Prevent Skin Cancer. Sun Safety 101

Sun Safety 101
Prevent Skin Cancer by Following These Simple Tips

Excessive exposure to the sun and other sources of ultraviolet (UV) radiation is clearly associated with a higher risk of multiple forms of skin cancer. Since skin cancer is diagnosed in over one million Americans every year (and rising), experts from the American Cancer Society, the National Cancer Institute, the American Academy of Dermatology, the National Comprehensive Cancer Network, and many other organizations are unanimous in strongly recommending that you should reduce your time in the sun.

That sounds simple, but how much sun is too much? Who is most at risk? What are the most effective ways to protect yourself? Here are answers to frequently asked questions about sun safety.

Am I at risk for skin cancer?
People of all races and skin colors can develop skin cancer, but some are more susceptible than others. If you have one or more of the following risk factors, you should be especially vigilant about reducing your UV exposure:

• Fair skin
• Blue, green, or hazel eyes
• Blond or red hair
• Freckles
• Moles (especially 50 or more)
• Family or personal history of skin cancer
• More listed here

When and where is the sun most dangerous?
UV radiation from the sun is especially damaging under certain conditions, including the following:

• from 10 a.m. to 4 p.m.
• from mid-Spring through mid-Fall
• at latitudes nearer the equator (for example, Florida)
• at higher altitudes
• when there is no thick cloud cover (and clouds only block 20% of UV rays)
• near water, snow, or other highly reflective surfaces

Sun damage accumulates over time, so if you find yourself in these conditions often, consistent protection is a must. Remember that besides skin cancer, the sun can also cause cataracts and other eye problems, a weakened immune system, unsightly skin spots, wrinkles, and "leathery" skin.

What is the most effective way to protect myself?
If you answered "sunscreen," you're wrong. The most effective way actually is to simply stay out of the summer sun in the middle of the day. If that's not possible, wearing dark, tightly-woven clothing and a wide-brimmed hat also works. Only then comes sunscreen, which isn't a panacea and shouldn't be exclusively relied upon. Here are some more tips to protect yourself:

• Wear sunglasses that include a warranty stating they provide 99-100% UVA and UVB (broad-spectrum) protection.
• Apply one ounce (a palm full) of sunscreen to all exposed skin 15 minutes before venturing outdoors. The sunscreen container should specify a sun protection factor (SPF) rating of 15 or above and should state that it provides broad-spectrum (UVA and UVB) protection. Lotion- or cream-based sunscreens tend to adhere to the skin longer, thus providing better protection.
• PABA-free sunscreens are recommended for persons with sensitive skin. Susceptible individuals may also want to avoid oxybenzone and dioxbenzone. Products that contain avobenzone (Parsol 1789), ecamsule, zinc oxide, or titanium dioxide are considered broad spectrum sunscreens and are thus offer protection against UVB and most UVA rays, as well as help reduce the development of wrinkles and skin aging.
• Depending on your activity (swimming, sweating), sunscreen should be re-applied at least every two hours.
* The SPF number on the sunscreen indicates how many times longer, under ideal conditions, a person can stay out in the sun without beginning to turn red in comparison with the amount of time totally unprotected skin would start to burn. Research indicates these numbers are sometimes overstated.
• Avoid tanning salons, beds, and sunlamps.

Do children need extra protection?
Yes. Up to 50% of an individual's lifetime contact with sunshine occurs before adulthood. Studies also show that the more incidents of sunburn kids have, the higher likelihood that they will develop skin cancer decades later. So it is especially critical to protect them from the sun. Here are a few tips:

• Babies 6 months of age or younger should be kept completely out of the direct sun at all times. In addition, sunscreen shouldn't be applied to babies this age.
• For children over 6 months, apply sunscreen every time they go outside.
• Children's swimsuits made from sun-protective fabric and designed to cover the child from the neck to the knees are popular in Australia. They are now available in some areas of the United States.

Are tanning salons healthier than the sun?
No. Tanning lamps give out UVA and frequently UVB rays as well and so can cause serious long-term skin damage and contribute to skin cancer. Remember, tanning is a sign of skin damage and does nothing to protect the skin from further injury. Experts recommend that you prioritize your health over vanity and avoid tanning salons altogether.

