Skin month used to warn of cancer

Patricia Jones walked into a doctor’s office one winter morning with a beautiful tan. She… Patricia Jones walked into a doctor’s office one winter morning with a beautiful tan. She left knowing that she had melanoma, the most dangerous form of skin cancer.

Every year for at least the last five, the 20-year-old Pittsburgh woman had carefully maintained her tan by going to indoor tanning salons and lying in the summer sun, not knowing that both of these activities could lead to skin cancer. She liked tanning because it kept her fair skin from burning and peeling.

Two surgeries later, one to test a mole and one to remove the subsequently identified cancer, she was able to return to normal life, said physician’s assistant Janice Shipe-Spotloe of the Hillman Cancer Center.

Jones’ doctors will see her at six-month intervals from now on, said Shipe-Spotloe. In follow-up visits she will likely have total-body photographs taken to map her moles.

Jones was lucky that they caught her cancer when it was 1 millimeter deep. Because of early detection and surgery, it is less likely that the cancer will metastasize or spread later. However, she is now more at risk to have skin cancer again.

November is National Healthy Skin Month, which is sponsored by the American Academy of Dermatology in order to raise awareness of skin care. The month enables the AAD to raise awareness of health issues such as skin cancer, which is the most prevalent type of cancer. The AAD Web site said in 2004 approximately one person died of melanoma every hour.

Dr. John M. Kirkwood, professor and vice chairman for clinical research and director of the Melanoma Center at the University of Pittsburgh Cancer Institute, said skin is the largest organ in the body.

Kirkwood said more than 1 million people in the United States contract skin cancer every year. As time has passed, cancers have developed in younger and younger people, and incidents of the most dangerous cancer has increased.

The majority of skin cancer is caused by cumulative lifetime exposure to the sun and can be easily removed with local therapy, Kirkwood said. Most of a person’s sun exposure occurs before they reach the age of 20.

Melanoma, the most serious and potentially deadly skin cancer, does not appear only where the sun shines, but can appear in nail beds and inside the nose, as well as on exposed skin. This cancer appears in more than 1 percent of all white people. Although melanoma can be found in fewer black people because of pigment in the skin, their mortality rate is much higher.

Dr. Susan C. Taylor, assistant clinical professor of dermatology at the College of Physicians and Surgeons at Columbia University, studies melanoma.

“Melanoma has a 96 percent cure rate when detected early,” she said.

Blacks tend to wait much longer before seeking treatment and so the cancer is less often diagnosed when in the early stages. The AAD site stated that by the time black people seek treatment, the cancer has spread to other parts of the body. By this time, the cancer is usually fatal.

Even when skin cancer has been removed, it can spread up to and perhaps beyond 10 years later, he said. Patients are followed and tested using a test that checks for any trace of cancer spreading. Patients who get melanoma once are more likely to get a new cancer than others.

Kirkwood said outdoor workers who go to hot climates and burn easily could get melanoma up to a decade after the sunburn.

The American Cancer Society recommends a four-step approach to skin cancer prevention, identified by the mnemonic “slip, slop, slap.”

“Slip on a shirt; slop on sunscreen with a sun protection factor of 15 or higher; slap on a hat and don’t forget to wear sunglasses,” said the ACS message.

Because of the intensity of the sun’s rays, the Society’s Web site says to limit direct sun exposure between 10 a.m. and 4 p.m.

The site explains how to check for skin cancer or pre-cancerous areas. Check all of your skin, freckles, moles and lesions for asymmetry, border blurriness and color inconsistency.

More importantly, Kirkwood said, people should watch to see if the skin lesion or mole changes, if something new appears where it was skin tone before or if something unusual or ugly appears on the skin. These are indications that a lesion might be skin cancer.

In addition to following all of the recommendations made for people with fair skin, black people and others with darker skin tones need to check other areas as well. The AAD Web site said only about 33 percent of black people get melanoma in sun-exposed areas.

Dr. Charles J. McDonald, chairman of the Department of Dermatology at Brown University, said in an article on the society’s Web site, “Moles on [fingers], particularly the nail bed, that show up as linear streaks at the base of the nail outward, are very common.”

Taylor recommended that black people also check for a spot that extends into the nail folds or the skin that supports the nail.

Editor’s Note: Names of patients in this story have been changed to protect their privacy.