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Skin Cancer in Colorado

Depending on how you look at it, Colorado enjoys or suffers some of the most intense sunlight on the planet. The high altitude allows a greater percentage of ultraviolet light-the primary cause of skin cancer-to penetrate to the surface. The dry atmosphere’s often cloudless skies and reflection from snow can result in ultraviolet intensity that is three times as strong to the skin of the spring skier versus what they would be exposed to on the beach in Miami.

The abundance of ultraviolet radiation coupled with our population’s desire for outside recreation undoubtedly contributes to the very high incidence of skin cancer in Colorado compared with other states. Educated awareness, sun protection, and appropriate screening can decrease the incidence and impact of this disease.

Skin cancer affects over 1 million Americans every year, and thus it is the most common type of human cancer. Factors that increase the chances for developing skin cancer include fair complexion, history of frequent sunburns, and family history of the disease. By far, the most prevalent skin cancers are the “Big Three”: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma.

Treatment of Basal and Squamous Cell Carcinomas

Treatment of Basal and Squamous Cell Carcinomas are generally the same, though multiple approaches are used. These vary from destructive techniques such as scraping and electrocautery, freezing, and laser to traditional excision surgery. Newer topical medications allow some variants of the tumor to be treated without surgery or physical destruction at all.

Basal Cell Carcinoma

Basal Cell Carcinoma is the most common of the human skin cancers. It usually occurs on the head/neck and hands, where skin has had the most overall hours of sun exposure, but it occasionally arises in other areas as well. Fortunately, it rarely metastasizes, and therefore is almost never fatal. However, its persistent invasive growth can create significant functional impairment and cosmetic destruction if left untreated.

Basal Cell Carcinoma can present in a variety of ways, but perhaps the most common is a “pimple that doesn’t go away.” A raised translucent papule, a persistent non-healing sore, and a localized permanent scaly patch can all be signs of the tumor.

Squamous Cell Carcinoma

Squamous Cell Carcinoma is the second most common skin cancer. It tends to occur in the same areas as Basal Cell Carcinoma. Although most such cancers are cured, Squamous Cell Carcinoma does have the ability to metastasize and result in death. Therefore, early recognition and treatment is important.

Squamous Cell Carcinoma can present as a scaly red patch or ulcer, but more frequently shows up as a rapidly growing flesh-colored warty growth.

Malignant Melanoma

Malignant Melanoma is in a class by itself. Although far more rare than the other skin cancers, it is also far more dangerous, and is the most common cause of “death by skin cancer.” It is important to realize, however, that the focus on early recognition and treatment now results in an overall cure rate for Malignant Melanoma of approximately 85%.

Malignant Melanoma occurs in different locations than the Basal and Squamous Cell Carcinomas. The most common area is the upper back and, in women, the lower legs. These tend to be the areas of occasional severe sunburn as opposed to areas suffering from long-term sun exposure.

Malignant Melanoma is a tumor of the melanocytes (the cells in skin responsible for color and tanning). It therefore usually shows as a dark spot in the skin. Distinguishing it from the hundreds of other skin spots on a person’s body requires some education, but fortunately, it is as easy as learning the alphabet:

In an attempt to educate the public about potentially dangerous pigmented lesions, the “ABCDE System” of instruction was developed and is widely used today. The system emphasizes the following points:

Asymmetry
One half does not match the other half.

Border Irregularity
The edges are ragged, notched, and poorly defined.

Color
The color varies greatly. Shades of brown and black are mixed with blue, red, and white regions.

Diameter
Probably the least specific of the findings (all melanomas start small), a lesion larger than the others can be suspicious.

Evolution
This requires ongoing observation to assess: Has the spot darkened or enlarged over a short period of time (doubled in size in three months)?

Treatment of Malignant Melanoma

Treatment of Malignant Melanoma is relatively simple and highly effective when the tumors are found early and are thin. In general, an excision with a margin of “normal skin” one centimeter to either side is adequate and can often be carried out in the doctor’s office. Should the tumor be thicker and more advanced, appropriate surgery entails larger removal of surrounding skin, sometimes requiring a skin graft to close the defect. In addition, removal of “sentinel nodes” is now fairly standard. In this situation, the first draining lymph node from the tumor area is removed and analyzed for presence of metastatic melanoma cells. If present, it portends a worse prognosis, and may be an indication to pursue more aggressive therapy.

Metastatic Melanoma remains a desperate disease. It generally is poorly responsive to traditional radiotherapy and chemotherapy, but several research studies employing immune system stimulators are showing early encouraging results.

Early Detection and Prevention

The impact of these diseases is lessened considerably by early recognition and treatment. Patients should be encouraged to examine their own skin on a monthly basis to “get familiar” with all their unique spots, and to seek medical care immediately if any suspicious or changing lesions are found. Individuals at high risk of skin cancer should also have a complete dermatological exam yearly.

An even more desirable goal than detection of the disease is prevention. The scientific evidence overwhelmingly supports the influence of ultraviolet radiation as the cause of most skin cancer. Avoiding ultraviolet involves a reasonable approach to sun exposure: Cover up with clothing and hats, avoid mid-day sun if possible, and frequently apply sunscreen to exposed skin. Reapply every two hours and use even on cloudy days.

Which type of sunscreen is best?

One that you will actually use! Men tend to dislike creams and lotions so a sports gel is more likely to be used. Children like to get sprayed. Women might prefer a moisturizing sunscreen. Whatever the form, the SPF value should be 30 or higher, and it should have “broad spectrum” coverage, meaning that the entire spectrum of ultraviolet (referred to as UVA and UVB) is affected. Ingredients to look for that deliver good UVA blocking include: Avobenzone (also known as Parsol 1789), Titanium Dioxide, Zinc Oxide, and the newly approved ecamsole.

What about tanning booths?

Tanning booths deliver very high amounts of UVA to the skin to induce tanning. In Colorado, by law, they have a warning label affixed, describing their tendency to cause premature aging of the skin and skin cancer. Heeding this warning seems reasonable.