The sun causes an estimated 90% of skin cancer cases. Reducing your exposure to UV radiation now is a simple, easy, and effective way to prevent a potentially devastating cancer later.

• What Is Skin Cancer?
• Symptoms of Skin Cancer
• Diagnosis of Skin Cancer
• Treatment of Skin Cancer

Sources:
"SunWise Program." Environmental Protection Agency. 15 September 2008.
"How Do I Protect Myself from UV Rays?" American Cancer Society. 15 September 2008.
"Facts about sunscreens." American Academy of Dermatology. 14 September 2008.
"Skin Cancer Prevention Program." California Department of Public Health. 14 September 2008.

Introduction to Skin Cancer Treatment Options

Skin Cancer Treatment
Introduction to Skin Cancer Treatment Options

The choice of skin cancer treatment depends on the type, stage, size and location of the tumor, whether or not the cancer has spread (metastasized), and your overall health. Skin cancer treatment options typically include surgery, radiation therapy, immunotherapy, and/or chemotherapy.

A team of doctors will work with you to determine the best skin cancer treatment plan. The team may include specialists such as a surgical oncologist, medical oncologist, radiation oncologist, dermatologist (a doctor who specializes in diseases of the skin), and a pathologist.

Surgery

Both non-melanoma (basal cell and squamous cell) and melanoma skin cancers can be successfully treated in almost all cases if they are diagnosed and treated when the tumor is relatively thin. Surgery to remove the tumor is the standard treatment but numerous other options are available. The type of treatment method for nonmelanoma or melanoma (early stage or late stage) cancers depends on how large the lesion is, where it is found on the body, and the specific type. Some of the common choices are as follows:

• Simple excision (removal) of the lesion and an area of normal-appearing skin surrounding it in all directions
• Curettage and electrodesiccation (scraping and cauterizing), which is effective for small basal cell and squamous cell cancers
• Mohs surgery (microscopically-controlled surgery), a highly specialized technique for basal and squamous cell carcinoma that doesn't cause as much scarring as other methods

After surgery for melanoma, the surgeon or medical oncologist may also recommend so-called "adjuvant" treatment based on what information was learned about the disease during surgery. This may include immunotherapy, chemotherapy, and/or radiation therapy. If the melanoma has spread to distant organs (stage IV) or recurs (comes back after treatment), surgery may be performed again to help control the disease.

Immunotherapy

Immunotherapy (also called targeted or biologic therapy) helps the body's immune system find and attack cancer cells. It uses materials either made by the body or in a laboratory to boost, target, or restore immune function. For basal and squamous cell carcinoma, the topical cream imiquimod is an "immune response modifier" that is commonly prescribed. Immunotherapy is also used to treat melanoma, particularly in reducing the risk that the melanoma will recur. The two most common drugs used are interferon alfa-2b and interleukin-2. Immunotherapy may be used in combination with surgery and/or chemotherapy, or as part of a clinical trial. Many other targeted drugs are being tested now, including therapeutic vaccines.

Side effects of these treatments vary. They can include fatigue, fever, chills, headache, memory difficulties, muscle aches, and skin irritation. Occasionally, side effects from immunotherapy can include a change in blood pressure or cause increased fluid in the lungs. You should discuss the benefits and risks of each treatment option with your doctor.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. For melanoma, this is typically used when there is a high risk that the melanoma may spread or to control advanced disease, although cure of widespread melanoma is rare. Several combinations of chemotherapy are currently being tested in clinical trials.

Common chemotherapy drugs used for melanoma include dacarbazine (DTIC), carboplatin (Paraplatin), cisplatin (Platinol), melphalan (Alkeran), and temozolamide (Temodar). The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. In addition to systemic chemotherapy, there are also techniques that focus the drugs on a specific region. Isolated limb perfusion (ILP) and isolated limb infusion (ILI) are examples of this method.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, some nerve damage resulting in alterations in sensation, and hair loss. These side effects usually go away once treatment is finished.

