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XII No.5 - Sunday March 10 - Saturday March 23, 2013

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Update by Saichon Paewsoongnern

Doctor's Consultation  by Dr. Iain Corness


Is Melanoma a real problem?

Shock, horror headlines in the Aussie media last year claiming that tanning beds kill 43 Australians a year through melanoma alone and are responsible for another 2600 annual skin cancer diagnoses. That is certainly attention grabbing news.
Some basis for this also comes from a team at the Queensland Institute of Medical Research that has estimated sun beds are responsible for 281 cases of melanoma each year, the deadliest skin cancer. Overall, 43 of those patients died.
While researching an item on the cancers of women, I came across the also somewhat disquieting figures that Malignant Melanoma has the second fastest increasing incidence of cancer for women. In fact, the age-standardized rates have risen by 46 percent in the last decade. Some of the apparent increase may be due to increased surveillance and early detection as well as improved diagnosis, but most is considered to be real and linked to changes in recreational or holiday exposure to UV rays (including sunlight and sunbeds), and we do get the odd bit of sunshine here in Thailand.
I remember the first time I went to a beach in Thailand and saw all these people emerging from the sea fully clothed, that I thought the Thaitanic must have gone down offshore. However, I later realized that Thai people are not silly when they go fully clothed to the beaches to swim! It is generally just the pale skinned farangs that go there to fry.
Having come from sub-tropical Queensland, I can tell you that the capital Brisbane is these days considered to be the melanoma capital of the world, and of all the skin cancers you can get, malignant melanoma is the worst. If ignored and not caught early, it spreads throughout the body and almost all of these sufferers die within 12 months. The generally accepted time between late diagnosis and death is 10 months. That is despite heroic (and expensive) treatment.
When we first began to keep statistics on the incidence of melanoma in Australia, it became quickly evident that the further north you went (towards the equator) the greater the numbers of melanomas. White skin and UV radiation did not go well together.
It did not need rocket science to see that perhaps the reason the indigenous native aboriginals did not have the same incidence of melanoma as the white settlers was linked to skin color.
However, human nature being as perverse as it is, the white folks want to be brown (which is why solariums are popular in Australia) and the brown folks want to be white (which is why whitening creams are the number one cosmetic cream sold in Thailand).
However, the Thai people, even with their naturally protective brown skin, do stay out of the sun as much as possible (standing in a line in the shadow of the telephone pole for example), and have reduced their incidence of possible melanoma. That is while we farangs, with our totally unsuitable pink one-button birthday suits, stand in the sun’s rays as much as possible. Having myself emigrated to Australia from sunless Scotland as a young teenager, I can remember my Mum chasing me out of the house to get my shirt off and get a “healthy tan”! How times and our knowledge have changed! And we can thank all those medical professionals who have kept the statistics to be used by the epidemiologists who could then impart these findings to us all. Statistics which we hopefully take on board to take ourselves out of the danger.
The bad news about malignant melanoma you have already read above, but there is some good news. Protect yourself by covering up and using a very strong sun blocker of SPF 30 and above any time you are at the beach. And re-apply after swimming each time.
However, if you have any dark colored ‘spot’ that has changed shape, color, or become itchy you should get some expert advice from a specialist dermatologist. It is too dangerous to ‘wait and see’. Catch it early enough, before it begins to spread, and you can escape!
I get my spots and dots checked each year and have had a couple removed “just in case!”

Battered babies

The item you are about to read is one of my favorite medical case histories. Bruises on a child’s body are often considered proof that a baby has been battered. A visible bruise on the buttocks, the shape of a hand and five fingers is almost ‘undeniable’ proof.
There was a very celebrated instance of a GP in the UK having discovered that so many of the Asian babies in the practice were showing signs of being ‘battered’ that the children’s welfare people were called in and an enormous number of children taken away. However, the highly observant GP was wrong!
In Thailand, and the rest of Asia, a new-born baby with the ‘handprint’ bruise is very common, while child abuse is not common at all. The problem, or rather the condition, relates back to Genghis Khan and the Mongol hordes. It is a wonderful piece of folklore and a fine example of applied genetics.
Let’s look at the folklore first, and you are going to have to dig very deep to get this tale anywhere else! A Mongolian baby, called Tanujin, was born just over 1,000 years ago, but did not breathe. His father, in desperation, held his new-born son upside down and smacked him severely over the bottom, so much so that the baby drew breath and lived, but carried the life giving bruise for the rest of his days. That baby later became Genghis Khan, which means King of the Earth, and by the time he died in 1227 he was the ruler of a large chunk of it, including the area which later became known as Thailand.
History has chronicled that the Mongol hordes raped, pillaged and annexed countries from China to Persia. His highly mobile troops traveled the difficult terrain of Siberia. Famous cities were captured and looted such as Tashkent, Baghdad (still a good place to stay away from, thanks George) and Bokhara. Cities that surrendered were spared but those that resisted were razed and the people slaughtered. The Mongols conquered northern India and Afghanistan. In 1222, they defeated the Russian and Bulgarian armies. At the time of Genghis Khan’s death, his empire stretched from China’s Yellow River to the Dnieper, in Russia.
And now back to some interesting folklore. The descendants of Genghis Khan also showed the hand-shaped bruise on the buttocks, beginning with his four sons Ogdai, Jagatai, Juji and Tule, who were given one quarter of the empire each after their father died. They in turn passed on this ‘trademark’ and so this continues till today. If your “Luk Krung” children have the sign of Genghis Khan, called Mongolian Blue Spot, you can claim descent from the warrior king. However, there is quite a number of you, so I think there won’t be much left in Genghis’ estate by today.
Now Mongolian Blue Spot, as a clinical condition, is well documented, and I came across figures suggesting that at least one Mongolian spot is present on over 90 percent of Native Americans and people of African descent, over 80 percent of Asians, over 70 percent of Hispanics, and just under 10 percent of fair-skinned infants (Clinical Pediatric Dermatology, 1993).
Medically we describe Mongolian Blue Spot as flat bluish to bluish gray skin markings that commonly appear at birth (or shortly thereafter) and scientifically they are called Congenital dermal melanocytosis. They are flat, pigmented lesions with nebulous borders and irregular shape. They appear commonly at the base of the spine, on the buttocks and back, but also can appear as high as the shoulders and elsewhere. The medical text books also warn that occasionally Mongolian Blue Spots are mistaken for bruises and questions about child abuse arise. Obviously a text book that the UK GP did not read! Mongolian Blue Spots are birthmarks, not bruises.
So, for all of you with children with a peculiar blue birthmark on their bottoms, or for those interested in checking friends and neighbors (or the young ladies dancing in the chrome pole palaces), it seems fairly positive that the lineage is verified. You really have found descendants of the man who conquered more of the world than Alexander the Great. And guess what - my children have it too!

HEADLINES [click on headline to view story]

Is Melanoma a real problem?

Battered babies



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