“How long has that been there?” my dermatologist asks at my annual skin exam. I wanted her to check out some funky-looking moles on my shoulders but instead she is examining what I thought was a pimple on my nose. Now that I think about it, it has been there for a while, hasn’t it?

She takes a biopsy and a few days later the results floor me: actinic keratosis, otherwise known as a pre-cancerous lesion. I never would have looked twice at the thing. Fortunately, it was caught before it could turn into cancer and, even better, there are now new therapies to cure it. But the whole experience was a definite wakeup call.

As a fair-skinned, freckled, green-eyed redhead, I misspent my youth with baby oil and reflectors in futile attempts to achieve a fleeting tan. Usually I just ended up with a miserable sunburn. Now I, along with millions of other Americans, am paying an even bigger price: a heightened risk for developing skin cancer. It’s the most common form of cancer in the U.S., with more than one million new cases diagnosed every year, according to the American Academy of Dermatology (AAD). And the rate of melanomas, the deadliest form of skin cancer, has doubled in the past 20 years. An estimated 7,600 Americans will die of melanoma this year.

Why the rapid increase?

Experts say the main reason is that we’re still not heeding the warnings about overexposure to the sun. Yes, some of the problem is due to the thinning of the ozone layer, which is allowing more radiation to hit the earth, but that’s just a small part of the story.

The truth is we are still a nation that prizes a good tan as a sign of health and wealth.

Compounding the problem is that when it comes to fashion, we are wearing less and exposing more. Since skin damage is cumulative over time, the current rising rates are reflecting our youthful abuse of our skin. (That would be me. I have a memory of a Florida vacation at age 13 when my father literally chased me around the pool with a bottle of suntan lotion.)

Doctors, however, are also seeing an increase in skin cancer among younger Americans. In fact, it’s the fastest growing category of cancer in women in their 20s and 30s, according to the AAD. Part of the problem is that teens and younger adults, hoping to recreate that Britney Spears glow, are flocking to tanning booths in the mistaken belief that they are safe. On an average day, more than one million Americans visit tanning salons, says the AAD. Unfortunately, tanning booths are just as damaging as sunning on a beach. They emit dangerous ultraviolet radiation and, unlike the beach, people use them all year.

What Is That Thing?

I can’t change the damage I have already done to my skin, but I can change my behavior from here on in. So can you. The first line of defense is early detection, which starts with knowing what to look for.

Malignant melanoma is the most dangerous form of skin cancer and can appear anywhere on the body, even on places not exposed to the sun. When checking for melanomas, remember the ABCD checklist for moles or suspicious changes: Asymmetry (halves don’t match); Border irregularity (edges are ragged or notched); Color (pigmentation is uneven); and Diameter (larger than the end of a pencil eraser).

Squamous cell carcinoma occurs most often on sun-exposed areas, usually the face. It appears as nodules or red, scaly patches.

Basal cell carcinoma usually appears as a small, fleshy bump. It may cyclically bleed and scab over.

Actinic keratosis is a precancerous growth. If left untreated, it can turn into squamous cell carcinoma. While it will not grow into melanoma, people who have it are at higher risk for developing melanoma. It looks like a rough spot or reddened patch, which may bleed and scab over.

As my story shows, however, not every cancer or precancer will look exactly the way you think it should. Mine looked like a pimple that hadn’t reached a head yet. David J. Leffell, M.D., professor of dermatology and surgery at Yale University School of Medicine in New Haven, Connecticut, advises watching for these telltale signs:

* Sores that don’t heal

* Sores that heal, scab over and break down again

* Scaly patches

* Little bumps that get progressively larger

* Any sudden change in the skin

* A mole or spot that itches

* Your intuition that something is just not right

“I tell my patients to be alert. People generally have a very good sense of their own bodies and they should trust their instincts. If you sense there is something of concern about a mole, even if you don’t know why, it’s important to have a doctor biopsy it,” says Dr. Leffell, author of Total Skin.