Radiation Therapy

Radiation therapy is the use of high-energy X-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

Radiation therapy for melanoma can be used in several ways. It is most commonly used to relieve symptoms caused by melanoma that has spread, especially to the brain and bones. It may also be used when cancer has spread to the lymph nodes, following a lymph node dissection. Finally, research is being done to test the effectiveness of chemoradiation, a combination of radiation therapy and chemotherapy.

Radiation therapy can cause skin irritation, nausea, fatigue and hair loss. If radiation therapy is used around the head and neck, side effects, such as altered taste and dry mouth, may occur. These side effects usually go away once treatment is finished. If lymph nodes near an arm or leg were affected, the person may be at higher risk of fluid build-up in that limb, a side effect called lymphedema.

Conclusion

There are many effective treatments for skin cancer. There is one catch, however: The disease has to be detected early in order for the treatments to be effective. If melanoma metastasizes to distant organs, the survival rate drops precipitously. For this reason, regular skin self-examinations and avoidance of risk factors just may save your life.

• What Is Skin Cancer?
• Symptoms of Skin Cancer
• Diagnosis of Skin Cancer
• Preventing Skin Cancer

Sources:
"Melanoma – Treatment Guidelines for Patients." National Comprehensive Cancer Network and the American Cancer Society. 21 July 2008.
"What You Need to Know about Skin Cancer." National Cancer Institute. July 2002. 21 July 2008.
"All About Skin Cancer – Melanoma." American Cancer Society. July 2008. 22 July 2008.

Skin Cancer Diagnosis. Skin cancer biopsies and staging

Skin Cancer Diagnosis
An Introduction to Skin Cancer Biopsies and Staging

An early warning sign of skin cancer is a new, suspicious looking lesion on your skin. Fortunately, there is no reason to panic, since most skin blemishes are not cancerous.

To determine if the lesion is cancerous or not, the doctor or nurse will usually first discuss your medical history to determine your risk factors, including the history of skin cancer in your family and the number of prior sunburns. A skin examination will follow, during which the doctor will note the size, shape, color, and texture of the suspicious area. He or she will then examine your lymph glands to check for swelling, a potential sign of cancer.

Biopsy

The only way to definitively diagnose the various types of skin cancer is to biopsy suspicious-looking lesions. Useful information, such as tumor depth, can only be obtained by biopsy. Biopsy methods include:

1. Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth. This is the most common form of biopsy when the doctor suspects a basal cell carcinoma or squamous cell carcinoma.

2. Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area.

3. Incisional biopsy: The doctor uses a scalpel to remove part of the growth.

4. Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it. Note that excisional biopsy is the ideal biopsy choice when a doctor suspects a melanoma. Depending on the size or location of the tumor, however, an excisional biopsy may not always be possible.

This procedure is done under local anesthesia in your doctor’s office or other outpatient clinic. The sample then goes to a lab where a pathologist will examine it under a microscope.

If the physician suspects metastatic melanoma, other tools of diagnosis and staging may include a blood test for LDH (lactate dehydrogenase) levels or imaging studies such as chest X-ray, CT (computed tomography), MRI (magnetic resonance imaging), and PET (positron emission tomography) scans. The doctor may also need to take a sample of your lymph nodes using procedures such as sentinel lymph node mapping or fine needle aspiration.

Staging

If the biopsy shows that you have melanoma, your doctor needs to know the extent (stage) of the disease to effectively plan your treatment. According to the National Institutes of Health, the stage is based on these three factors:

• The size of the growth
• How deeply it has grown beneath the top layer of skin
• Whether it has spread to nearby lymph nodes or to other parts of the body

Briefly, the stages of melanoma are as follows:

• Stage 0: The cancer involves only the top layer of skin. It is called melanoma in situ.
• Stage I: The growth is less than two millimeters deep.
• Stage II: The growth is more than two millimeters deep.
• Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or to nearby lymph nodes. It has not spread to other places in the body.
• Stage IV: The cancer has spread to other places in the body.

