Prevention Beat

 

              May 6, 2008

Did you know...?        

 

May is Melanoma/Skin Cancer Detection and Prevention Month

 

More than one million non-melanoma skin cancers are diagnosed each year, which makes it the most common cancer in the United States.  There are also 65,000 new cases of melanoma diagnosed annually.  And of those 65,000 cases, approximately 15% will die from the disease. 

 

There have been dramatic increases in all three types of skin cancers and the reason is thought to be increased exposure to the sun through outdoor recreation beginning in childhood.  The most significant factor associated with the development of basal cell carcinoma and squamous cell carcinoma is exposure to the sun.  There is a high associated rate between sun exposure and skin cancers, and the reason is the high rate of non-melanoma skin cancers that develop on body areas that are most frequently exposed to the sun, such as face, neck and hands. 

 

Of the two non-melanoma skin cancers, 75% of them are basal cell carcinomas and 20% are squamous cell.  While melanomas account for approximately five to six percent of all skin cancers, approximately 65% of all deaths related to skin cancer are melanomas. 

 

The risk for skin cancers varies among several populations, which are defined by sex, age, ethnicity and geographic location.  The highest rates of skin cancer is in white men who are older than 50 years of age, but both types of the common non-melanomas are now occurring in an increasing percentage of people younger than 40 years of age, and a disproportionate increase in the number of basal cell carcinomas among women of the 40 year age group has been noted. 

 

Skin cancers can develop in all individuals regardless of skin pigmentation, but the risk is approximately 10 to 15 times higher for the white population than for populations with darker skins, such as Black, Indian, Hispanics and Asian populations. 

 

Although sun exposure is a primary factor in the development of non-melanomas, the pattern of exposure appears to differ.  The risk of basal cell carcinoma associated with intense intermittent exposure to the sun is higher than the risk associated with a similar degree of continuous exposure.  In contrast, chronic (cumulative) exposure to the sun is associated with a higher risk of squamous cell carcinomas. 

 

Detection and Diagnosis

 

The early detection and diagnosis of skin cancers, especially melanomas, is critical for selecting the appropriate treatment approach, and to an optimal outcome.  The primary challenges in diagnosing skin cancers are to distinguish between benign and malignant lesions, and to identify lesions with malignant potentials.  Symptomatology does not play a large role in the detection and diagnosis of skin cancers as early stage lesions are usually asymptomatic.  Advanced lesions may be associated with non-healing ulceration, bleeding or pain.  A sore that does not heal may be a sign of either basal cell or squamous cell carcinoma.  A biopsy should be performed on any lesion that is sufficiently suspicious. 

 

Treatment Options

 

There are a number of different treatment options, but generally the most appropriate is surgical excision.  Non-operative alternatives include radiation therapy, chemotherapy, immunotherapy and photodynamic therapy.  A surgical approach is the most common treatment used for basal cell carcinoma, but radiation therapy can also be an effective modality. 

 

As with basal cell carcinoma, the most common treatment for squamous cell carcinoma is surgical excision, although radiation therapy can also be used in many cases. 

 

For malignant melanoma, surgical excision with wide margins is the recommended treatment. 

 

Appropriate treatment of basal cell and squamous cell carcinomas can lead to high cure rates.  But it is noted that for patients who have basal cell carcinoma an additional basal cell carcinoma will develop within five years in 33% of the patients. 

 

Education is key to helping patients understand the risk of sun exposure and the ways to reduce these risks.  Efforts to educate patients should include emphasis on protection from ultraviolet rays, the importance of self-examination and exam­ina­tion of family members, and the need to monitor existing moles for change.  Protection from the sun is most critical for children, as they are at the highest risk for sunburn and because the greatest amount of sun exposure occurs before 18 years of age.  Special attention should be paid to children with a family history of skin cancer. 

 

To learn more about cancer prevention and treatment visit the American Cancer Society's website at:  http://www.cancer.org/docroot/home/index.asp. 

 

This month's article has been provided by Dr. William T. Raue, D.O., FAOCOPM.   Dr. Raue is Board Certified in Occupational and Preventive Medicine.

 

*Please feel free to forward this information to any member of management in your company who would benefit from it.*

 

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