Doctors are seeing more instances of skin cancer among younger people. With early detection and treatment, the disease is beatable.
Cheryl Ricker’s sunbathing habits in her teens and 20s were fairly typical for her generation. Like many young women—and men—she worshipped the sun with a purpose: acquiring a golden bronze glow. Ricker never considered the long-term consequences of all that direct sun exposure.
“I was so horrible as a teenager,” the 48-year-old Westerville mother of two says. “I was rubbing baby oil on me and laying on foil—anything to get a tan.”
Interestingly, it was vanity, not the fear of getting skin cancer, that later changed Ricker’s sunbathing habits. “I actually did stop tanning in my early 30s,” she says. “It wasn’t so much because of skin cancer, but because of aging.” She didn’t want her skin to look freckled, leathery or crepe-y.
Yet the damage had already been done. Now, Ricker knows what it’s like to live with skin cancer. “My first diagnosis was actually in 2009,” she says. “I had a red spot on my forehead. I didn’t know what it was. I thought it was a pimple. It had a pearly white top on it.”
The blemish wasn’t going away and since her family has a history of skin cancer, Ricker went to see her physician. “She said, ‘Oh yes, you need to get that biopsied.’ ”
Dr. Jean McKee, Ricker’s primary care physician, and other area doctors and dermatologists say patients are generally more watchful now for changes to their skin. “The number of times someone has come in to check a mole is definitely increasing,” says McKee, of Mount Carmel Medical Group. And early detection generally translates into much higher cancer survival rates.
Ricker now sees her dermatologist every six months and has undergone several procedures since her initial diagnosis to remove both precancerous and cancerous growths on her face, legs, arms, back, chest and shoulders. “They’re not moles,” she says. “They’re mostly red spots.”
Doctors say the good news is that people increasingly understand that limiting exposure to the sun’s harmful ultraviolet rays also limits skin cancer risk. The use of sunscreen, particularly by diligent parents protecting their kids from sunburn, is growing, they say. And new federal regulations effective this year make it easier to purchase sunscreen that provides the best “broad spectrum” protection against both UVA and UVB rays.
But here’s the bad news: Melanoma, the deadliest type of skin cancer, is now the most common in young adults ages 25 to 29; it’s the second most common in the 15-29 age group.
“Many, many people die from melanoma,” says Dr. Kari Kendra, an oncologist at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and an associate professor of clinical, medical oncology at Ohio State University. “It may be local or may have spread to the lymph nodes or it may be metastasized” and spreading to other parts of the body.
“We’ve seen a rise in skin cancer in younger people,” says Dr. Michael Conroy, a dermatologist with Dermatologists of Greater Columbus, which has offices in Dublin and Upper Arlington.
A board member for the Ohio Dermatological Association, Conroy places much of the blame on tanning beds. He says he and colleagues have lobbied hard to get state legislators to prohibit teens from using tanning beds. “I think tanning beds are right in the crosshairs,” he says. “Even artificial sun from tanning beds—there’s nothing safe about a tanning bed. It’s still UVA and some UVB rays.”
Most basal cell and squamous cell skin cancers are highly curable if detected and treated early, says Wendy Simpkins, spokeswoman for Ohio’s east central division of the American Cancer Society. Melanoma can be as well.
Nationally, the five-year survival rate for melanoma patients is 91 percent. If caught and treated at the local stage, Simpkins says, the five-year rate is 98 percent. The survival rate falls dramatically to just 16 percent if the disease spreads to other parts of the body.
“One in five Americans will develop skin cancer in their lifetime,” says Dr. Stephanie Cotell, a Columbus dermatologist with Northeast Dermatology & Cosmetic Surgery.
Melanoma, basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. Basal and squamous cell “are really viewed as a warning sign, cause for a patient to be more diligent,” says Kendra. Once basal cell and squamous cell growths are removed, “You’ll do well.”
