Skin Cancer: What You Need to Know
Transcription
Skin Cancer: What You Need to Know
Skin Cancer: What You Need to Know You Can Protect Yourself Against Skin Cancer! Table of Contents 3–4 Types of Skin Cancer Our skin is actually the largest organ of the human body and the health and appearance of our skin often has a profound impact on our quality of life. It plays an extremely important role in protecting our entire body from 5–6Risk Factors for Skin Cancer harmful bacteria, water loss, and serves as a buffer between the outside 7–13 Melanoma Skin Cancers control body temperature, protects the rest of the body from ultraviolet —Signs and Symptoms (UV) light, and helps the body make Vitamin D. It also plays a key role —Identifying Moles —Ultraviolet Radiation in creating and maintaining our individual identity, as this protective —Staging Melanoma —Treatment Options 14–15 Prevention and Early Diagnosis 16–17Teen Tanners 18Questions to Ask Your Doctor 19Contact Information world and our inner organs, including muscle, bones, etc. Skin also helps covering helps create the ‘picture’ of what we see when we look in a mirror. Human beings have long been concerned with their appearance, and therefore have taken an interest in “skin” appearance since the dawn of mankind. As the largest—and often the most exposed—organ of the body, it should not be surprising that skin cancers are far and above the most common cancer that occurs in humans. Fortunately, the vast majority of these cancers are very treatable, and with timely care, they do little to interfere with our daily lives. The two most common types of skin cancers (Basal Cell and Squamous Cell) occur so often, that they are not even tracked by our national or global Tumor Registries. These are sometimes referred to as non-melanoma skin cancers (NMSC). The American Cancer Society (ASC) estimates that 3.5 million cases of NMSC were diagnosed in 2012 in the United States alone. Most NMSCs are highly curable with timely Skin cancers are far and above the most common cancer that occurs in humans. treatment; however, identifying the problem, seeking treatment, and obtaining timely treatment can still be a challenge for many people. In 2012, more than 75,000 Americans were diagnosed with melanoma, the most serious skin cancer. Most significant is the fact that melanoma incidence rates have been increasing by almost three percent per year in both men and women, according to the National Cancer Institute (NCI) and the ACS. The trauma and losses from delays in treating even the most common skin cancers are very significant. As with all cancers, early diagnosis and timely intervention is vital to good health and even survival. The focus of this report will be on the most serious of skin cancers: melanoma. However, references will be provided for further information on the NMSCs, as they too demand timely attention. 2 What is Skin Cancer? There are three main types of Skin cancer develops when skin cells start to grow in an abnormal way. It most often begins on areas of your skin that have had significant exposure to sunlight, but it can also occur in skin cells that would not normally be exposed to sun. Like other cancers, if left alone, the abnormal cells will continue to grow and eventually will push their way into healthy tissues, causing many different types of problems, depending on the type of cancer, the growth rate, and the location. That is why our focus for all skin cancers is (1) Prevention and (2) Early Diagnosis and Treatment. skin cancer: Types of Skin Cancer • Basal cell carcinoma • Squamous cell carcinoma • Malignant melanoma All of these cancers need early identification and intervention/ treatment to minimize the damage to surrounding healthy There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Basal cell and Squamous cell are far more common than melanoma, and fall into the category of NMSC (Non-melanoma skin cancer). However, all of these cancers need early identification and intervention/treatment to minimize the damage to the healthy cells around the abnormal cancer cells. cells. Melanoma incidence rates have been increasing by almost three percent per year in both men and women (NCI, ACS). Human Skin Layers Epidermis—Top layer of skin. Made up of squamous cells Melanocyte Melanin Squamous cell skin cancers start here Basal Cells—line the basement membrane which protects dermis and blood vessels Basal cell skin cancers start here Melanocytes—exist in base of epidermis. Make brown pigment (melanin) which gives skin its color. Helps protect deep skin layers from sun (UV radiation) Malignant melanoma skin cancers start here ARTWORK WIKIMEDIA COMMONS 3 What Does Skin Cancer Look Like? The signs and symptoms, Basal Cell Carcinoma as well as the treatment Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sunexposed skin of the head, neck or shoulders. Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring. and prognosis, are based upon the type of skin cell the cancer originated in, and how far and fast it has grown. The information here shows examples of three different types of cancerous skin lesions. James Heilman, M.D., photo Squamous Cell Carcinoma Often a very rapid growing tumor, squamous cell carcinoma (SCC) is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma. Malignant Melanoma The common appearance is an asymmetrical area, with an irregular border, color variation, and often greater than 6 mm diameter (pencil eraser). Most melanomas are brown to black looking lesions; a few melanomas are pink, red or fleshy in color which are called amelanotic melanomas. Unfortunately, these tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding of a mole. 4 PHOTOGRAPHS WIKIMEDIA COMMONS Who Gets Skin Cancer? Nearly everyone on earth, if they live long enough, will develop some sort of skin cancer. There are, however, different levels of risk, depending on each person’s exposure to known “risk factors” for skin cancer. A risk factor is anything that affects your chance of developing a problem or disease. Having a known risk factor does not mean you will definitely develop a disease. Also, not having any known risk factors does not mean you will never develop a specific disease. Rather, knowledge about risk factors allows you to evaluate your own personal risk (chance) of developing that disease, and should also teach you how you can minimize your individual risk for any specific disease. Ultraviolet radiation is divided into three wave length ranges: Risk Factors for Skin Cancer UVB rays can cause direct damage to the DNA, and are the main rays that cause sunburns. They are also thought to cause most skin cancers. #1 Ultraviolet (UV) radiation exposure. Ultraviolet (UV) radiation is a major risk factor for nearly all skin cancers. UV radiation damages the DNA of skin cells. Skin cancers begin when this damage affects the DNA of genes that control skin cell growth. Sunlight is the main source of UV radiation, which can damage the genes in your skin cells. Tanning lamps and beds are also sources of UV radiation. A tan is your skin’s injury response to excessive UV radiation. In 2012, California became the first state to ban the use of UV indoor tanning beds for all minors under age 18. People with high levels of exposure to light from these sources are at greater risk for skin cancer, including malignant melanoma. Additional Risk Factors for Developing Skin Cancer Sources: (Mayo Clinic 2012; Skin Cancer Foundation 2012 ) Fair skin. Anyone, regardless of skin color, can get skin cancer. However, having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair and light-colored eyes, and you freckle or sunburn easily, you’re much more likely to develop skin cancer than is a person with darker skin. A history of sunburns. Having had one or more blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor. Sunny or high-altitude climates. People who live in sunny, warm climates (closer to the equator) are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation. UVA rays cause cells to age and can cause some damage to cells’ DNA. They are linked to long-term skin damage such as wrinkles, but are also thought to play a role in some skin cancers. UVC rays don’t get through our atmosphere and therefore are not present in sunlight. They are not normally a cause of skin cancer. While UVA and UVB rays make up only a very small portion of the sun’s wavelengths, they are the main cause of the damaging effects of the sun on the skin. Both UVA and UVB rays damage skin and cause skin cancer. UVB rays are a more potent cause of at least some skin cancers, but based on what is known today, there are NO safe UV rays. The amount of UV exposure depends on the strength of the rays, the length of time the skin is exposed, and whether the skin is protected with clothing or sunscreen. 5 Additional Risk Factors for Developing Skin Cancer, continued Occupations/lifestyles that increase UV light exposure. People who spend the majority of the daylight hours outdoors (agriculture, ranching, forestry, etc.), as well as those who drive for a living. Moles. People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer. These abnormal moles—which look irregular and are generally larger than normal moles—are more likely than others to become cancerous. If you have a history of abnormal moles, watch them regularly for changes. Precancerous skin lesions. Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches that range in color from brown to dark pink. They’re most common on the face, head and hands of fair-skinned people whose skin has been sun damaged. They are usually easily removed/treated by your doctor. A family history of skin cancer. If one of your parents or a sibling has had skin cancer, you may have an increased risk of the disease. A personal history of skin cancer. If you developed skin cancer once, you’re at risk of developing it again. Even basal cell and squamous cell carcinomas that have been successfully removed can recur. A weakened immune system. People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS or leukemia and those taking immunosuppressant drugs after an organ transplant. Exposure to radiation. People who received radiation treatment for skin conditions such as eczema and acne may have an increased risk of skin cancer, particularly basal cell carcinoma. Exposure to certain substances. Exposure to certain substances, such as arsenic, may increase your risk of skin cancer. Age. Although the risk of nearly all cancers increase with age (more time for skin damage), malignant melanoma, the most serious form of skin cancer is one of the most common cancers in people younger than 30. Melanoma that runs in families may occur at a younger age. 6 PHOTO BY CHRIS BURKARD Melonoma: The most dangerous type of skin cancer Definition of Melanoma: Melanoma is a form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented (colored) tissues, such as in the eye or in the intestines. We do not always know exactly what damages the DNA in skin cells that leads to melanoma. It appears that it is often related to a combination of things, including environmental and genetic factors. Still, doctors believe exposure to ultraviolet (UV) radiation from the sun and from tanning lamps and beds is the leading cause of melanoma. The risk of melanoma seems to be increasing in people under 40, especially women. (Mayo Clinic) Knowing the warning signs of skin cancer can help ensure that cancerous changes are detected and treated before the cancer has spread. Melanoma can be treated successfully if it is detected early. Non-Melanoma Skin Cancers (NMSC) Due to the fact that nationwide statistics are not maintained on non-melanoma skin cancers (NMSC), the next section of this summary will focus on melanoma. However, the last portion of this report, focusing on prevention and early detection, will be applicable to ALL skin cancers. Signs and Symptoms Melanomas can develop anywhere on your body. They most often develop in areas that have had exposure to the sun, such as your back, legs, arms and face. Melanomas can also occur in areas that don’t receive much sun exposure, such as the soles of your feet, palms of your hands and fingernail beds. These hidden melanomas are more common in people with darker skin. The first melanoma signs and symptoms often are: • A change in an existing mole • The development of a new pigmented or unusual-looking growth on your skin • Melanoma doesn’t always begin as a mole. It can also occur on otherwise normal-appearing skin. Estimated new cases and deaths from melanoma in the United States in 2012 (NCI): New cases: 76,250 • Deaths: 9,180 7 Melanoma, continued Melanomas can vary greatly Normal Moles in how they look. Many show Normal moles are generally a uniform color, such as tan, brown or black, with a distinct border separating the mole from your surrounding skin. They're oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter—the size of a pencil eraser. Most people have between 10 and 45 moles. Many of these develop by age 40, although moles may change in appearance over time and some may even disappear with age. all of the ABCDE features. However, some may show changes or abnormal areas in only one or two of the ABCDE features. In more advanced melanoma, the change. The skin on the Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. Melanoma may also appear as a new mole. Thinking of “ABCDE” can help you remember what to look for: surface may break down • Asymmetry: The shape of one half does not match the other half. and look scraped. It may • Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin. texture of the mole may become hard or lumpy. The surface may ooze or bleed. Sometimes the melanoma is itchy, tender, or painful. (Source: NCI) • Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen. • Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch). • Evolving: The mole has changed over the past few weeks or months; the mole is new. Melanomas Normal Moles ABCD rule illustration: On the left, from top to bottom: melanomas showing (A) Asymmetry, (B) a border that is uneven, ragged, or notched, (C) coloring of different shades of brown, black, or tan and (D) diameter that had changed in size. The normal moles on the right side do not have abnormal characteristics (no asymmetry, even border, even color, no change in diameter). 