SKIN CANCER UPDATE  07/19/01

CHARLES GRIFF, M.D.

CANCER. Few words in the English language provoke as much fear as the word cancer. The goal of this article is to educate you on the most common form of cancer in the world; skin cancer. Through this guide to recognition, early detection, and prevention, the fear surrounding skin cancer will hopefully be diminished.

If you are not convinced you're at risk, read on. Over one million Americans are diagnosed with skin cancer each year. Eighty percent or more of all skin cancer cases are directly related to overexposure to the sun. Reflection of the sun's rays off of the water gives boaters at least a twenty percent higher exposure to harmful ultraviolet radiation. More people have skin cancer than all other cancers combined. Skin cancer kills over 10,000 Americans each year - more than one person an hour. If all of these statistics are making you think about giving up boating (boat donations gladly accepted by and for the author), and taking up caving, there is some good news. Once educated and aware, one may detect skin cancer at its earliest stages - when it is completely curable. Even melanoma!

There are three common forms of skin cancer; basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Boaters, through increased sun exposure, are at higher risk of developing all three types.

Basal Cell

Basal cell carcinoma is the most common type of skin cancer and, fortunately, the least aggressive. There will be close to one million cases of basal cell carcinoma in the United States in 2001. Although basal cell carcinoma rarely metastasizes (spreads to other parts of the body) and are slow growing, they can extend below the skin to the bone and cause considerable damage. Each year thousands of individuals may lose eyes, ears, and noses secondary to basal cell carcinomas. The skin cancer usually appears as a small, slightly reddish pink translucent bump. Often the cancer will have a slight central depression and small superficial blood vessels at the periphery. Untreated or undetected, the cancer will begin to bleed, crust over, bleed again and continue to grow slowly. Fortunately, these lesions are quite easily detected by a skin care professional - a dermatologist. Once detected, these skin cancers can be easily removed and cured through surgery or cautery. Recent advances include a topical cream that is being investigated that may eliminate many basal cell carcinomas without surgery.

Squamous Cell

Squamous cell carcinoma is the second most common type of skin cancer. There will be roughly 200,000 cases of squamous cell carcinomas in the United States in 2001. Unfortunately, several thousand Americans will die this year secondary to squamous cell carcinoma of the skin. Typically, these cancers are found on the rim of the ear, nose, face, lips, and the back of the hands. The most aggressive lesions are found on the lips. Most experts believe that many of these skin cancers evolve from a precancerous skin lesion called an actinic keratosis. Squamous cell carcinomas usually appear as a raised, rough, scaly red bump. These lesions may develop into large masses and spread to lymph nodes and internal organs if not caught early and treated appropriately. However, when found early and treated properly, usually with local surgery, the cure rate is over 95 percent.

Malignant Melanoma

Malignant melanoma is the third most common type of skin cancer. In 2001, it is estimated that there will be 51,400 new cases diagnosed in the United States. Almost 8000 Americans will die of melanoma this year - more than one person an hour. The risk of developing melanoma in 2001 is one in 71. In fact, the incidence of melanoma is rising faster than any other cancer, and it is now the most common cancer in women age 19-29. Enough bad news. With early detection and local surgery it may be cured in over 92 percent of cases. So what do we look for? It is as simple as ABCD. A = asymmetry; B = border irregularity; C = color variance; D = diameter. Any brown spot where one half does not match the other half (asymmetry); the edges are ragged, notched or blurred (border irregularity); the pigmentation is not uniform with shades of tan, brown, or black or any shade of red, white or blue (color); the width is greater than six millimeters, the bottom of a pencil eraser (diameter). It is important to realize that a lesion does not have to be elevated to be a melanoma. In fact, all melanomas probably start out flat. Although the sun plays a significant role in the development of melanoma, it is important to realize that melanoma can develop anywhere on the body - even the palms and soles of the feet. Early detection is critical; follow the ABCD's, do regular monthly self examinations, and see your dermatologist at least once a year. If a melanoma is detected early it may be treated with a simple excision. However, if detected with any delay, a larger surgery will be necessary including an evaluation of the lymph nodes.

We have learned about the three common types of skin cancer, their detection and treatment. What more can one do? Prevention! This is especially important with boating and sun exposure on the water. Obviously sunblock is critical. However, it is not a simple choice. It is essential to use a sunblocking agent with at least an SPF of 15 or higher. Unfortunately, the SPF really only measures protection from UVB wavelengths and a significant amount of damage arises from the UVA wavelength. Active ingredients necessary for adequate broad spectrum coverage include Parsol 1789, zinc oxide and titanium dioxide. To work effectively, the sunblock must be applied 15-30 minutes prior to sun exposure and re-applied liberally every several hours. In addition to sunblock, a wide brimmed hat is essential - a brim larger than 3 inches is optimal. Recently many lines of clothing have been introduced that provide complete sunblock, and there is even a laundry detergent that will make every day clothing ( average SPF of a T-shirt is 6-8) more protective. If possible boat early - before 10am or late - after 4pm, and schedule your dermatologist appointment for the midday.

Note: Dr. Griff is a graduate of University of Pennsylvania School of Medicine, and interned at some hot-shot New York Hospital. He's associated with Forest Hill Dermatology Associates in West Palm Beach. (561) 964-5800.