Gone are the days when people sent children outside to play to get a little
color in their cheeks. They know too much about the dangers of unprotected sun
exposure and the threat of skin cancer. Or do they? Despite the fact that 58%
of parents remembered hearing about the importance of protecting their children
from the sun, children are still playing in the sun without sunscreen or
protective clothing (3., p 1). Sunburn is the most preventable risk factor of
skin cancer. Skin type and family history cannot be changed. Protection from
the sun and education of the potential hazards of the sun need serious attention.
The American Cancer Society estimates that over 850,000 cases of skin cancer
will occur in the United States during 1996. Of those cases, they predict that
9,430 will end in death (4., p 1). Apparently, Americans still do not have an
adequate amount of prevention information to help reduce the disfigurement and
mortality from this cancer.
Exposure to the ultraviolet radiation from the sun is the most frequently blamed
source of skin cancer. Due to the reduction of ozone in the earth’s atmosphere,
UV radiation is higher today than it was several years ago. Ozone serves as a
filter to screen out and reduce the UV light that reaches the earth’s surface
and its people. Very simply, sunburn and UV light can damage the skin and lead
to skin cancer (1., p 1). The American Cancer Society also faulted repeated
exposure to x-rays, artificial forms of UV radiation like tanning beds, and
contact with chemicals like coal tar and arsenic as other causes of skin cancer
(4., p 1). Additionally, if there is a history of skin cancer in the family, an
individual may be at a higher risk (1., p 1). Individuals who have experienced
only one serious sunburn have increased their risk of skin cancer by as much as
50% (1., p 4).
There are three main types of skin cancer: basal cell carcinoma, squamous cell
carcinoma, and malignant melanoma. Basal cell carcinoma usually imposes itself
on areas of the skin that have been exposed to the sun. It usually appears as a
small raised bump with a smooth shiny surface. Another type resembles a scar
that is firm to the touch. Although this specific type of skin cancer may
spread to tissue directly surrounding the cancer area, it usually does not
spread to other areas of the body (9., pp 2-3).
Squamous cell carcinoma growths also appear most frequently on areas of the
body that have been exposed to the sun. These areas can include the hands,
lower lip, forehead, and the top of the nose. Additionally, skin that has been
exposed to x-rays, chemicals, or has been sunburned can host these tumors. The
squamous tumors may feel scaly or develop a crusty appearance. Some growths may
bleed. These particular tumors may spread to lymph nodes in the surrounding
area (9., pp 2 -3).
Malignant melanoma is a far more serious type of skin cancer. It can spread
quickly to other parts of the body through the lymph system or blood. This type
of skin cancer is more common among adults. Findings have indicated that men
most often develop melanoma on the trunk of the body. Whereas, women most often
develop it on the arms and legs (6., pp 2-3). The warning signs of melanoma
are: changes in the color, size, or shape of a mole, bleeding or oozing from a
mole, or a mole that is hard, lumpy, swollen, and is tender to the touch, or
feels itchy. A new mole can also be an indicator of melanoma. A simple “ABCD”
rule outlines the warning signs of melanoma. “A” is for asymmetry. One half of
the mole does not match the other. “B” is for border irregularity. The edges
are ragged, notched, or blurred. “C” is for color. The pigmentation is not
uniform. “D” is for a diameter of greater than 6mm. Any progressive increase
in size should be of particular concern (8., p 1).
For both basal and squamous cell carcinomas, surgery is the most common
treatment. Electrosurgery is the process in which the cancer is scooped out
with a sharp instrument and then an electric current is used to burn the edges
around the site to kill any remaining cancer cells. Cryosurgery freezes the
tumor to kill the diseased tissue with liquid nitrogen. Simple excision cuts
the cancer from the skin along with some of the healthy tissue around it.
Micrographic surgery removes the cancer and as little normal tissue as possible.