8 PHOTOGRAPHS WIKIMEDIA COMMONS Incidence (How Often it Occurs) The incidence of melanoma Melanoma does not occur as often as the non-melanoma skin cancers (3.5 million/year), but due to the potentially deadly results, it is considered a serious cancer. Based on rates from 2007-2009, 2 percent of men and women born today will be diagnosed with melanoma of the skin at some time during their lifetime. This number can also be expressed as one in every 50 men and women will be diagnosed with melanoma of the skin during their lifetime. As noted within risk factors, people with fair skin and hair have the highest risk of developing melanoma. This is reflected in the U.S. incidence rates by race in the chart below (Source: NCI). These rates are based on cases diagnosed in 2005-2009 from 18 SEER geographic areas (nationwide data). has been increasing for at least 30 years. Since 2004, the incidence rates among whites have been increasing by almost 3 percent per year, for both men and women (ACS). Melanoma Incidence Rates by Race in U.S. Race/EthnicityMale Female All races 27.2 per 100,000 men 16.7 per 100,000 women White 31.6 per 100,000 men 19.9 per 100,000 women Black 1.1 per 100,000 men 0.9 per 100,000 women Asian/Pacific Islander 1.6 per 100,000 men 1.2 per 100,000 women American Indian/ Alaska Native 4.3 per 100,000 men 4.0 per 100,000 women Hispanic 4.7 per 100,000 men 4.6 per 100,000 women Diagnosing Melanoma (and other Skin Cancers) If you have a change on your skin, your doctor must find out whether or not the problem is from cancer. You may need to see a dermatologist, a doctor who has special training in the diagnosis and treatment of skin problems. The dermatologist will check the skin all over your body to see if other unusual growths are present. If your doctor suspects that a spot on the skin is cancer, you may need a biopsy. For a biopsy, your doctor may remove all or part of the skin that does not look normal. The sample then goes to a lab. A pathologist checks the sample under a microscope, looking for changes in the skin tissue cells. Sometimes it’s helpful for more than one pathologist to check the tissue for cancer cells. You may have the biopsy in a doctor’s office or as an outpatient in a clinic or hospital. You will probably have a local anesthetic before the biopsy is taken. (Source: NCI) 9 Diagnosing Melanoma (and other Skin Cancers), continued Staging is a critical step in determining your future plan of care. There are four common types of skin biopsies: • Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth • Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area • Incisional biopsy: The doctor uses a scalpel to remove part of the growth • Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it; this type of biopsy is most commonly used for growths that appear to be melanoma Staging Melanoma If the biopsy shows that the skin change is melanoma (or any other cancer), then further testing may be required to determine the “stage” of this particular cancer. Staging is a critical step in determining your future plan of care. To assign a stage to your melanoma, your doctor will: • Determine the thickness. The thickness of a melanoma is determined by carefully examining the melanoma under a microscope and measuring it with a special tool called a micrometer. The thickness of a melanoma helps doctors decide on a treatment plan. In general, the thicker the tumor, the more serious the disease. (Mayo Clinic) • See if the melanoma has spread. To determine whether your melanoma has spread to nearby lymph nodes, your surgeon may use a procedure known as a sentinel node biopsy. During a sentinel node biopsy, a dye is injected in the area where your melanoma was removed. The dye flows to the nearby lymph nodes. The first lymph nodes to take up the dye are removed and tested for cancer cells. If these first lymph nodes (sentinel lymph nodes) are cancer-free, there’s a good chance that the melanoma has not spread beyond the area where it was first discovered. Cancer can still recur or spread, even if the sentinel lymph nodes are free of cancer. (Mayo Clinic) • Order a more comprehensive work up if there is any evidence that the melanoma has spread. This may include a number of diagnostic scans, depending on the location of the melanoma, and other factors. Your doctor may recommend a CT scan, an MRI, and/or a PET scan to help determine if and where there might be additional melanoma cell clusters. 