"Melanoma Dangers During SM Play"

Copyright by Jay Wiseman, author of "SM 101: A Realistic Introduction"
All rights reserved.

Quick Summary

Melanoma is an increasingly common form of life-threatening cancer, usually found on the skin, and known for its early and rapid tendency to spread to other organs. Melanoma is frequently found on the back -- a location often whipped during SM play. The back is also a location not easy for a person to examine themselves. Studies have shown that manipulation of a melanoma (and a whip stroke, spank, or other type of blow would, obviously, be a form of "manipulation") definitely increases the number of cancer cells that break off and begin to spread to other parts of the body. It is therefore essential that SM practitioners know how to spot possible melanomas, both on themselves and on their partners, to avoid whipping or otherwise disturbing melanomas, and to receive early, definitive medical diagnosis and treatment.

First Notice

Earlier this year, my partner Lady Green taught one of her workshops on the fundamentals of female domination. After the class, one of her students privately shared a concern of his. It seems that a few months earlier he had been about to receive a whipping from a woman but, upon examining his back, she found a suspicious-looking mole. She told him about the mole, and about her concerns, then proceeded to "torture" him in a manner that avoided his back. He promptly consulted a physician, who diagnosed the mole as a malignant melanoma and excised it. At last report, the man remains in good health.

The incident raises a number of concerns, both about the disease itself and about its relationship to SM play. I have spent a considerable amount of time researching this condition and discussing it with at least half a dozen physicians, including a dermatologist who specializes in treating melanoma patients and a pathologist who specializes in skin diseases. Here is my report.

Basic Facts

Melanoma is a form of cancer that arises from a type of cell called melanocytes. Most of these cells are, obviously, in the skin, but melanocytes are also in the mucous membranes, under the nails, in the mouth, and in the eye (including the retina). Melanomas can develop from the sites of existing skin lesions or can develop on their own in areas of previously clear skin.

Melanoma is the eighth most common form of cancer in the United States and currently accounts for about 2% of all cancer deaths, with 6,900 deaths predicted for 1994. The U.S. death rate from melanoma has been growing steadily at a rate of about 4% per year for the last thirty years and is now more than double what it was in 1960. The frequency of melanoma is expected to continue increasing.

The skin is by far the most common melanoma site. About 600,000 new cases of skin cancer are diagnosed in the U.S. each year. Roughly 95% of these are "relatively" benign basal cell or squamous cell carcinomas and about 5% (32,000 cases) are melanomas. (Non-melanoma skin cancers are predicted to cause 2,300 deaths in 1994.)

Risk Factors

The average overall lifetime risk of developing melanoma is about one in a hundred. Melanoma is most commonly found in fair-skinned Caucasian people, especially if they have blue eyes and naturally blonde or red hair. It is more common in people who have a family history of melanoma, and more common in people who have more than fifty ordinary moles. Melanoma is most frequently found in people aged twenty to sixty. A strong correlation exists between episodes of severe sunburn during childhood and increased risk of developing melanoma later in life.

Exposure to sunlight

Exposure to large amounts of sunlight, both in childhood and as an adult, increases the probability of certain subtypes of melanomas appearing, but not of others. (There are four basic subtypes.) Melanomas are more frequent near the equator, and the population of Arizona has the highest frequency of melanoma in the United States. Cancer prevention authorities recommend the use of sun block with a SPF of 15 or greater.

Melanoma and non-Caucasians

Melanoma is distinctly rare in non-Caucasians, and all but unheard of in Asians. Non-Caucasians face about one-twelfth the average overall lifetime risk of melanoma that Caucasians face. (Still, 200+ non-Caucasians die of melanoma every year -- the majority of them either Black or Hispanic.) When a melanoma is found on a non-Caucasian, it is usually found on the palms or soles, under the nails, on a mucous membrane (including inside the mouth), or within the eye.

Melanoma and people with HIV

Melanoma is distinctly more frequent and more aggressive in people who have HIV or are otherwise immunosuppressed. These people must be watched especially carefully.

Location on the body

Melanomas can appear anywhere on the body's surface, including the ano-genital region, the hair on the head, the inside of the mouth -- including the palate, and the interior of the eye. The back and lower legs are the most common sites in women. The back, chest, abdomen, and arms are the most common sites in men. (The issue of whether or not melanomas can be encapsulated with breast cysts -- and possibly released during heavy breast play -- was not itself specifically explored during the research done for this article; no mention of such a phenomenon was noted in the references consulted.)

Appearance of Melanoma

Melanomas are described according to the classic ABCD criteria:

Asymmetry: Common moles are both round and symmetrical. A line drawn through a melanoma, no matter from what direction, will not create matching halves.

Border: Common moles usually have smooth, even borders. Melanoma borders are usually uneven.

Color: Common moles are usually a uniform shade of brown. Melanomas can be of differing shades of brown, and/or may have various patches of red, white, or blue skin. (When I was in medical school I heard it referred to as "the patriotic lesion" for this reason.)

