North Carolina is known as the Tar Heel state, and the term “tar heel” dates back to the state’s early history, when workers would collect tar on their heels while barefoot and burning pine boughs to produce tar and pitch. The name was not a compliment.

Despite its origins as an insult, North Carolinians adopted the moniker, and now it’s an honored nickname. Many collegiate sport teams, businesses, organizations, and other entities now use the name with pride.

So what is the state of the Tar Heel state when it comes to melanoma?

In 2021 it’s projected that there will be 4,250 cases of invasive melanoma diagnosed in North Carolina and 210 people will die of the disease. North Carolina has the 18^th highest incidence rate of melanoma in the U.S., using the most recent data available.

Just as they turned Tar Heel from an insult to an honor, North Carolinians have been attempting to take a negative and turn it into a positive with their response to melanoma in their state.

One important example is North Carolina’s laws regarding indoor tanning. North Carolina has arguably the strongest statutes in the country as it pertains to the regulation of commercial indoor tanning devices. The state requires the registration and regulation of facilities and equipment which “employ ultraviolet and other lamps for the purpose of tanning the skin of the living human body through the application of ultraviolet radiation.” North Carolina requires licensing of the tanning devices, placement of warning signs in the facilities, items such as physical barriers to protect customers, timers, usage of protective eyewear, mandated operator training by one of the approved courses—and more.  In fact, North Carolina’s regulation and licensing of tanning salons has been used as a model to draft legislation in other states. In 2015, North Carolina became the 12th state to ban minors under the age of 18 from indoor tanning devices, an effort which AIM at Melanoma actively led with the North Carolina Dermatology Association and the American Cancer Society Cancer Action Network.

North Carolina is home to several cancer institutions known for their expertise in melanoma treatment and clinical trials. One is Atrium Health’s Levine Cancer Institute (LCI) in Charlotte. Besides its treatment and research programs, LCI offers a number of melanoma-related outreach programs. The ICAN Cancer Ambassador Program is an education and prevention program for North Carolina youth. Within the curriculum, there is a dedicated lesson about melanoma and other skin cancers, with a focus on sun safety and prevention. Code T.O.M.—Firefighters Taking on Melanoma—is a cancer education program that raises awareness about melanoma and other cancers that are high risk for firefighters. Both of these programs have reached thousands of students and firefighters. LCI has offered free skin cancer screenings for many years. LCI also offers a variety of free melanoma/skin cancer educational opportunities, including the Living with Melanoma symposium with AIM at Melanoma in October 2020. The total reach for that event was at least 1300, with availability through Facebook Live, live stream, and YouTube (watch it here). You can find other melanoma information and events for LCI on their website.

Duke Cancer Institute (DCI) in Durham is another melanoma treatment and research center in North Carolina known for its expertise. DCI is part of the National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 31 leading cancer centers devoted to patient care, research, and education. Especially notable on the programming front is DCI’s annual melanoma consortium, first organized in 1988 by Hilliard Seigler, MD. Now called Hilliard Seigler Duke Melanoma Consortium, the “Seig DMC” gives patients, families, and friends updates on advances in melanoma. This valuable annual event, now in its fourth decade, continues to serve Duke’s melanoma community. For other DCI melanoma programming and information, see their website.

One consistency we see all across the country is that many melanoma survivors, families, and providers work publicly in the fight against melanoma. North Carolina’s residents are no different. April Salama, MD, is a great example of a Tar Heel who is deeply involved in the effort to find the cure for melanoma. She is the director of the Duke Cancer Institute’s Melanoma (and advanced skin cancers) Disease Group. She grew up in Raleigh and attended UNC Chapel Hill for both undergraduate and medical school. She wanted to serve patients in her native North Carolina, so after residency and fellowship at the University of Chicago, she returned to the Tar Heel state. Among other accolades, in 2017, she received a National Cancer Institute Cancer Clinical Investigator Team Leadership Award—one of only ten recipients nationally that year. Executive director of Duke Cancer Institute, Michael Kastan, MD, PhD, said that under her leadership, the melanoma clinical trials program had received national recognition as “a leading site for patient accrual in a number of landmark melanoma trials.” We are proud to note that Dr. Salama is one of AIM’s Women in Melanoma members.

The Code T.O.M. program at LCI, noted above, is named after Tom Robinson, a firefighter who died of melanoma in 2013. His son, James Robinson, an Atrium Health employee and volunteer firefighter, co-founded the program with Levine Cancer Institute in 2016. LCI brings Code T.O.M. directly to current and former firefighters at firehouses throughout the state. The workshop teaches them to be vigilant about their own health, to know the early symptoms of cancer, and to ask questions when they see their physician. LCI also offers firefighters free screenings that can detect cancer early, when it’s easiest to treat, and improves overall survival.

Tracy Callahan is another notable melanoma survivor and advocate in North Carolina. At 38 she was diagnosed with early-stage melanoma. She would end up with four more melanoma diagnoses. After her third diagnosis, and inspired by the nickname “Polka Dot Mama,” given to her by her two boys, Tracy started a blog and began to network with survivors and skin cancer organizations across the country. Soon her activities became, officially, the Polka Dot Mama Melanoma Foundation.

The recent trend of North Carolina’s melanoma incidence rate of 24.6 melanoma cases per 100,000 people is “stable,” and the melanoma death rate of 2.3 people per 100,000 is “falling.” Stable incidence is good, but it would be better, of course, if both numbers were trending lower. To get there, it’s people like Dr. April Salama, James Robinson, Tracy Callahan, and many others who work alongside them and throughout North Carolina that are making a difference for their fellow Tar Heels.