Skin Cancer

In May 1987, Marilyn noticed a raised brown lesion on her leg. She didn’t think much of it at first but eventually she asked a friend who was a registered nurse if it looked suspicious. Her friend suggested she see a dermatologist, and the lesion was removed. To Marilyn’s surprise, the lesion was diagnosed as being a stage II melanoma. She went back to the dermatologist soon afterwards for a biopsy and had “a chunk of skin” removed. Marilyn had trouble walking for a few days following the biopsy. Fortunately, the lesion never recurred. Marilyn continues to do self-examinations on a regular basis. Her friend Douglas, however, wasn’t as fortunate. He died from complications related to a melanoma in 1988.

Skin Cancer: A Very Real Danger
In the United States, 1 out of every 6 or 7 people develops some form of skin cancer. Melanomas account for 7,500 deaths annually. The main culprit behind the rise of skin cancer is too much exposure to the sun. Many years ago, pale skin was a sign of aristocracy while a deep tan was a sign of having to do manual labor for a living. In the 1980s, practically everyone tried to get a tan using Coppertone, Hawaiian Tropic, or even baby oil. Tanning salons are prevalent in south Florida, which is ironic considering that the state’s subtropical climate allows for maximum sun exposure even during winter months. While the word “cancer” is frightening to most people, doctors reassure patients that if treated early, skin cancers can be curable. The U.S. National Institute on Aging states: “All skin cancers could be cured if they were discovered and brought to a doctor’s attention before they had a chance to spread.”

The skin, or integumentary system, is the body’s largest organ. In males, it comprises an average of 20 square feet. In females, the average is 17 square feet. It is a human’s first line of defense against heat, cold, trauma, toxins, chemicals, and pollutants. However, while sunlight is essential for life—it provides warmth and stimulates the body to make vitamin D—it is also the skin’s natural enemy. According to the book Saving Your Skin, “ultraviolet (UV) light damages DNA, causes immunosuppression and may activate chemicals in the body that stimulate the chain of events leading to cancer.” The most common type of cancer is skin cancer, which includes melanomas, basal cell and squamous cell carcinomas.

Basal and squamous cell carcinomas begin in the outer layer of the skin (the epidermis), which is only 1/25th of an inch thick on average. These non-melanoma cancers appear to result from chronic sun exposure, such as that of outdoor workers and they appear almost exclusively on sun-exposed body parts such as the face and hands. Malignant melanomas, which account for 5% of all skin cancers, also begin in the outer layer of the skin. One factor contributing to the development of melanomas appears to be intense, intermittent exposure to the sun, such as that received by indoor workers who vacation in the sun. Melanomas can develop from pigmented moles on the upper back or legs. Marilyn’s skin cancer was located behind her left knee. Melanomas can invade the deeper layer of the skin (the dermis) and from there quickly spread to the blood vessels or lymph. From there, it can metastasize, or transfer, to other internal organs. Yasmin E. Johnston, M.D., cautions, “Once a melanoma has gone into the deeper layers of the skin, there is no effective cure.” Paradoxically, if a melanoma is discovered and treated early (before reaching a depth of 0.76 mm), it is a highly curable disease.

The ABCDs of Melanoma
The Skin Cancer Foundation (www.skincancer.org), a nonprofit organization based in New York, NY, provides some key warning signs of malignant melanoma as shown below:
Asymmetry
Most early melanomas are asymmetrical: a line through the middle would not create matching halves. Common moles are round and symmetrical.

Border
The borders of early melanomas are often uneven and may have scalloped or notched edges. Common moles have smoother, more even borders.

Color
Common moles usually are a single shade of brown. Varied shades of brown, tan, or black are often the first sign of melanoma. As melanomas progress, the colors red, white and blue may appear.

Diameter
Early melanomas tend to grow larger than common moles - generally to at least the size of a pencil eraser (about 6mm, or 1/4 inch, in diameter). However, they may also be smaller.
Treatments available for skin cancers include surgical excision, scraping, burning with an electric needle, cryosurgery (freezing) and radiotherapy. A procedure known as Mohs micrographic surgery, using microscopically controlled excision, is effective in eradicating both basal and squamous cell carcinomas and has a cure rate of 95% to 99%. Tissue reconstruction, including skin grafting, may be necessary. The question then becomes: what can be done to prevent skin cancer?

Skin Cancer Prevention in Five Easy Steps

1. Limit your sun exposure, especially between 10:00 am and 4:00 pm, which are peak hours for ultraviolet (UV) radiation. If you’re outside during those hours, protect yourself with a broad-spectrum sunscreen with an SPF (sun protection factor) of 15 or higher. Cosmetic giant L’orèal recently presented Mexoryl SX, a wonder ingredient that may change sunscreens forever. It’s a sheer UVA/UVB blocker that can offer an SPF range anywhere between 65 and 90. However, it has not received clearance from the FDA (Food and Drug Administration) as of this writing. Regular car windows screen out close to 100% of UVB rays but allow UVA rays through. Factory-applied films can filter out up to 99% of UVA/UVB rays.
2. Examine your skin from head to toe at least once every three (3) months. Use a full-length mirror to examine the backs of your legs, arms, and buttocks and use a hand-held mirror to examine your head, scalp, ears, and neck. See a dermatologist annually for an examination.
3. Remember that no sunscreen is 100% effective against sunburn, nor does it prevent skin cancer. Reapply sunscreen every two (2) hours when outdoors, especially if you’ve been active (swimming or jogging). And also remember that SPF is not cumulative. If you apply a moisturizer that contains SPF 15 and then use a sunscreen with an SPF of 30, you do not have an SPF of 45. Most cosmetics including moisturizers, face creams, foundations, and even lipsticks have SPF in them.
4. Education regarding skin protection and skin cancer prevention begins in childhood. Teach your children good sun protection habits.
5. Wear protective clothing such as long pants, long-sleeved shirts, broad-brimmed hats and UV-protective sunglasses when outdoors. A typical white T-shirt has an SPF 8, but you can boost its sun protection factor if you wash it with Rit SunGuard treatment (about $20). Add the product during the wash cycle and your clothing will provide extra protection for up to 20 washes. There are also shirts and shorts with high SPF factors available from companies such as SunSafe (www.sunsafe.com), Sportif USA (www.sportif.com), and Solumbra (www.sunprotections.com).


Ultimately, the best prevention rests with an educated, motivated patient. Give serious attention to safe sun habits. Remember that the sunburn you receive today may develop into skin cancer 20 years or more in the future.