But, she adds, “People can develop many, many of them. Eventually, though they may not be as lethal, they can be deformative” as chunks of skin are removed along with the cancer. Sun damage to the surrounding tissue is distinctly noticeable, she says, “especially when someone is younger. So it’s sort of like a smoker: There is always going to be some residual damage to the lung” even if you’ve kicked the habit.
McKee’s patients generally range in age from their teens to late 50s, she says; more are women than men and many are quite health-conscious. With her 20- and 30-something patients, “I certainly take off quite a few moles because I’m not happy with what they look like,” she says.
Patients in their 40s and 50s may have gray-brown and other discolored skin patches. “Unfortunately, that’s the kind of skin damage you start to see from 20, 30 years ago,” McKee says.
Once a person has had skin cancer, he or she is very likely to get it again, doctors say. Ricker’s experience demonstrates that: “I know my damage is done, and I’ll probably be plagued with this the rest of my life.”
Doctors say patients should keep a close eye on their skin and make an appointment if they notice anything suspicious. “We need to continue to educate people and not assume that they know what they’re looking for,” says Kendra, “anything that looks funny or different or new.”
Ask a family member to check areas you can’t see, and look for growths, sores or suspicious moles. Dermatologists recommend the ABCDE method of monitoring moles:
• Asymmetry – If one-half of a skin growth or mole is unequal or asymmetric to the other half, consider it suspicious.
• Border – Irregular, scalloped, notched or indistinct borders are more likely to be precancerous or cancerous.
• Color – Suspicious moles often exhibit variation of one color or shade. Varying shades of black, brown, blue, red and white are cause for concern.
• Diameter – A mole with a diameter that is larger than a pencil eraser (6 millimeters or more) is considered suspicious.
• Evolution/Elevation – If the mole is changing, it’s best to get it checked by a doctor. The same is true for moles that are elevated, or raised, from the skin.
Conroy calls it “mole surveillance. That’s probably the most important part of our job.”
Once a suspicious mole or growth has been identified, it’s not always as simple as cutting or freezing it away. Ricker learned that firsthand. She has undergone Mohs surgery two times to remove spots on her face. The procedure is used to microscopically remove basal cell and squamous cell growths layer by layer until no cancer cells are detected. “One was a really, really yucky one,” Ricker says. “It took a long time to heal.”
More traditional surgical procedures for precancerous or basal cell and squamous growths include removing the cancer with a scalpel or a sharp spoon-shaped tool called a curette. Cryosurgery—applying liquid nitrogen to very thin skin growths—freezes and kills cancer cells.
Depending on a growth’s location and depth, surgery may be followed by cosmetic procedures and/or skin grafts. Skin cancer that has spread to the lymph nodes may necessitate their removal. Chemotherapy or radiation may be utilized in severe cases, particularly if a skin cancer has metastasized.
OSU’s Kendra says three new U.S. Food and Drug Administration-approved drugs show some “very exciting” promise for extending melanoma patients’ lives, albeit for months, not years. One drug is used for early-stage melanoma treatment and the other two for patients whose melanoma has metastasized. Still, “None of these drugs are curative,” she says.
Some people are more susceptible to skin cancer than others. Fair-skinned and freckled folks with light hair and blue eyes are at greater risk for sunburn, and thus, for skin cancer. “Even one significant sunburn puts you at increased risk of skin cancer years down the line,” Conroy says.
Outdoor workers exposed to the sun day-in and day-out may not get burned, but the damage to their skin—which often becomes leathery-looking—is continual. “I see a lot of pre-cancer, especially on the ears, the face, the scalp, the hands and arms,” McKee says.
Then there are folks who live in places such as Ohio who, after being cooped up all winter, head south for spring break and get significant sun exposure over a short time period. “We don’t realize how much damage we do,” McKee says. “It’s cumulative every year. Every time, you’re damaging your DNA. So once it’s done, you can’t get it back. Radiation from the sun gets into the cells and damages the DNA.”