10 Melanoma is staged using the Roman numerals I through IV. A stage I melanoma is small and has a very successful treatment rate. But the higher the numeral, the lower the chances of a full recovery. By stage IV, the cancer has spread beyond your skin to other organs, such as your lungs or liver. These are the primary stages of melanoma (Source NCI): Several factors may go • Stage 0: The melanoma involves only the top layer of skin. It is called melanoma in situ. aggressiveness of a melanoma • Stage I: The tumor is no more than 1 millimeter thick (about the width of the tip of a sharpened pencil.) The surface may appear broken down. Or, the tumor is between 1 and 2 millimeters thick, and the surface is not broken down. into determining the stage (and guide the treatment recommended). Specifically, the pathologist evaluates the by evaluating the cell patterns and apparent rate of growth (cell division). • Stage II: The tumor is between 1 and 2 millimeters thick, and the surface appears broken down. Or, the thickness of the tumor is more than 2 millimeters, and the surface may appear broken down. • Stage III: The melanoma cells have spread to at least one nearby lymph node. Or, the melanoma cells have spread from the original tumor to tissues nearby. • Stage IV: Cancer cells have spread to the lung or other organs, skin areas, or lymph nodes far away from the original growth. Melanoma commonly spreads to other parts of the skin, tissue under the skin, lymph nodes, and lungs. It can also spread to the liver, brain, bones, and other organs. Stage of Melanoma of the Skin When Diagnosed Comparison of National, Dignity Health of the Central Coast Oncology Services (DHCCOS) Findings [National=Data from Comprehensive Hospital in All States] Stage # National Totals National Percent of all Melanomas DHCCOS Totals DHCCOS Percent 03,548 22.06%521.74% I 6,68041.53% 6 26.09% II 2,23413.89% 7 30.43% III 1,233 7.67% 1 4.35% IV 905 5.63% 3 13.04% N/A 1 0.01% Unknown 1,484 9.23% 1 4.35% Total 16,085100.00% Source: NCD Benchmark Reports, NCI & SEER Data 2012 23 100.00% 11 Treatment Options for Melonoma Patients The best treatment for any skin cancer, including melanoma, depends on the stage of your cancer and your age, overall health and personal preferences. In most cases, the goal of treatment is to remove or destroy the cancer completely. Most skin cancers can be cured if found and treated early. (Sources: Mayo Clinic, NCI, ACS) Treating early-stage melanomas: Treatment for early-stage melanomas usually includes surgery to remove the melanoma. A very thin melanoma may be removed entirely during the biopsy and require no further treat ment. If there are any melanoma cells seen at the edges (border) of the biopsy, then your surgeon will remove the cancer as well as a small border of normal skin and a layer of tissue beneath the skin. For people with earlystage melanomas, this may be the only treatment needed. Treating melanomas that have spread beyond the skin: Your doctors will discuss a variety of options and choices available to you, if you need treatment beyond the initial surgery. You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat skin cancer include dermatologists and surgeons. Some people may also need a reconstructive or plastic surgeon. People with advanced skin cancer may be referred to a medical oncologist or radiation oncologist. Your health care team may also include an oncology nurse, a social worker, and a registered dietitian. Because skin cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. Side effects depend mainly on the type, location, and extent of the treatments and are unique for each person. Before treatment starts, your health care team will tell you about possible side effects and suggest ways to help you manage them. Recent years of research have opened up new hope for patients that have a melanoma that has spread beyond the skin. Treatment options may include: • Surgery to remove affected lymph nodes. If melanoma has spread to nearby lymph nodes, your surgeon may remove the affected nodes. Additional treatments before or after surgery may also be recommended. • Chemotherapy. Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be given intravenously, in pill form or both so that it travels throughout your body. • Radiation therapy. This treatment uses high-powered energy beams, such as X-rays, to kill cancer cells. It’s sometimes used to help relieve symptoms of melanoma that has spread to another organ. Fatigue is a common side effect of radiation therapy, but your energy usually returns once the treatment is complete. 