This is known as the TNM system of staging. Your doctor may also assign a Clark and Breslow number -- measurements of tumor penetration and thickness, respectively -- to further stage your melanoma and determine your prognosis. Staging is a critical step, since it determines your treatment options. To ensure an accurate diagnosis, consider getting a second opinion from a specialist such as a dermatologist.

• What Is Skin Cancer?
• Symptoms of Skin Cancer
• Diagnosis of Skin Cancer
• Treatment of Skin Cancer
• Preventing Skin Cancer

Sources:
"What You Need to Know about Skin Cancer." National Cancer Institute. July 2002. 21 July 2008.
"All About Skin Cancer – Melanoma." American Cancer Society. July 2008. 22 July 2008.

What are the Signs and Symptoms of Skin Cancer?

Skin Cancer Symptoms
What are the Signs and Symptoms of Skin Cancer?

Skin cancer symptoms can include many different shapes, sizes and colors of skin lesions, or no visible lesions at all. Some lesions may not even be cancerous or may be related to another medical condition. It is also important to remember that skin cancer -- including basal cell carcinoma, squamous cell carcinoma, and melanoma -- can appear anywhere on the body, even on areas that are not exposed to the sun, and can occur in people of any race or skin color. Diagnosing skin cancer is not as straightforward as you might think!

However, in general, you should look for these signs during your regular skin self-exam:

• A new, possibly large, irregularly shaped, dark brownish spot with darker or black areas
• A simple mole that changes in color (particularly turning darker), size (growing), or texture (becoming firmer), and/or flakes or bleeds
• A suspicious change in an existing mole or spot
• A lesion with an irregular border and red, white, blue, gray, or bluish-black areas or spots
• Shiny, firm, dome-shaped bumps anywhere on the body
• Dark lesions under the fingernails or toenails, on the palms, soles, tips of fingers and toes, or on mucous membranes (the skin that lines the mouth, nose, vagina, and anus)
• A sore that doesn't heal within two weeks

Pictures of basal cell carcinoma, squamous cell carcinoma, and melanoma are available that may help you decide if what you are seeing is a harmless mole (or "nevus"), a pre-cancerous skin lesion, or something more serious that needs to be further analyzed by a professional.

Early Detection of Melanoma
The earlier melanoma is detected, the better the chance for successful treatment. Monthly self-examinations may help find it early. Often, the first sign of melanoma is a change in the size, shape, or color of an existing mole. It also may appear as a new or abnormal-looking mole. The "ABCDE" rule can be used to help remember what to watch for:

Asymmetry: The shape of half of the mole does not match the other.
Border: The edges are ragged, notched, or blurred.
Color: The color is often uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, or blue may also be seen.
Diameter: The diameter is usually larger than six millimeters (the size of a pencil eraser) or has grown in size.
Evolving: The mole has been changing in size, shape, color, appearance, or growing in an area of previously normal skin. Also, when melanoma develops in an existing mole, the texture of the mole may change and become hard, lumpy, or scaly. Although the skin may feel different and may itch, ooze, or bleed, melanoma usually does not cause pain.

Sometimes, the letter "F" is added, for "funny looking." This is meant to highlight that you should look for moles that do not resemble other moles on your body, or moles that are increasing in size or changing color.

If you see this happening to one of your moles, contact your doctor promptly. Often, a diagnosis can only accurately be made after a lesion is removed and examined (biopsied).

• What Is Skin Cancer?
• Diagnosis of Skin Cancer
• Treatment of Skin Cancer
• Preventing Skin Cancer

Sources:
"Melanoma – Treatment Guidelines for Patients." National Comprehensive Cancer Network and the American Cancer Society. 21 July 2008.
"What You Need to Know about Skin Cancer." National Cancer Institute. July 2002. 21 July 2008.
"All About Skin Cancer – Melanoma." American Cancer Society. July 2008. 22 July 2008.

What is Skin? Cancer Causes Symptoms Treatment Prevention

What is Skin Cancer?
Skin Cancer Types, Causes, Symptoms, and Treatment

What is Cancer?
Normal cells in your body divide in an orderly and balanced fashion. Cancer occurs when certain cells begin to grow out of control. Cancer cells can also spread to other parts of the body through the blood, nerves or lymph system, in a process called metastasis.

