SKIN CANCER PREVENTION

By Vern S. Cherewatenko, MD, MEd

INTRODUCTION

Skin covers our entire body. It is made of two layers the Epidermis Layer and the Dermis Layer. There are three type of cells which make up the outer epidermis layer, they are:

Squamous Cells - The flat, scaly cells found on the outer layer of the skin.

The Dermis layer, below the epidermis, contains deeper structures like blood vessels, nerves and glands.

There are three types of skin cancer which occur in each epidermal cell type. Skin cancer is slow to develop and can take up to 20 years to be seen. Squamous Cell Cancer and Basal Cell Cancer are the most common and respond the best to treatment. The most serious form of skin cancer is Melanoma. Melanoma is on the rise in our population, increasing by 4% each year. An estimated 800,000 cases of skin cancer diagnosed each year. Many of these cancers will be in the form of the two most common skin cancers, basal cell carcinoma and squamous cell carcinoma, however Melanoma will affect about 80,000 people this year. Skin Cancer is the term given to any of the three kinds of cells described above.

WHAT CAUSES SKIN CANCER?

Sunlight, made up of ultraviolet radiation, causes direct damage to the cells of the epidermis. As the damage occurs the cells can become cancerous and can become malignant or spread to areas away from the primary source. Sunlight is made of both UVA and UVB rays. Tanning is your skins reaction to UV light, however, it does not prevent skin cancer.

UVA: Aging Rays - The UVA rays penetrate the skin deeply, all the way to the dermis and causes fine lines and wrinkles, or aging of the skin. The leathery appearance of the skin of "sun worshippers" is caused from UVA rays of sunlight.

UVB: Burning Rays - UVB rays cause damage to the epidermal cells of the skin; the squamous cells, basal cells and melanocytes. UVB can cause these cells to become cancerous and potentially malignant leading to death. Approximately 8000 deaths per year are from malignant melanoma.

The total amount of sun received over the years and episodes of intense sun, including sunburn increases your risk of skin damage leading to skin cancer. It is estimated that people get 80% of their lifetime exposure to the sun by the age of 18. Children are particularly at risk for getting too much sun and ultraviolet exposure. Since the sun you get while you are a child can affect you when you are an adult, it is critical to protect our children from the sun's harmful rays using adequate sun block.

Heredity and Environment also is involved in the skin cancer equation. Fair skinned people have a higher risk as their natural protection is minimal. The Ozone layer, which filters out UV radiation, is thinning allowing more UV radiation through to the earth. UV light is stronger as altitude increases due to less atmospheric protection. The closer to the equator you are the higher risk for overexposure to UV light. Clouds afford some protection by blocking up to 50% of the rays from penetrating to the earths surface.

All of us, everyone needs protection from the suns harmful rays, but many ignore or deny the ill effects the sun can cause. We admire tanned bodies and sometimes spend a lot of money to get one, either naturally or artificially. The sun can be a wonderful friend, making us feel healthy and cheerful. The fact is that the sun is responsible for 90% of the skin cancers yearly in the United States for those who are in it unprotected.

• When possible, avoid the sun between the hours of 10:00am and 3:00pm. This is the period when the sun's rays are the most dangerous.
• Use a sunscreen of SPF 30 or higher whenever you spend time outdoors.
• Apply the sunscreen a half hour before going outdoors.
• Apply the sunscreen liberally to all exposed areas of the skin.
• Wear protective clothing, including a broad brimmed hat to shade the neck and ears.
• Wear UV-blocking eyewear or sunglasses to prevent damage to the retina.
• Practice self-skin examination. Look at your moles and the features of your skin. If you spot anything which looks concerning, see your doctor immediately.
• Protect your children!, Do not allow children under the age of 6 months to be exposed to the sun as sunscreens should not be used in this age group.
• Reapply sunscreens liberally, every two hours, especially after swimming or perspiring.
• Wear clothing that protects your body and shades your face, hats should provide shade for your face and the back of your neck.