12 • Biological therapy. Biological therapy boosts your immune system to help your body fight cancer. These treatments are made of substances produced by the body or similar substances produced in a laboratory. Biological therapies used to treat melanoma include interferon and interleukin-2. Side effects of these treatments are similar to those of the flu, including chills, fatigue, fever, headache and muscle aches. Ipilimumab (Yervoy) is another drug that uses your immune system to fight melanoma. Ipilimumab is used to treat advanced melanoma that has spread beyond its original location. • Targeted therapy. Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells. Vemurafenib (Zelboraf) is a targeted therapy approved to treat advanced melanoma that can’t be treated with surgery or melanoma that has spread through the body. Vemurafenib only treats melanoma that has a certain genetic mutation. Cells from your melanoma can be tested to see whether this treatment may be an option for you. Experimental Melanoma Treatments Clinical trials are studies of new treatments for melanoma. Doctors use clinical trials to determine whether a treatment is safe and effective. People who enroll in clinical trials have a chance to try evolving therapies, but a cure isn’t guaranteed. And sometimes the potential side effects aren’t known. Some melanoma treatments being studied in clinical trials include: Supportive Care: Many skin cancers can be removed quickly and easily. But some people may need supportive care to control pain and other symptoms, to relieve the side effects of treatment, and to help them cope with the feelings that a diagnosis of cancer can bring. Additionally, some people need assistance in finding or accessing the care they need. These support services are available, free of charge to all patients here on the Central Coast. Please note the locations and contact numbers listed on page 19. • New combinations of treatments. Researchers are testing whether combining treatments may increase the effectiveness of melanoma treatment. For instance, different combinations of chemotherapy, biological therapy, targeted therapy and radiation have been proposed. However, combining treatments can make severe side effects more likely. • New targeted therapies. Researchers are testing new targeted medica tions in people with advanced melanoma. For instance, targeted drugs designed to stop melanoma from attracting blood vessels have shown some success. Blood vessels carry nutrients to the melanoma, and blood vessels help spread cancer cells throughout the body. A drug that stops this process could cause a melanoma to remain small and localized. • Vaccine treatment. Vaccines for treating cancer are different from vaccines used to prevent diseases. Vaccine treatment for melanoma might involve injecting altered cancer cells into the body to draw the attention of the immune system and hopefully stimulate it to develop defensive cells. 13 Prevention and Early Diagnosis is Vital We now realize how critical it is to protect our skin from the day we are born! Keep in mind that knowing what you should do to prevent skin cancers is not enough. You must actually follow through on the actions recommended to decrease the risk of developing skin cancer. As noted throughout this report, there is an enormous survival advantage for those that are able to be diagnosed earlier with melanoma (before it has spread to other areas). An even greater advantage would be if we could prevent the melanoma (or other skin cancers) from developing in the first place. This is why (1) Prevention and (2) Early Diagnosis is what we shout within the cancer care community! Since we believe that the majority of UV radiation that contributes to skin cancer starts years before the visible evidence of the skin damage/cancer shows up, we now realize how critical it is to protect our skin from the day we are born. Here are a few proactive steps each of us can take in our daily life to reduce our personal risk. Preventive Measures • Avoid midday sun. Avoid the sun when its rays are the strongest. For most places, this is between about 10:00 a.m. and 4:00 p.m. Because the sun’s rays are strongest during this period, try to schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Seek the shade when you can. • Protect yourself from “reflected” sun. UV light is reflected by sand, water, snow, ice, and pavement. The sun’s rays can go through light clothing, windshields, windows, and clouds. • Wear sunscreen year-round, every day. Use a broad-spectrum (UVA and UVB) sunscreen with a sun protection factor (SPF) of at least 15. (Some doctors will suggest using a lotion with an SPF of at least 30). For extended outdoor activity, use a water-resistant, broad spectrum product with an SPF of 30 or higher. Apply sunscreen generously, and