care doctor checks your skin at yearly checkups, and see a dermatologist if you have an area of concern.
Areas of concern, Dr. White says, fall under the ABCDE’s of melanoma. Using the ABCDE rule helps to identify possible signs of melanoma:
● A is for asymmetry. One side of the area does not match the other. This includes moles, spots and birthmarks.
● B is for border. The edges are uneven, ragged, notched, scalloped or blurred.
● C is for color. The color is irregular. It may appear as one or several shades of brown, black, pink, red, white or blue.
● D is for diameter. The spot is larger than 6 millimeters in diameter — about ¼ inch, or the size of a pencil eraser.
● E is for evolving. The mole does not go away and is instead changing in size, color or shape.
Early detection can be the difference between life and death.
According to Dr. White, Sheriff Norman’s decision to see his dermatologist was one that potentially saved his life.
“Left undiagnosed and untreated, the melanoma could have continued to grow and threaten his life,” said Dr. White. “Afterall, melanoma isn’t dangerous because of the spot you can see—it’s dangerous because of the potential for it to spread cells to other areas, such as the lymph nodes, brain or liver.”
Now that Sheriff Norman is healing and back to the gym, he adds a couple more steps to his health regimen. He’s parted ways with all forms of tanning and visits his dermatologist every 90 days. He applies sunscreen regularly, even on cloudy days, and pays close attention to anything that appears to be an abnormal mark on his skin.
“I was fortunate to catch mine in time, and lucky to have who I consider
one of the best physicians in the nation,” said Sheriff Norman. “Early
intervention saved me from the mistakes I made in my younger years. Now I
can look to the future — and I have Dr. White to thank for that.”
Learn more about services and world-class care available at Atrium Health’s Levine Cancer Institute.
About Richard White, MD
Dr. White is the Distinguished Chair in Surgical Oncology. An award-winning physician and surgeon, Dr. White is renowned for developing Atrium Health’s novel immunotherapy program. He earned a medical degree from Columbia University in New York and completed his residency at Georgetown University, followed by a fellowship at the National Cancer Institute. Dr. White’s tenure at Atrium Health spans over 24 years. He received notable awards and served on many nationally distinguished boards including the Board of Directors of the American Cancer Society South Atlantic Division, the American College of Surgeons on the Commission on Cancer, the Alliance for Clinical Trial in Oncology, the society of Surgical Oncology and the American Society of Breast Surgeons.