During this surgery, the doctor removes the cancer and then uses a microscope to
look at the cancerous area to make sure no cancer cells remain. This particular
treatment has the highest 5-year cure rate. Laser therapy uses a narrow beam of
light to remove the cancer cells. Surgery may leave a permanent scar on the
skin. Depending on the size of the cancer removed during surgery, skin grafting
may be necessary. Radiation therapy uses x-rays to kill cancer cells and shrink
tumors. Chemotherapy uses drugs to kill the cancer cells. Topical chemotherapy
is often administered as a cream or lotion placed on the affected skin to kill
the cancer cells. Systematic chemotherapy is a treatment administered in the
form of a pill or injection. This allows the drug to enter the bloodstream,
travel through the body and kill cancer cells. Systematic chemotherapy is in
the process of being tested in clinical trials. Biological therapy, or
immunotherapy tries to get the person’s own body to fight the cancer. It uses
materials made from the infected person’s body to boost, direct, or restore the
body’s own natural defenses against the cancer. Photodynamic therapy uses a
certain type of light and a special photosensitive chemical to kill cancer cells
(9., pp 2-5).
Malignant melanoma is classified by stages. In Stage 0 melanoma, abnormal cells
are localized to the outer layer of the skin cells and do not invade deeper
tissues. At stage I, cancer is found in the epidermis and/or the dermis, but it
has not yet spread to nearby lymph nodes. The tumor measures less than 1.5
millimeters thick. At stage II, the tumor measures 1.5 millimeters to 4
millimeter thick. The cancer has spread to the lower part of the dermis, but
not into the tissue below the skin or into the nearby lymph nodes. At stage III,
indications are that the tumor has spread to nearby lymph nodes or there are
additional growths between the original tumor and the lymph nodes in the area.
At stage IV, the tumor has spread to other organs or to lymph nodes far away
from the original tumor. The type of treatment is based on the stage of the
cancer. Four of the most common kinds of treatments are: surgery, chemotherapy,
radiation therapy, and biological therapy. Surgery is the primary treatment for
all stages of melanoma. After surgery, chemotherapy is normally used to kill
any cancer cells that may remain (6., pp 2-5).
Individuals that have treatment for basal cell carcinoma should be clinically
examined every 6 months for at least 5 years. Thereafter, an examination for
recurrent growths or new tumors should be done on an annual basis. It has been
found that 36% of individuals who develop a basal cell carcinoma will develop a
second primary basal cell carcinoma within 5 years. Since squamous cell
carcinomas have definite metastatic potential, these patients should follow a 3
month re-examination schedule for the first several years, and then follow a 6
month schedule of examinations for an indefinite period of time (10., pp 4-6).
Overall, there is an increased incidence of second primary melanomas in affected
individuals. A minimum of 3 percent will develop second melanomas within 3
years. Thus, patients need close follow up for the development of subsequent
primary melanomas. An appropriate interval of re-examination may be 6 months
for patients with atypical moles and without a family history of melanoma. If
patients have not shown evidence of recurrence or a second primary melanoma by
the second anniversary of diagnosis, the interval between examinations can be
extended to 1 year. For patients with atypical moles, or a positive family
history of melanomas, examinations should be considered every 3 to 6 months (11).
The American Cancer Society reports that basal cell carcinoma, the most
prevalent skin cancer, and squamous cell carcinoma have a notable prognosis if
detected and treated early. Although, individuals with non-melanoma skin
cancers are at a high risk for developing future skin cancers. While melanoma
is the rarest of the skin cancers, it is the most deadly (7., pg. 1). The
American Cancer Society also states, “Malignant melanoma can spread to other
parts of the body quickly; however, when detected in its earliest stages, and
with proper treatment, it is highly curable. The 5-year relative survival rate
for patients with malignant melanoma is 87%. For localized malignant melanoma,
the 5-year relative survival rate is 94%; and rates for regional and distant
disease are 60% and 16%, respectively. About 82% of melanomas are diagnosed at
a local stage” (8., p 2).
When the statistics show that over one million new cases of skin cancer will be
diagnosed in the United States this year, Americans have their work cut out for
them. By the year 2000, Americans will have a 1 in 75 lifetime risk of
developing melanoma or other skin cancers (5., p 1). Early detection is by far
the most crucial element of surviving this terrible disease. Changing society’s
belief that being tanned connotes health and beauty continues to be a challenge.
The notion has to be replaced with the belief that staying out of the sun, or
taking extreme precautions while in the sun is smarter.