Diameter: Common moles are usually six millimeters -- a quarter of an inch -- or less in diameter. (About the size of a pencil eraser.) Melanomas, particularly in their early stages, can be larger.

Some authorities add a fifth ( E ) criteria:

Elevation: A dark nodule elevated above the rest of the skin can be a melanoma.

Detection

Experts recommend that each person conduct a monthly self-examination of their skin, including their scalp. Mirrors can help a great deal, as can a helpful partner. Learn the location, size, color, and other characteristics of whatever marks your skin already has. This will allow you to quickly detect any changes in existing marks or the appearance of new ones. "Knowing your skin," particularly the skin on your back, is your first, best line of defense against this very serious disease.

This monthly self-exam should be supplemented with an unhurried annual examination of your skin by an experienced physician. (One physician I consulted stressed this point, and also cautioned that not all examinations done by physicians are unhurried.)

Several different sources cautioned that moles which bleed relatively easily should be regarded with the traditional "high index of suspicion."

Treatment

Treatment is usually by excisional biopsy, which involves removing the entire lesion plus a few centimeters of surrounding healthy skin. A pathologist then evaluates the tissue. If the suspected melanoma is unusually large, an incisional biopsy is done. However this is avoided if possible because of concerns that cutting into the melanoma might cause it to shed cells. In the case of melanomas that are exceptionally large, or on a location that has cosmetic importance, such as the face, the patient may be referred to a plastic surgeon.

Complications and Prognosis

Melanoma can metastasize by either the bloodstream or the lymphatic system. If found while still localized, the overall five-year-survival rate is in excess of 90%. If the disease has spread to the local lymph nodes but no farther, the five-year-survival rate is approximately 50%. If the disease has spread beyond the lymph nodes, typically to sites such as the liver, lungs, bones, or brain, the five-year-survival rate is less than 15%. Melanomas on the torso have a grimmer prognosis than do melanomas on the limbs because less "filtering" by the lymphatic system occurs in that region.

Pathology

Cancer cells do not bond to each other as strongly as healthy cells usually bond to each other. Therefore, many cancer sites "leak" cells, which then travel elsewhere in the body, to a greater degree than healthy tissues leak cells. This is known as increased friability.

Studies have definitely proven that manipulating a melanoma increases the number of cancer cells that break off and "float downstream" (or is it "upstream"?). While the body's immune system consumes most such cells, preventing them from forming new cancer sites, it certainly cannot be assumed all such cells will be so consumed.

Medical-related precautions

Medical professionals are cautioned not to manipulate a suspected melanoma site any more than absolutely necessary. The treatment is excisional biopsy if at all possible. Incisional biopsies, and other cuttings of the site, are avoided unless clearly necessary. Electrolysists are trained not to stick their needles (which can give off heat, or electricity, or both) into moles. There could also be Sports Medicine aspects, particularly regarding contact sports such as football or the martial arts.

SM-related precautions

SM-related precautions include not whipping or otherwise striking a possible melanoma, not piercing or cutting through it, and noticing if a mole starts to bleed after being whipped. Those about to receive a whipping, piercing, or cutting should caution their partners about "suspicious" moles on their skin. In addition, subjecting the site to intense heat (from dripping candle wax, for example) or to jolts of electricity (from a cattle prod or violet wand) could also be much more risky than previously thought.

For further information:

The following organizations provide excellent educational literature for the general public, including relatively inexpensive color brochures that could be bought in large quantities and distributed to SM clubs and other groups. Small samples will be sent on request. I have looked over most of the available materials, and can be contacted at the addresses listed in the copyright statement regarding recommendations.

• National Cancer Institute, Cancer Information Center
  (800) 4-CANCER
• American Cancer Society, 1599 Clifton Road, N.E.,
  Atlanta, GA 30329, (800) ACS-2345
• Skin Cancer Foundation, 235 Fifth Avenue, New York, NY 10016,
  (212) 725-5176
• American Academy of Dermatology, P.O. Box 3116,
  Evanston, IL 60204-3116, (708) 869-3954
• American Society of Plastic and Reconstructive Surgeons,
  444 East Algonquin Road, Arlington Heights, IL 60005, (800) 635-0635

The academic references listed below were consulted during the preparation of this article. (Editor's Note: links have been provided where possible to the latest editions of the publications listed here.)

• Andrews' Diseases of the Skin: Clinical Dermatology, 12e
• Dermatology Skills for Primary Care: An Illustrated Guide (Current Clinical Practice)
• Goodheart's Same-Site Differential Diagnosis: A Rapid Method of Diagnosing and Treating Common Skin Disorders
• Bates' Guide to Physical Examination and History-Taking

Conclusion

While many sadomasochists like "on the edge" play, I doubt that many would want their submissive partners, no matter how self-sacrificing, to risk getting a fatal case of cancer. Like many other cancers, melanoma is almost completely curable if detected and treated early. Informed, monthly self-examination of the skin is the most important step.

Check your partner's skin. If you spot a funny-looking mole, don't whip it!