What is Skin Cancer?
Skin cancer is a cancer of the cells in the outermost layer of skin, called the epidermis. The epidermis itself has three layers: an upper and middle layer made up of squamous cells, and a bottom layer made up of melanocytes and basal cells. Different types of skin cancer affect each of these types of cells, including the following most common forms:

Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common form of skin cancer, accounting for 75% to 80% of cases. Upwards of one million people are diagnosed with basal cell carcinoma each year in the United States. It was once found mostly in middle-aged or older people but now it is also being seen at younger ages. Basal cell carcinoma usually begins on areas exposed to the sun such as the head and neck. It is a slow-growing cancer that rarely spreads to other parts of the body, but people with a history of BCC are at higher risk for getting a second BCC. If basal cell carcinoma is not treated, it can damage the surrounding tissue, including bone. Treatments are very effective, however, if the tumor is detected while it is small and thin.

Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) accounts for 16% to 20% of skin cancer cases and occurs twice as often in men than in women. Approximately 200,000 to 300,000 people are diagnosed with squamous cell carcinoma each year in the United States, and about 2,500 die from the disease. It usually appears on the face, ear, neck, lips, and backs of the hands. SCC can also begin within scars or skin ulcers on other places on the body. As with basal cell carcinoma, the available treatments are very effective if the tumor is detected while it is small and thin.

Melanoma
Melanoma affects cells called melanocytes, which produce the skin's color. Melanoma can appear in an area no different from surrounding skin, or it can develop from or near a mole. It is found most frequently on the backs of both men and women or on the legs of women, but melanoma can occur anywhere on the body, including the head and neck, soles of the feet, fingernails, and other areas not exposed to the sun. Melanoma is much more dangerous than the other types of skin cancer: 62,000 people will be diagnosed with melanoma in the United States in 2008 and over 8,400 will die from the disease. Unfortunately, it is increasing at a faster rate than for any other cancer, with the exception of lung cancer in women. In the United States, the incidence of malignant melanoma from 1973 to 2002 increased by 270%. Melanoma is treatable in its early stages, but survival drops precipitously when it metastasizes to distant lymph nodes or organs.

What Causes Skin Cancer?
Besides lung cancer, skin cancer is one of the most preventable types of cancer. This is due to the fact that the major risk factor is ultraviolet (UV) radiation. The sun is, of course, the main source of UV radiation, but it can also come from tanning booths. The amount of UV exposure depends on the strength of the light, how long the skin was exposed, and whether the skin was covered with clothing or sunscreen. Many studies also show that being sunburned at a young age increases the likelihood of skin cancer even decades later.

The other major risk factor is fair skin. Skin cancer is much more common in Caucasians than in African-Americans, for example. This is because the pigment, called melanin, offers some protection from UV radiation and people with dark skin have more melanin. People with fair skin that freckles or burns easily are at especially high risk. However, remember that people of all races and skin colors can get skin cancer.

Other causes of skin cancer include:

• long-term exposure to chemicals such as arsenic, tar and oil
• radiation from other cancer treatments
• previous history of skin cancer
• family history of skin cancer
• scars from burns or previous skin infections
• certain treatments for psoriasis involving UV light
• certain rare skin diseases, such as xeroderma pigmentosum and basal cell nevus syndrome
• weakened immune system
• infection by certain types of human papilloma virus
• smoking
• certain types of moles
• other risk factors

Each year, over one million people are diagnosed with cancer of the skin, making it the most common type of cancer in the United States. Unfortunately, it is also one of the few types of cancer that has become more common in recent years. The good news is that skin cancer is one of the most preventable and treatable of all cancers.

• Symptoms of Skin Cancer
• Diagnosis of Skin Cancer
• Treatment of Skin Cancer
• Preventing Skin Cancer

Sources:

"Melanoma – Treatment Guidelines for Patients." National Comprehensive Cancer Network and the American Cancer Society. 21 July 2008.

"What You Need to Know about Skin Cancer." National Cancer Institute. July 2002. 21 July 2008.

"All About Skin Cancer – Melanoma." American Cancer Society. July 2008. 22 July 2008.