reapply every two hours—or more often if you’re swimming or perspiring. Use a generous amount of sunscreen on all exposed skin, including your lips, the tips of your ears, and the backs of your hands and neck. • Wear protective clothing. Sunscreens don’t provide complete protection from UV rays, so wear tightly woven clothing that covers your arms and legs and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. Some companies also sell photoprotective clothing; your dermatologist can recommend an appropriate brand. • Don’t forget sunglasses. Look for those that block both types of UV radiation—UVA and UVB rays. 14 You can still enjoy the outdoors while using sun safety at the same time. • Avoid tanning beds. Tanning beds emit UV radiation, which can increase the risk of skin cancer. • Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months. • Become familiar with your skin so you’ll notice changes. Examine your skin monthly, so that you become familiar with what your skin normally looks like. This way, you may be more likely to notice any skin changes. With the help of mirrors, check your face, neck, ears and scalp. Examine your chest and trunk and the tops and undersides of your arms and hands. Examine both the front and back of your legs and your feet, including the soles and the spaces between your toes. Also check your genital area and between your buttocks. If you notice anything unusual, point it out to your doctor at your next appointment. Sources: Mayo Clinic, NCI, and Skin Cancer Foundation (See References) PHOTO BY CHRIS BURKARD 15 Teen Tanners: The New Faces of Melanoma Women ages 18 to 39 are now Limit the Sun, Not the Fun! eight times more likely to be If there’s any good news about melanoma, it’s this: You have the power to substantially lower your risk of getting it. All it will cost you is a little extra time spent protecting yourself from the sun and paying attention to the moles on your skin. Developing protective habits as children and teens can be life-saving in later years. All skin types (fair, medium and dark skin) and people of all ages need protection from UVA and UVB rays. Everyone should protect their skin: use sunscreen properly, wear a hat, cover up! (Please see pages 16-17 for more suggestions.) diagnosed with this potentially deadly skin cancer than they were just 40 years ago. The Dangers of UV Indoor Tanning Beds While it’s no secret that the number of people developing melanoma has long been climbing, one group has had a disproportionately meteoric rise. Women ages 18 to 39 are now eight times more likely to be diagnosed with this potentially deadly skin cancer than they were just 40 years ago. This is significant because the years of potential life lost due to melanoma are higher than for other cancers. An American dying from melanoma loses about 20 years of life. This rise in skin cancer rates happens to coincide with the growth of indoor tanning. Young women are by far the most frequent users of tanning machines: 71 percent of tanning salon patrons are girls and women aged 16-29. However, people who tan indoors are 74 percent more likely to develop melanoma, 2.5 times more likely to develop s quamous cell carcinoma, and 1.5 times more likely to develop basal cell carcinoma than non-tanners. 16 Melanoma is a potentially deadly form of skin cancer that is on the rise in teens. One blistering sunburn in childhood more than doubles a person’s chances of developing the deadliest form of skin cancer later in life. SCARY FACT #1 San Luis Obispo County has the highest rate of new melanoma diagnoses in the state: 106 percent above the national average. SCARY FACT #2 Ninety percent of childhood melanoma cases occur in girls aged 10-19, and in those cases 40 percent of the time the diagnoses and treatment are delayed. SCARY FACT #3 About two Californians die of melanoma each day, for a total of more than 800 deaths from melanoma every day. SCARY FACT #4 Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have not tanned. Did you know? Due to the harmful effects of tanning beds, California has banned the use of UV indoor tanning beds for all minors under 18. PHOTO BY CHRIS BURKARD 17 Questions to Ask Your Doctor Before Treatment Good communication with What is the stage of the disease? your health care professional Has the cancer spread? Do any lymph nodes or other organs show signs of cancer? is critical. Come to each appointment prepared with your questions and write down the answers so you can review them later. What are my treatment choices? Which do you suggest for me? Why? Is this something that can be treated locally, or should I seek care from a university setting, in a major city? What are the expected benefits of