Skin cancer a serious concern, detectable

By Christina Weaver
Special to the Coastal Point

Barbara Jayne virtually grew up on the beach, in Long Island, N.Y. Throughout her childhood, she had her share of summer fun in the sun. She had her share of sunburns, too. When Jayne and her husband, Gary, retired, they moved to South Bethany, where once again, the beach has become integral to their lives.

Gary Jayne is mayor of South Bethany, but at home Barbara Jayne rules the roost. And during the family’s traditional “beach week,” when all of their children and grandchildren visit, one of the rules is not to go outside without a liberal coating of sunscreen lotion. Jayne reports that the grandchildren don’t have to be told any more. “Yes, Grandma, we’re coated,” they call out as they run out the door.

“I started to find pre-cancerous skin lesions on my face and arms when I was in my 40s,” she said. “Then in my 50s and 60s, my doctor removed several basal cell and squamous cell carcinomas.

“But the shocker came about five years ago. I had been diagnosed with breast cancer and was visiting the radiation oncologist. She examined my back and found an early-stage melanoma, the most deadly variety of skin cancer. It was one I couldn’t see, so having breast cancer probably saved my life from skin cancer.”

According to The Skin Cancer Foundation, basal cell and squamous cell carcinomas are both caused by chronic exposure to sunlight and are the most common forms of skin cancers. They are also the most treatable. Often, people who have one lesion get recurrent ones. However, just because they are common and treatable, the Foundation warns, does not mean their presence should be trivialized. Signs to watch out for include:

• A persistent, open and non-healing sore that may bleed or crust;

• A reddish patch or irritated area, frequently occurring on the chest, shoulders, arms or legs. It may itch or hurt or have no discomfort;

• A pink growth with a slightly elevated rolled border and a crusted indentation in the center;

• A shiny bump or nodule that is pearly or translucent and is often pink, red or white but can be tan, black or brown in dark-haired people;

• A scar-like area that is white, yellow or waxy, and often has poorly defined borders.

Diagnosis of these kinds of skin cancer, many of which are quite tiny, is confirmed by a biopsy, in which a small piece of the tissue is removed and examined under the microscope. Choice of treatment is based on the type, size, location and depth of penetration of the tumor, as well as the patient’s age and general health. The choices are almost all performed on an outpatient basis and include excision of the growth, electrosurgery, cryosurgery using freezing nitrogen, and a technique, used by Jayne’s dermatologist, called MOHS micrographic surgery.

Jayne now has every six months total body checks in which occasional cancerous lesions continue to be found. She describes the MOHS procedure as involving the physician removing very thin layers of the malignancy, layer by layer, checking each thoroughly under a microscope, until the site is tumor free.

“I go with a good book, expecting to be in the office for several hours,” she said. “But when I leave, I know that I am cancer-free and that I will have virtually no scar after the area has healed.”

It is melanoma, commonly called “black-mole cancer,” however, that is the most dangerous form of skin cancer. This cancer grows quickly and, once it reaches a certain depth, metastasizes or spreads to vital organs throughout the body. Unlike basal cell and squamous cell cancers, it tends to strike younger in life and can occur in places not normally exposed to the sun’s rays. Indeed, melanoma is now the most common type of cancer in women ages 25 to 29.

The lifetime risk of developing melanoma is increasing. In the United States, it used to be 1 in 100. Now it is 1 in 70, and in Delaware the rate is higher than the national average. Not surprisingly, the increased occupational and recreational sun exposure in Sussex County makes residents here the most at risk in the state. Melanoma is seen as much in indoor professionals as outside workers. This is thought related to the short but intense exposure to sunlight during weekends or vacations. Although fair-skinned persons are most at risk, darker-skinned individuals are not immune.

Dr. Mark Pittelkow of the Mayo Clinic notes that, while using sunscreen helps prevent the development of melanoma, some people think of sunscreen as a license to stay out in the sun for long periods. A broad-spectrum sunscreen with a sun protector factor (SPF) of at least 15 should be used and reapplied every two hours. He indicates that it is best to stay out of the sun as much as possible between 10 a.m. and 2 p.m. Wearing wide-brimmed hats (not baseball caps that protect the forehead but expose the back of the neck) and long sleeves provides additional protection.

Pittelkow stresses the importance of thorough self-examination for melanoma. Caught early, melanoma can be cured. Discovered too late, melanoma kills. Again, because melanoma strikes young people, self-examination should not be just considered a precaution for retirees. Likewise, those who work in the sun, such as farmers, construction workers and lifeguards, are at high risk. With the help of mirrors, the exam should include one’s shoulders, back, and even genital area.

As you examine your skin, use the ABCDE guide for melanoma’s warning signs:

• A is for asymmetrical shape. It means that when you visually split the mole in half, one side is much different from the other;
• B is for irregular border. Notched, scalloped or irregular borders are characteristic of melanoma;

• C is for color. Moles that are uniform in color pose a lower risk. Moles that have many colors (dark, light, reddish, bluish) are more worrisome;

• D is for diameter. Moles that are larger than 1/2 inch pose a higher risk;

• E is for evolving. A mole that is changing or growing can be characteristic of melanoma.

Stay out of the sun. Use sunscreen. Wear a floppy hat. Rent a beach umbrella.

It sounds so easy. But recent studies involving sun-tanning booths have shown that the sun’s rays increase the natural endorphins or “feel-good” chemicals the body produces. In other words, people don’t just like to get a tan, they like the feeling the rays evoke. Indeed, the studies have shown that people can actually become physically addicted to UV rays. Ask around how many people, including teenagers, visit tanning salons multiple times a week. You will be surprised. This may explain the cavalier attitude to the sun that will be evident on our beaches for the next three months.

Barbara Jayne knows the dangers of skin cancer. And it’s not just her family who benefits from her experience. “If I see families on the beach not protecting their children, I’m not afraid to say something,” she said, adding. “I’d like to see a mention about the danger of sun exposure on the lifeguard stands, along with the warnings about ocean swimming.” That may be the kind of attention skin cancer deserves.