Khloé Kardashian normally makes the news for outfits, appearances at glitzy events, and of course, for the family TV show, Keeping Up with the Kardashians. But more recently she made the news for a much more serious reason. After several months of waiting for a small, innocuous-looking blemish on her face to clear up on its own, she found she had a rare and serious form of skin cancer.
In this post, we’ll look at how events unfolded for Khloé Kardashian, and at how we can try to turn this into a teachable moment for our patients.
Khloé Kardashian’s story
Khloé Kardashian’s fans see a lot of her face; she’s an active Instagrammer, in addition to photos and TV appearances. So when she started wearing a skin-colored bandage on her face, they were bound to notice. Khloé initially said she had a bump on her face, maybe a spot, that she just felt more comfortable covering up.
Seven months later, in October this year, she told fans she had a brush with skin cancer. The ‘bump’ was a malignant melanoma.
It’s great that Khloé managed to get her issue dealt with in a timely manner, but it’s hardly surprising that a lot of people wait so long before seeing a doctor. Even in her Instagram photo, Khloé’s skin cancer doesn’t look like much of anything.
That’s an illusion: it’s a melanoma, a type of skin cancer which can spread to other parts of the body (metastasize) and become untreatable if it’s not caught early and dealt with. Melanomas don’t always stay on the skin: they can spread to the lymph nodes, lungs, gastrointestinal (GI) tract, bones, or brain. Melanomas are caused by ultraviolet rays from the sun damaging the DNA in skin cells, which then become cancerous. It’s thought to be mostly UV-B radiation that causes skin cancers.
What prompted Khloé Kardashian to see a doctor?
Khloé has had melanomas before, and she’s serious about checking for them and practicing good skincare.
‘At 19 years old, I had melanoma on my back and I had a surgery to remove that as well, so I am pre-composed to melanomas. Even those who are not, we should be checking all the time,’ she said.
After having what she assumed was a zit for seven months, she decided to have it biopsied to be on the safe side; doctors ordered a second biopsy to be sure, because melanomas like Khloé’s are ‘incredibly rare for someone my age,’ she explained.
‘I am someone who wears sunscreen every single day, religiously so no one is exempt from these things,’ Kardashian went on. ‘Please take this seriously and do regular self-exams as well as your annual checkups.’
We second that last part loud and clear. So does Dr. Tess Mauricio, one of the dermatologists who autopsied Kardashian’s melanoma, who told RealSelf: ‘I have personally diagnosed skin cancers where the original lesion looked very innocent. It can look like just a small, skin-colored growth, a pearly, translucent smooth growth, a changing mole, or discoloration on the skin.’
‘It’s important to be self-aware, do regular skin checks at home and know your moles and lumps and bumps, where they are, and how they look. If you get any new growths or the old ones are changing, bring it to your dermatologist’s attention.’
How did Khloé Kardashian’s doctor treat her cancer?
Melanomas have to be removed surgically. A wide local excision removes the melanoma and, to be safe, some of the normal tissue around it. Skin grafting is sometimes used to reduce scarring. Some patients are given adjuvant chemotherapy after the surgery to reduce the risk that the cancer will return.
The operation to remove Kardashian’s cancer was a success, and ‘all my margins appear clear and now we are onto the healing process. So, here we are...you'll continue to see my bandages and when I'm allowed, you'll probably see a scar (and an indention in my cheek from the tumor being removed).’
What signs of skin cancer should you and your patients look out for?
The first, most common sign of melanomas is usually an existing mole changing shape or color, including:
- Getting bigger
- Changing shape
- Changing color
- Bleeding or becoming crusty
- Itchy or sore
Some clinicians recommend using the ‘ABCDE’ mnemonic to remember key things to watch out for:
- Asymmetrical: moles are normally more or less symmetrical even when they’re not round. Melanomas usually have two very differently-shaped halves and are an irregular shape
- Border: melanomas usually have a notched or ragged border, where moles usually meet the skin smoothly
- Color: moles are usually a markedly different color from the surrounding skin but a similar color across the mole itself. Melanomas will usually be a visible mix of two or more different colors.
- Diameter: melanomas are usually larger than 6mm (about ½ inch) in diameter
- Enlargement or Elevation: a mole that changes size over time, or stands out more than it used to, is more likely to be a melanoma
These aren’t foolproof: some moles are larger than 6mm, some melanomas are smaller. The classic melanoma is discolored, raised, an uneven shape, large and asymmetrical, but there are always exceptions — just ask Khloé Kardashian. We should encourage patients who have a mole that meets even one of these criteria to get their skin checked.
Another possible sign of skin cancer is a new mole, or a mole that itches or bleeds. Any new mole should be checked, and a mole that starts to bleed spontaneously is probably a melanoma. Worse, it’s a sign of a more advanced, and therefore more serious, melanoma. Remind your patients that they don’t need to worry about moles that bleed after being scratched or cut though — that’s normal.
Best practices for protection
What should patients do to protect themselves from the risks of melanoma?
First, sunscreen. We’re right with Khloé Kardashian on this one: everyone should be wearing some sunscreen pretty much all the time. It’s true in summer and winter, and it’s true for people with dark skin tones: paler skin is more vulnerable to UV damage, but darker skin isn’t immune.
Sunscreen alone won’t fix the problem. It needs to be the right kind of sunscreen. Melanomas are caused primarily by UV-B radiation, so encourage patients to check that the sunscreen they’re using specifically protects against UV-B or advertises itself as ‘broad spectrum.’
(If you’re not at risk of overloading them with information, remind them that you can get melanomas in your eyes too, and suggest they check that their sunglasses also specifically protect against UV-B.)
Sunscreen also needs to be an appropriate SPF (Sun Protection Factor). Most dermatologists recommend using an SPF of at least 30, which blocks 97% of UV-B rays. In very bright sun or sunshine brighter or more prolonged than they’re used to — on vacation, for instance — patients should be encouraged to wear a stronger SPF.
In many cases, patients are using sunscreen but they’re not using it right. When they’re outdoors, suggest they apply sunscreen to all exposed skin a half-hour before leaving the house, then reapply roughly every two hours. Swimmers should reapply sunscreen every time they get out of the water.
No sunscreen can fully protect your skin alone. Patients should also be encouraged to consider wearing light layers and hats to offer some sun protection, and seeking shade during the brightest hours of sunshine. Even now, when people are aware of the dangers, it’s difficult to convince some people against spending long hours outdoors in the sun in just a bathing suit, but even a single incidence of sunburn can increase a patient’s risk of skin cancer.
Conclusion: Keeping up with the Kardashians
Kudos to Khloé for using her own cancer scare as a teachable moment. Far too many Americans are unaware of the real risks, don’t know how to check themselves for skin cancers or recognize them when they see them, and don’t understand how serious they can be. Hopefully, we can use it as a teachable moment for our patients, and encourage them to check themselves, come to us if they find anything worrying, and take protecting their skin from the sun seriously!