Growing up in Jeffersonville, Indiana, blond-haired, fair-skinned Tobi Sample wanted to be bronze just like all the other cheerleaders and members of her high-school swim team. "We'd put baby oil on and lie on the roof so we'd be closer to the sun," she recalls. "I started going to a tanning salon when I was in my sophomore year, and I'd buy the unlimited monthly package because it was the cheapest and I could get really tanned."
Sample was still a sun lover after she became a nurse and had two daughters of her own. "Funny thing is, I'd protect my girls from the sun with sunscreen, but I would lie out to tan," she says. When friends warned that she'd get skin cancer, she joked, "At least I'll die pretty."
Those words haunt her to this day, because the tiny flesh-colored bump she found on her chest nine years ago turned out to be melanoma, the most serious type of skin cancer.
"It didn't look like anything more than a mosquito bite," she says. However, it worried her enough that she made an appointment to see a dermatologist. By the time she went, though, the bump was gone. Then it returned a year later, and this time it was bigger, red and scabby, and had a nodule underneath like a pimple. "I immediately knew something wasn't right," Sample says. The dermatologist wasn't concerned and didn't even want to biopsy it—but Sample insisted. Although surgery (which left her with a 4-inch scar) showed that the melanoma hadn't spread to her lymph nodes, her battle was just beginning.
Sample's attitude toward the sun changed completely. She started using sunscreen daily, as well as UV-protective clothing, sunglasses, and a wide-brimmed hat—and insisted that her daughters do the same. Her goal was to make it through the next five years with no signs of recurrence—a milestone that would greatly increase her chance of survival.
However, in 2013, two months short of the five-year mark, she found another tiny bump—this time on her shoulder. Tests confirmed that the melanoma was back, and now it had spread to her spine, ribs, collarbone, arm, and one of her lungs. "I feared the worst," Sample says. She knew that the average life expectancy for advanced melanoma was only ten months. Imagining her daughters' proms, graduations, and weddings that she'd miss, she resolved to do everything she could to combat the cancer.
There were very limited options for treating metastatic melanoma at the time, so her husband, Steve, an emergency-room physician, and her sister, also a nurse, began searching for clinical trials. They learned about Keytruda, an experimental immunotherapy drug that revs up the body's own disease-fighting cells. A trial in Chapel Hill, North Carolina, had one spot left and Sample was admitted just minutes before the recruitment deadline. She flew from Indiana to receive the intravenous drug every three weeks for a year. The travel exhausted her and strained the family's finances—and she hated that her absences reminded her girls how sick their mother was.
It was well worth it. After a few months, scans showed her tumors were shrinking, and she now has no signs of melanoma. "The doctor won't say 'cured' or 'in remission,' " Sample says. "They call it 'no evidence of disease.' " Although she'll take Keytruda indefinitely, it was recently approved by the FDA, so she no longer has to travel to North Carolina to get it. The tumors and radiation weakened her bones, but she's kept up with her passion for running and recently completed a half marathon—wearing a shirt with other skin-cancer patients' names on it, "in honor of all of us who are in the fight."
Melanoma is on the rise, especially in women under 40. The incidence rate in this group increased 178 percent from 1975 to 2012, but this number only reflects cases reported to the National Cancer Institute; the actual rate may be much higher. Researchers at Mayo Clinic found that there was an eight-fold increase in cases in women ages 18 to 39 in Minnesota between 1970 and 2009—and tanning salons are likely the cause.
You can't undo the damage that years of tanning has done to your skin. Melanoma—which is less common than basal-cell carcinoma or squamous-cell carcinoma—is the type of skin cancer responsible for the greatest number of deaths. If melanoma is detected before the tumor has spread to the lymph nodes, the five-year survival rate is about 98 percent, reports the American Cancer Society. However, five-year survival is 63 percent when the disease has spread to nearby lymph nodes or organs and only 17 percent when it has metastasized to distant organs.
In 2009, the World Health Organization designated indoor tanning a known carcinogen, but one study in JAMA Dermatology found that nearly 32 percent of teenage girls and 69 percent of female college students have used a tanning bed. Ultraviolet radiation (artificial and natural) damages the DNA in skin cells, making them prone to cancer, and people who first use a tanning bed before age 35 increase their risk of melanoma by 75 percent.
"Tanning is a hard habit to break," says Dawn Davis, M.D., a pediatric dermatologist at Mayo Clinic. "Research has shown that being in a tanning bed causes the release of pleasurable chemicals in the brain, so it can be addicting, just like smoking." Amazingly, Dr. Davis has had patients as young as age 5 who had atypical moles and had tanned at salons with their mother. "The mothers say it's easier and cheaper than getting a babysitter, so they'll sign consent for their child to have a tanning-bed session at the same time as theirs," Dr. Davis says.
There is one piece of good news: Even though more young women are getting melanoma, the death rate from the disease is decreasing. We're learning to check our skin regularly, so skin cancers are being detected early. Especially if you have a history of tanning, look for the ABCDEs of moles: Asymmetrical shape, irregular Border, Color variations, Diameter larger than a pencil eraser, and Evolving changes over time. Skin cancer can appear on the palms or on the soles of the feet (in African Americans, they are among the most common spots) and even on skin that's never exposed to the sun. Use your phone to take a photo of any suspicious mole next to a ruler (so you can track if it's changing) and see a dermatologist.
Sample's melanomas did not develop in a mole, though—which emphasizes the importance of watching for any skin growth that lasts longer than two weeks. "Even if looks harmless, get it evaluated soon," says Dr. Davis. "It is uncommon to develop new moles after approximately age 25."
Sample wants to spread the message about the dangers of tanning to moms like her and to teens who are in danger of getting hooked. "I hope I can help prevent them from making the same poor choices I made when I was a teenager and thought I was invincible," she says. She spoke at her daughters' school on Melanoma Monday last May and told the stories of women she's met during treatment, including one who lost part of her face to skincancer surgery and one whose cancer spread to her brain. "The tanningbed industry claims that tanning is healthy because it helps you make vitamin D," says Sample, who's been cancer-free for the last year. "But you can get vitamin D from your diet and from vitamins without putting yourself at risk for melanoma."