SPF stands for sun protection factor. This is the incremental time period you can stay in the sun without burning. If you normally burn in 10 minutes without protection, then an SPF 30 lotion will provide you with 30 times or 300 minutes of protection without burning. A sunscreen should provide both UVA and UVB protection.

Moles and pigmented lesions on the skin should be observed for several changes.

• A skin growth that increases in size, and appears pearly, translucent, tan, black, brown or multicolored.
• A mole that changes color or texture, becomes irregular in shape and gets larger.
• A spot or growth that continues to itch, hurt, crust, erode or bleed.
• An open sore that lasts for more than four weeks, or that heals and then reopens.

There are four warning signs when it comes to melanoma, we call them the ABCD warning signs:

A - Asymmetry -- some part of the mole doesn't appear like the other part

B - Border -- irregular, notched or jagged edges

C - Color -- varied and multiple colors of the mole or lesion

D - Diameter -- size which is larger than a pencil eraser (>6mm)

It is a good idea that partners look at each others skin one time each month and report any unusual appearing lesions or new moles or spots to their health care provider.

Melanoma, like most cancers, is best treated when found early. Melanoma can spread, or metastasize, quickly to other parts of the body through the blood vessels and the lymphatic system. You should see your doctor if you have any of the warning signs such as; change in size of a mole, oozing or bleeding, itching, hardness, lumpy, swollen or tender to the touch. Melanoma can appear as a new mole or pigmented lesion. Melanoma is more common on the arms and legs in women and more common on the trunk in men. Melanoma is the worst of the skin cancers. Approximately 80,000 new cases are diagnosed each year. This is nearly twice that which has been reported previously. Under-reporting is felt to be the cause of the low numbers previously.

• Approximately 50% occur in people under 50 years of age.
• Malignant Melanoma is the most frequent cause of cancer in females aged 25-29
• Malignant Melanoma is the 2^nd most frequent cancer(after breast cancer) in the 30-34 age group.
• Nearly 8000 deaths are estimated yearly due to malignant melanoma.
• Early diagnosis and prompt excision is the key.

Nonmelanoma skin cancer is the most common malignancy occurring in the Caucasian population of the United States. There are 18 times more nonmelanoma cancers than melanoma cancers. Estimates of up to 1.2 million cases of nonmelanoma skin cancers are diagnosed annually. Approximately 2100 deaths are caused by nonmelanoma skin cancers.

Ask your employer to learn more about skin cancer. Refer them to this website. We provide resources for employers to protect their employees from the risk of skin cancer. Many employers are required or choose to provide protective equipment while their employees are on the job. Protection against skin injury from sunlight is no different from protecting against getting hit in the head with falling debris. Prolonged exposure to the sun injures skin causing the potential to develop skin cancer at a later point in time. We must think of prevention with sun exposure just as we do with smoke exposure of our workers. Workers exposed to the sun should have available either a SPF 30 or SPF 45 sunblock for the exposed places such as face including ears and forehead, neck, arms, hands, fingers, basically anything that is not covered by clothing. A large brimmed hat is recommended also. If your employer will not provide sunblock for you then purchase it and protect yourself.

WHAT DO YOU LOOK FOR IN A GOOD SUNBLOCK?

Our recommendations are to find a sunblock which is waterproof, non-greasy, fragrance free, hypoallergenic, doesn't cause acne or blocked pores and is PABA-free. A professional sunblock we recommend is BioSun^TM by Platex Products. The BioSun^TM product is recommended by The Skin Cancer Foundation. BioSun^TM comes in SPF 30 called Ultra Sunblock Lotion and SPF 45 called Maximum Sunblock Lotion. The SPF-30 is available in premeasured 0.5 ounce packets for individual use to prevent waste, or both are available in 6oz. squeeze bottles. These products offer professional protection for the outdoor worker and assurance for your at home use. 90% of skin cancers are caused by the sun, one in five Americans will develop skin cancer. 80% of the skin cancers occur on the face, head, neck and back of the hands.

BioSun^TM is available in the products section of the HealthMax