Think a “base tan” will protect you from harm? Think again. “There is no such thing as a good tan,” cautions Conroy. “Tanning is your body screaming for you to protect it.”
Family history also plays a role in skin cancer, though researchers are still trying to determine how. “We know there is a genetic component,” says Kendra.
Even folks with darker-pigmented skin can get skin cancer. “We still have African-Americans who have melanoma, and their skin is dark,” Kendra says, adding the same is true for those of Hispanic descent.
Meanwhile, physicians continue to push for legislation banning tanning bed use by anyone under age 18. “It’s slow going,” Conroy concedes. “We’re a small fish compared to the indoor tanning lobby. They’re much richer than we are.” The Indoor Tanning Association says that parents—not the government—should decide if minors may use tanning beds.
As a family physician, McKee uses time with her teenage patients to counsel against tanning, either outdoors or in a tanning bed. Conroy does likewise in his dermatology practice, although doctors concede it’s not easy to penetrate the air of invincibility that teens typically possess. “They feel indestructible,” he says.
“Especially young people, there’s so much peer pressure to be attractive,” McKee says. “They think with that brown, bronzy glow you look better.”
Yet doctors say they are noticing a heartening trend in Hollywood and fashion magazines. Fewer models, Cotell says, sport tanned skin these days. “Now, at the Academy Awards, people are not as spray-tanned anymore. There is definitely a recognition that pale is the new tan,” she says.
Conroy agrees: “From the red carpet to the Academy Awards show, it’s becoming more acceptable to have your own skin color.”
Doctors say there are ways to protect your skin and minimize your risk of getting skin cancer.
Optimally, avoid sun exposure between the hours of 10 a.m. and 4 p.m. Doctors realize, though, that’s a tall order. Many people work outside or play sports, or they just want to bask in the warmth of a beautiful sunny day. “I don’t think you should be a hermit,” Conroy says.
Sunscreen, purchased wisely, offers valuable protection for fun in the sun. Effective this summer, the new federal labeling requirements should help shoppers choose the most protective products. “There’s a lot of buzz about this,” McKee says. “It’s huge.”
Look for sunscreens labeled “broad spectrum” to ensure full protection against both UVA and UVB rays, doctors say. Sunburn is primarily caused by the latter, but both can cause sunburn, skin cancer and premature aging.
According to the FDA’s new regulations, products that protect against all types of sun-induced skin damage will be labeled “broad spectrum” and carry SPF 15 or higher. A certain percentage of broad-spectrum sunscreen must protect against UVA rays. The new labels also inform consumers that sunscreen not only protects against sunburn, but, if used as directed with other sun protection measures, can also reduce skin cancer risk and early skin aging.
It’s important to apply a good base coat of at least SPF 30 sunscreen to all exposed skin, Conroy advises. Applying a dab of sunscreen on your face, then going outside for six or seven hours won’t cut it, he says. And reapplying every few hours is critical.
Ricker has made this a standard practice for herself, her 17-year-old daughter and 11-year-old son. “I [still] love sitting outside and going to the beach,” she says.
There are plenty of options for those who think sunscreen is too sticky or heavy, including lightweight lotions, creams and sprays. The sprays are a good follow-up once you’ve applied a thorough sunscreen base coat, dermatologists advise.
Just wearing a hat can reduce skin cancer risk significantly. Hats “are incredibly useful, and easy,” Kendra advises, offering protection for the face, head, neck and ears. Wearing clothing that blocks the sun’s rays also is recommended.
Sun protection also can provide something the plethora of anti-aging products can’t: genuinely younger-looking skin. Doctors don’t hesitate to appeal to their patients’ vanity: “If people just understood how much better they would look,” says McKee.
Debbie Briner is a freelance writer.
Reprinted from the May 2012 issue of Columbus C.E.O. Copyright © Columbus C.E.O.