MMS Physician Focus: July 2010
By Louis Kuchnir, M.D., Ph.D.
For physicians who constantly warn patients about skin
cancer, a recent poll by the Marist Institute for Public
Opinion brought some disturbing news: Only one-fifth
of Americans use sunscreen before going outdoors during the summer,
and another one-third wear it for only a few days during the
season.
The poll of more than 1,000 people also discovered that about 40
percent of Americans never use sunscreen at all, and only 9 percent
wear it every day.
This lack of self-protection is one reason why skin cancer is
the most common form of cancer in the United States.
The two most common types are basal cell carcinoma, found in the
lowest layer of the epidermis, and squamous cell carcinoma, found
in the middle layer. More than two million of these types are
diagnosed every year. Fortunately, both are highly curable.
However, the third type - melanoma - is less common, but more
serious. If not detected early, melanoma can be deadly. In its
advanced stages, melanoma can spread to the lymph nodes and
internal organs. Some 54,000 people are diagnosed with
melanomas of the skin every year, according to the Centers for
Disease Control. And its incidence has been increasing for the last
30 years, especially among young, white women 15-30 and white
adults 65 and older.
As we hit the mid-point of summer, remember that too much fun in
the sun can be dangerous. The primary cause of all skin cancers is
excessive exposure to the ultraviolet (UV) rays of the sun, which
makes the poll results cited above so disturbing. This is the most
important preventable cause of all skin
cancers.
Here's more unsettling news from the poll: the age group with
the lowest rate of sunscreen use was the 18-29 age group, at a mere
4 percent. In fact, melanoma is the most common form of cancer
among young adults 25-29. If we expand the age group to 15-29, we
find that melanoma is the second most common form of cancer among
that population.
The best way to detect the onset of skin cancer is to recognize
changes in your skin, especially for the early stages of melanoma.
That means examining your skin, especially the upper back, torso,
lower legs, head and neck - places where melanomas tend to
occur. If you notice a mole that has changed, or is different
from others, you should see a dermatologist to be examined within a
week or two.
The good news is that if detected early, melanoma is highly
curable. But early detection is essential: a
direct correlation exists between the thickness of the melanoma and
survival rate. Only five percent of patients whose melanoma has
spread to internal organs will survive for six months.
Patients with known risk factors - those with more than 50 or
unusual moles, those with blood relatives who have had melanoma,
Caucasians with light skin - should be examined annually.
Although people with dark skin are less likely to
get melanoma, they should be cautious as well. While Blacks,
Asians, Hispanics, and Native Americans develop fewer skin cancers
than do whites, the cancer tends to be more aggressive and is more
often diagnosed in its later stages.
Remember that sun protection remains the best prevention. Here
are some recommendations from the American Academy of
Dermatology:
- Use a water-resistant sunscreen with a Sun Protection Factor
(SPF) of at least 30.
- Wear protective clothing, like long-sleeved shirts,
wide-brimmed hats, and sunglasses.
- Seek shade whenever possible; the sun's rays are strongest
between 10 a.m. and 4 p.m.
- Use extra caution near water, snow, and sand: they reflect the
damaging rays of the sun.
- Get Vitamin D with a healthy diet and supplements; don't try to
get your dosage from the sun.
- Avoid tanning beds; ultraviolet light from these is proven to
cause all three types of skin cancer.
- Check your skin regularly.
- Protect children, with appropriate clothing and by teaching
them sun-safe habits.
For more information on skin cancers and skin disease, visit the
American Academy of Dermatology's website www.aad.org or the Skin Cancer
Foundation at www.skincancer.org
Luis Kuchnir, M.D., Ph.D. of Kuchnir Dermatology and
Dermatologic Surgery in Marlboro, Milford and Shrewsbury, is
president of the Massachusetts Academy of Dermatology. Physician
Focus is a public service of the Massachusetts Medical Society.
Readers should use their own judgment when seeking medical care and
consult with their physician for treatment. Comments toPhysicianFocus@mms.org
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