May is Melanoma Awareness Month, and this edition of A.S.K the Derm is dedicated to my dear friend Jean Schlipmann and all the families affected by melanoma.

The Epidemic

In the US, 1 in 5 people will develop skin cancer in their lifetime, and about 1 in 60 will get invasive melanomas, the deadliest type of skin cancer.  According to the American Academy of Dermatology (AAD), on average one American dies from melanoma every hour, and in 2014 alone, it is estimated that 9,710 deaths will be caused by melanoma (http://www.aad.org/spot-skin-cancer/).

While many factors, including genetic and environmental influences, come together to cause skin cancer, the single most important factor is exposure of the skin to ultraviolet (UV) radiation. This also happens to be the factor over which we have the most control.

The Key Word is…”Prevention”

For most people, the most critical damage to the skin, the damage for which they pay the price later in life, with skin cancer, unsightly sun spots, and wrinkles, often happened in their youth. There is strong evidence that a history of sunburns,  and of indoor tanning significantly raise a person’s risk of getting melanoma, and that the risk goes up exponentially for those who tanned and burned early in life (1).  This is problematic in the United States, as the Centers for Disease Control and Prevention (CDC) has reported that over 30% of people in the US get sunburned at least once a year (2), and almost 30 million Americans (including roughly 2.3 million teenagers) visit indoor tanning salons each year, fueling a 5 billion dollar per year industry (3,4).

When someone comes into the clinic with skin cancer, especially a young person in their 20’s and 30’s who has melanoma care of the tanning epidemic, dermatologists often wish they could have had the chance to educate that person sooner, as a child or teenager, and teach good habits like sun protection and avoiding tanning beds, because where skin cancer is concerned, there is truly nothing like “an ounce of prevention.”

Take Home Message:

• Prevention applies to both avoiding the risk factors of skin cancer, and also preventing the growth and spread of skin cancers through early detection.
• The overwhelming majority of skin cancers are actually curable if a person goes to the doctor and has them removed in time!

Steps to Skin Cancer Prevention:

(1) UV Protection and Avoidance:

* Wear sunscreen and reapply every 2-3 hours. The American Academy of Dermatology Recommends:  High SPF 50 or above,  Broad spectrum (covering both UVA and UVB rays), water resistant sunscreens that contain either zinc or titanium as active ingredients

* Wear sun protecting hats and clothing that contain Ultraviolet Protection Factor (UPF)

* Avoid sun exposure during times of day when UV exposure is at its highest intensity (10 am – 4 pm)

* Avoid tanning beds

(2) Know what to look for and go to the dermatologist if you see any of the following:

* Enlarging reddish, scaly, irritated, or ulcerated spots that persist or grow rather than resolving could be a sign of non-melanoma skin cancers

(e.g. Basal Cell Carcinoma or Squamous Cell Carcinoma) or precancerous growths.

OR

* Moles that display the ABCDE’s of Melanoma:

• Asymmetry
• Border irregularity (scalloped or hazy borders)
• Color irregularity (unusual colors for moles e.g. black, white, grey, blue, pink)
• Diameter/size > 6 mm (greater than the size of a pencil eraser)
• Evolution (moles that are growing, darkening, changing in appearance in any way or become symptomatic (itching, bleeding, irritation)

(3) Help others by spreading awareness about Skin Cancer Prevention!

Here are some great resources from non-profit organizations that have accurate information:

The American Academy of Dermatology (AAD) 

Spot the Spot Campaign:

http://www.aad.org/spot-skin-cancer

The Skin Cancer

Foundation:

http://www.skincancer.org

Aim at Melanoma:

http://www.aimatmelanoma.org

So in honor of Melanoma Monday,

and especially in honor of all those who battle skin cancer and their families,

please “Be Sun Wise,” and encourage your loved ones

to protect their skin and get checked.

~ A.S.K., MD

References:

1. Lucas R, McMichael T, Smith W, Armstrong B. Solar Ultraviolet Radiation: Global burden of disease from solar ultraviolet radiation. Environmental Burden of Disease Series, No. 13. Pruss-U¨ stun A, Zeeb H, Mathers C, Repacholi M. Geneva: World Health Organization, 2006.

2. Saraiya M, Hall HI, Uhler RJ. Sunburn prevalence among adults in the United States, 1999. Am J Prev Med 2002; 23:91–97.

3.  Levine JA, Sorace M, Spencer J, Siegel DM. The indoor UV tanning industry: A review of skin cancer risk, health benefit claims, and regulation. J AmAcad Dermatol 2005; 53:1038–1044.

4. Dellavalle RP, Parker ER, Ceronsky N, Hester EJ, Hemme B, Burkhardt DL, et al. Youth access laws: in the dark at the tanning parlor? Arch Dermatol 2003;139:443-8.