each kind of treatment? What can I do to prepare for treatment? Will I need to stay in the hospital? If so, for how long? What are the risks and possible side effects of each treatment? How can side effects be managed? Will there be a scar? Will I need a skin graft or plastic surgery? What is the treatment likely to cost? Will my insurance cover it? How will treatment affect my normal activities? Would a research study (clinical trial) be a good choice for me? How often should I have checkups? PLEASE NOTE: References Used in This Report The following programs/tutorials on melanoma are available at these sites in English or Spanish: American Cancer Society. Cancer Facts and Figures 2012. Atlanta: American Cancer Society, 2012. Pg 21-22; Pg 32. http://www.cancer.org/acs/groups/content/@ epidemiologysurveilance/documents/document/acspc-031941.pdf. Accessed Dec 6, 2012. http://www.nlm.nih.gov/medline plus/tutorials/melanoma/htm/ index.htm http://www.nlm.nih.gov/medline plus/spanish/tutorials/melanoma spanish/htm/index.htm 18 Primary Source: Mayo Clinic Mayo Clinic Web Site. http://www.mayoclinic.com/health/skin-cancer. Accessed Dec 6, 2012. Mayo Clinic Web Site. http://www.mayoclinic.com/health/melanoma. Accessed Dec 6, 2012. National Cancer Institute Web Site. What You Need To Know About Melanoma and Other Skin Cancers. http://www.cancer.gov/cancertopics/wyntk/skin. Accessed Dec 6, 2012. National Cancer Institute Surveillance Epidemiology and End Results Web Site. http://seer.cancer.gov/statfacts/html/melan.html. Accessed Dec 7, 2012. Skin Cancer Foundation Web Site. http://www.skincancer.org/prevention. Accessed Dec 6, 2012. Turn to Us for Answers About Cancer Dignity Health is committed to helping people stay well by making healthy lifestyle choices. If you have concerns, please call us! Dignity Health Central Coast Marian Regional Medical Center at Mission Hope Cancer Center cancer services regional Director 1325 East Church Street, Suite 102, Santa Maria, CA 93454 805.219.HOPE (4673) • Se habla español: 805.346.3406 www.missionhopecancercenter.com Jenni Davis Sean Hunt, RN, BSN, OCN Oncology Counselor and Patient Advocate Cancer Care Navigator/ Survivorship Program 346.3402 346.3401 Jennifer.Davis005@dignityhealth.org Sean.Hunt003@dignityhealth.org Liz Elliott, RN, OCN, CBCN, CBPN-IC Michelle Lamarche, RN Breast Care Navigator 346.3405 Elizabeth.Elliott@dignityhealth.org Alison Fernandez, RN, MPH, OCN UCLA Clinical Research Coordinator Katherine.Guthrie@dignityhealth.org Tina McEvoy, RN, BSN, CHPN Hospice and Palliative Care Director 739.3828 Tina.McEvoy@dignityhealth.org 346.3421 Michelle.Lamarche@dignityhealth.org Chris Magana cancer center transport coordinator 346.3444 Chris.Magana@dignityhealth.org Alison.Fernandez@dignityhealth.org John Malinowski Carol Herrin, RN, OCN cancer exercise trainer 346.3463 346.3434 assistant nurse manager mission hope infusion center 346.3461 Clinical Research Navigator Katherine M. Guthrie 346.3413 John.Malinowski@dignityhealth.org Carol.Herrin@dignityhealth.org Arroyo Grande Community Hospital Coastal Cancer Care Center French Hospital Medical Center Hearst Cancer Resource Center 921 Oak Park Boulevard, Suite 100B Pismo Beach, CA 93449 www.arroyograndehospital.org 1941 Johnson Avenue, Suite 201A San Luis Obispo, CA 93401 www.frenchmedicalcenter.org Mary Fedel, RN, OCN Gloria Caine, RN, BSN, OCN, CBPN-C Cancer Care Navigator 481.7245 Mary.Fedel@dignityhealth.org Infusion Center of San Luis Obispo 715 Tank Farm Road, Suite B San Luis Obispo, CA 93401 Susan L. Diaz, RN, OCN clinical supervisor Nurse Navigator, HCRC 542.6234 m e dic a l di r e c t o r s marian regional medical center Robert A. Dichmann, M.D. Arroyo Grande Community Hospital Edwin Hayashi, M.D., F.A.C.S. Gloria.Caine@dignityhealth.org French Hospital medical center Beverly Kirkhart Thomas Spillane, M.D. Director, HCRC 542.6269 Beverly.Kirkhart@dignityhealth.org 786.6144 Susan.Diaz@dignityhealth.org 19 1325 East Church Street, Suite 102 Santa Maria, CA 93454 D I G N I T Y H EALT H o f t h e C E N TRAL C OAST Marian Regional Medical Center Marian Cancer Care www.marianmedicalcenter.org/mariancancercare Email: mariancancercare@dignityhealth.org 1325 East Church Street, Santa Maria 805.219.HOPE (4673) Commission on Cancer Comprehensive Community Cancer Program Arroyo Grande Community Hospital Coastal Cancer Care Center www.arroyograndehospital.org 921 Oak Park Blvd., Suite 100B, Pismo Beach 805.481.7245 Commission on Cancer Community Cancer Program French Hospital Medical Center Hearst Cancer Resource Center www.frenchmedicalcenter.org 1941 Johnson Avenue, Suite 201A, San Luis Obispo 805.542.6234 20 HEARST CANCER RESOURCE CENTER cover PHOTO BY CHRIS BURKARD