Skin Cancer

As a kid, I often went to Rockaway Beach.  We would pile in the car (no seat belts) roll down the windows and cruise (in Queens, you cruise) down Woodhaven Boulevard all the way to the ocean.  My mom would pack drinks, sandwiches, snacks and a blanket to lie on.  Forget something?  Nope.  Umbrellas were for rain, chairs were for the elderly and sunscreen was for, wait … what is sunscreen?  At about 5pm, my mom would yell into the water, “Come out and put a t-shirt on, I think your shoulders are getting burned.”  Usually, I would already be blistering.

I hit my teenage years and invested heavily in baby oil and lemon juice.  Not a pretty scene.  A tan was great but a burn wasn’t bad because in exactly 32 hours, it would turn into a tan. I blame all this sun exposure for why I cannot look in my car’s visor mirror during the daylight hours — wrinkles, sunspots, freckles, wrinkles, oh and new wrinkles.    Still, now when I use sunscreen, part of me resents it — I still feel better with a tan.  No skin cancer yet, but that is just a matter of time.  I thought I could excuse my own lack of sunscreen use because the “damage has been already been done.”  I focused my efforts on my children, running after them on the beach with one of those aerosol spray cans and covering them and anyone downwind of them.  Turns out I was wrong about it being too late for me.  Check out # 2 below and then go put on some sunscreen.

Facts about skin cancer:

1.  Skin cancer is the most common type of cancer and will affect about 3 million people this year.  The incidence of skin cancer is increasing, originally attributed to better screening and earlier diagnosis.  But it is now widely accepted that it is simply on the rise.  It historically affects more men than women although the gap seems to be shrinking.

2. Sun exposure is the biggest risk factor and the vast majority of skin cancers are found in sun exposed areas.
The following chart disputes that most of your sun exposure happens before you are 18.  As I said, I held onto that one for a while because it alleviated some of my guilt.  I was able to blame all of my risk for skin cancer on my parents and on the weak advertising department at Coppertone in the 80s.  The following does make sense though.  Did we all suddenly become vampires at age 19?
Lifetime UV Exposure in the United States
Ages      Average Accumulated Exposure*
1-18        22.73 percent
19-40      46.53 percent
41-59      73.7 percent
60-78      100 percent
*Based on a 78 year lifespan (which is perfect because that’s about what I should be hoping for.  As a wise person once told me, “Life is like a party.  Leave before you embarrass yourself.  Leave them wanting more.”  I have never been able to follow her advice at a party as I have serious (debilitatingly serious) leaving issues.  Maybe in life, I can get it right.

3, 4 and 5. There are 3 types of skin cancer.  I have included a “typical” picture of each but remember that you may not be “typical”. Get anything checked out that is new, itchy, painful, growing, not resolving, concerning, etc. – you get the idea.  Like all cancers, early detection is KEY!

Basal Cell Carcinoma (BCC) is the most common type affecting 2 million Americans each year.

- though rare in children, more and more people in their 20s and 30s are being diagnosed
– risk factors include fair skin, blond or red hair, light eyes, repeated sunburns, unprotected sun exposure, previous skin cancer
– it almost always is found in sun- exposed areas
– it is painless, usually light or flesh colored and may have a pearly sheen with dimpling
– it may be very small, bleed easily, and it may present as a sore or growth that won’t heal
– treatment in the early stages is excision and is usually successful

Squamous Cell Carcinoma (SCC) is the second most common  type
–  >700,000 new cases each year
– can occur anywhere,  but again usually occurs in sun exposed areas
– rare in people younger than 50 and usually diagnosed in people over than 70
– risks are the same as with BCC and can occur in old burns on the skin or in areas of chronic inflammation.  People who are immunosuppressed (e.g. HIV, chemotherapy, chronic illness) are more likely to develop SCC
– there is a possible genetic link which is being studied
– like BCC, it very rarely metastasizes but will invade surrounding tissue

Melanoma is the least common but deadliest form of skin cancer
– about 120,000 new cases every year in the US
– risk factors – as above as well as number and type of moles on the skin, prior cancer diagnosis including breast and thyroid, and family history.  If you have a first degree relative (parent, sibling, child) with melanoma, you have a 50% increased risk of develping it
– unlike BCC and SCC, melanoma will metastasize to other sites in the body and when it does, it is very difficult to treat.  There were almost 9000 deaths from melanoma last year.
– can appear suddenly or arise from an existing mole
– like BCC and SCC, its appearance can vary.  It helps to look for the ABCDE warning signs of melanoma.
Asymmetry – one half does not match the other
Borders are irregular
Color – often the color is not uniform and it will have different shades of tan, brown and black
Diameter – most melanomas are diagnosed when they are over 6mm but they can be smaller
Evolving – have anything checked out that is changing in its appearance or symptoms, i.e. if a mole is growing, looks different, becomes itchy or bleeds easily

- When caught early melanoma is very treatable with a 98% 5 year survival rate

Get a full length mirror and take your clothes off. The nice thing about skin cancer is that most of the time you can see it if you are looking for it.   Told you I would get a little more hopeful as the week went on.

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