Protect and Prevent

Ultraviolet radiation compromises the skin’s immune system, which is your body’s last line of defense against skin cancer, says Mark Naylor, M.D., associate professor of dermatology at the University of Oklahoma Health Sciences Center in Oklahoma City. Avoiding that dangerous scenario is simple.

Take cover. Whenever I’m in the sun now, I wear a hat, a long-sleeved shirt and pants. For good protective clothing, check out Sun Precautions (800-882-7860 or log on to www. sunprecautions.com).

Lotion up. I always put on sunscreen when I go outside, all year round. There are many good moisturizers out now that have sunscreen in them. (And don’t forget to use lip balm with sun protection in it as well.) You want a product with SPF 15 or higher that provides both UVA and UVB protection.

Use a sunscreen that doesn’t sting, burn your eyes or cause pimples. It should be free of PABA, fragrance, dyes and oils, says Shelley Sekula-Gibbs, M.D., clinical assistant professor of dermatology at Baylor College of Medicine in Houston. Sunblocks, usually zinc oxide or titanium dioxide, actually reflect the sun’s rays and block both UVA and UVB rays.

Check up. All skin cancers are highly treatable if caught early. See a dermatologist annually for an all-over skin check. If you have a family history of skin cancer or have had problems yourself in the past, you need to go twice a year, as I do now. Give yourself an all-over skin check once a month.

Get to know the landscape of your body and be aware of any changes. Take time to educate yourself about the warning signs. According to a report in the Journal of the National Cancer Institute, doing a once-a-month full-body scan may reduce your chances of dying from a melanoma by up to 63 percent.

Review your medications. Certain drugs, such as tetracycline, diuretics and some antidepressants and heart medications, can make you photosensitive, meaning that you are more prone to an exaggerated, accelerated sunburn-like rash. When you take these medicines, you need to be extra-cautious about going out in the sun. Read the package inserts or talk to your doctor to see if any of the medications you take fall into this category, advises Dr. Sekula-Gibbs.

Be careful with retinoids and glycolic acid. These cosmetic applications don’t pose a huge threat, but be aware that they do strip off a layer of skin, which may increase your sensitivity to the sun. They don’t, however, photosensitize your skin the way certain medications can. Just be sure to wear sunscreen when you are using these products, says Dr. Leffell.

Don’t use tanning booths. UV exposure from tanning beds can be just as harmful to your skin as exposure from the sun. Also, since in many states tanning salons don’t need to be licensed and aren't regulated, they may not provide proper safeguards such as eye protection. Studies have found an increased incidence of melanoma in those who visit tanning booths.

Fake it. Today’s self-tanners and bronzers are a vast improvement over earlier products, so they look quite natural. Just remember that the creams and bronzers don’t necessarily provide sun protection. If youre going to be out in the sun for any length of time, you still have to wear sunscreen, says Dr. Leffell.

New Therapies, New Hope

In the past decade or so, researchers have come up with new and improved ways of dealing with this modern scourge.

Topical chemotherapy for actinic keratosis. After surgically removing my actinic keratosis, my doctor had me apply a topical cream that brought whatever bad cells remained to the surface of the skin. She then easily scraped them off. No muss, no fuss. In cases where precancerous changes are not too advanced, topical chemo alone may be sufficient, says Dr. Naylor.

Mohs micrographic surgery for basal and squamous cell carcinomas Until recently, only a few physicians knew how to perform this procedure. Now most major university and cancer centers can do it. This technique can be performed in the doctor’s office and allows the physician to completely evaluate the affected area through an advanced mapping technique. It also usually has a better cosmetic result since less tissue needs to be excised.

Keep in mind, however, this plea from Dr. Naylor: “We can work on better and earlier diagnosis and treatment. But in order to really reduce the mortality rate from skin cancer, we need to change human behavior. People have to start taking seriously how dangerous sun exposure can be. Prevention is always better than treatment.

 

 

 

 

 

 

 

 

 

 

 

 

 

Woman's Day June 2003