SKIN CANCER & TANNING

The idea of a “healthy tan” is a myth which must be corrected in order to reduce the increasing incidence of skin cancer in the world.
An individual's skin color is determined by their genes and their environment. Our skin can change color in reaction to sun exposure. This is called the "tanning response." When skin absorbs UV radiation, melanin is produced and transferred to the keratinocytes cells within the skin thereby darkening the color of the skin. Melanin in the skin absorbs and scatters UV radiation entering the body and helps protect the skin from adverse reactions to radiation. Thus, the "tanning response" is really a defensive reaction by the body to the presence of damaging radiation, and an effort by the body to protect itself from the harmful affect of ultraviolet A and ultraviolet B (UVA and UVB) rays (“Anatomy”).
A tan still remains in the minds of many as socially desirable. Each day we are confronted with images on television and in magazines of golden-brown models and celebrities. In addition, we are the targets of local advertising and promotion of tanning salons. People must understand that a tan is not necessary; and that in addition to the premature aging of the skin, there are serious and possibly deadly consequences from the overexposure of one’s body to UVA and/or UVB rays. The deadly consequence is skin cancer.
When people think of cancer they relate to the threat of colon cancer, breast cancer, lung cancer, prostate cancer or the more than 90 other forms of cancer ( “Cancer”) but they seem to either disregard the potential seriousness of skin cancer or are simply unaware of it. The fact that many people may be unaware of a potentially dangerous killer is inexplicable.
The National Cancer Institute in January 2007 published a list of the most common forms of cancer in the United States (those cancers diagnosed with the greatest frequency - annual incidence of 30,000 cases or more). By all measures, the most common cancer is skin cancer, including melanoma and nonmelanoma (“Common”).
Nonmelanoma skin cancer, with more than 1,000,000 new cases diagnosed annually, is by far the most frequently diagnosed cancer in the United States. In fact, the combination of melanoma and nonmelanoma skin cancers represent approximately one half of the whole range of all types of cancer diagnosed in the United States each year (“Common”). Of those people diagnosed with skin cancer each year, the National cancer Institute estimates that approximately 10,200 people will die. Of that number, approximately 8,100 will die from melanoma (“Common”). This represents over 20 people each and every day or about 1 per hour.
The number of cases of melanoma in the United States is on the rise. The incidence of melanoma has increased in recent years more than that of any other cancer in the United States. In 1960, one in 1,500 Americans was expected to develop melanoma during their lifetime. In the year 2001, that number was approximately one in 70 (Goldstein and Goldstein 1359) and in 2007 that number is one in 59 – approximately one in 49 for men and one in 73 for women (“2007”) Melanoma is now more common than any non-skin cancer among people between the ages of 25 and 29 years old.(“Burden”) Melanoma is primarily a disease of whites; rates are more than 10 times higher in whites than in African Americans and 7 times higher than in Hispanics (Goldstein and Goldstein 1360).
Skin cancer refers to the uncontrolled growth of skin cells. It develops when the DNA (the molecule found in cells that encodes genetic information) in skin cells is damaged or mutated in ways that the body cannot repair causing the damaged cells to proliferate in an abnormal manner. This proliferation results in a mass of malignant tissue called a tumor or lesion (Wright and Frey 1864)
The skin has two main layers - the outer layer called the epidermis and the inner layer called the dermis (“Skin”).
The outer layer of the skin contains three kinds of cells. Most of the cells are squamous cells which are flat, unpigmented, scaly skin cells located in the middle of the epidermis. Cells near the bottom of the epidermis, under the squamous cells, are called basal keratinocyte cells. These cells are round cells. The remaining cells within the outer layer of the skin are called melanocytes. These cells produce a brown pigment called melanin which gives the skin its color (“Skin”).
Each of the three types of cells can become cancerous. As a result, there are 3 types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (Wright and Frey 1864). Skin cancer is often classified as either melanoma or nonmelanoma. Basal cell carcinoma and squamous cell carcinoma are considered nonmelanoma skin cancers.
Basal cell carcinoma is the most common but least dangerous form of skin cancer. It is a skin cancer that originates from basal cells which are the unpigmented skin cells found deep in the epidermis. There are approximately 850,000 cases diagnosed each year in the United States. It grows slowly and rarely spreads beyond its original starting point and is seldom life threatening (Spickler and Odle 117-19). However, if not detected and treated early it can invade and spread out into all of the layers of the normal skin and grow beneath the skin into other tissue, cartilage, muscles, and bone.
Basal cell carcinoma can appear in many forms either as a small open sore, reddish patch, shiny bump, a pink growth or a scar like area of change in the skin’s appearance. Although it can appear anywhere on the body, it is usually found on the face and neck (Spickler and Odle 117-19).
Basal cell carcinomas are most common from middle age until old age. They are more frequent in men than women. They are seldom diagnosed in people with dark skins. In the United States, Caucasians have about a one in 3 chance of developing basal cell carcinoma over a lifetime (Spickler and Odle 117-19)
There are 3 common types of basal cell carcinomas.. Nodular basal cell carcinomas are the most common form. These tumors begin as a tiny red or clear bump on the skin. Over time, they develop into a growth with clear or white "pearly" raised edges and, often, a depressed area in the middle. A network of tiny blood vessels usually crisscrosses the surface, and the tumor may bleed repeatedly or crust over. Morpheaform basal cell carcinomas are more difficult to detect. These tumors are usually pale, firm, flat growths that can blend into the normal skin around them. Many look just like a scar. Superficial basal cell carcinomas are flat, red, scaly plaques that can look like psoriasis or eczema. Unlike other basal cell carcinomas, they are usually found on the arms, legs, and torso (English III, Canchola and Finley 1861-63).
The second type of skin cancer is squamous cell carcinoma. This type of skin cancer originates within the squamous cells and becomes visible as a small growth or area of change in the skin’s appearance. Squamous cell carcinoma is the second most common type of skin cancer in North America. There are approximately 250,000 cases diagnosed each year in the United States. It is more common in the older adult population rather than the young (Spickler and Frey 1132-35).
Most squamous cell carcinomas appear on areas that have experienced increased levels of exposure to the sun or other UV radiation, such as the face, lips, neck, fore-arms, backs of the hands, upper part of the torso, and lower legs. Many squamous cell carcinomas originate as precancerous patches called actinic keratoses which are rough, scaly patches on the skin that usually start to show up in middle age. They are associated with a lifetime's exposure to the sun. Squamous cell carcinomas can also originate in old scars and burns, long-standing sores, and other areas of chronic skin irritation (Spickler and Frey 1133-35). .
The least dangerous type of squamous cell carcinoma is called Bowen's disease. Bowen's disease can show up anywhere on the skin, but it is especially common on the head and neck. This cancer usually grows slowly; but may evolve into a more serious, spreading form if it is not removed. Other types of squamous cell carcinomas grow fairly quickly, can develop within a few months and can also metastasize, or spread to other areas. Approximately, 2–6% of squamous cell carcinomas metastasize, but the rate varies with the tumor site. At least 95% of the tumors that originate in actinic keratoses remain in the skin; but up to 38% of the cancers originating from sites of scars, burns, etc metastasize (Spickler and Frey 1132-36)
Squamous cell carcinoma tends to be most dangerous in individuals with dark skin. The mortality rate for African-Americans with squamous cell carcinomas is 17–24%, much higher than the 2% death rate for white males with this skin cancer. One reason for this disparity is that the cancers that develop in dark skin are more likely to come from old scars and burns than from actinic keratoses (Spickler and Frey 1133)
The third type of skin cancer is malignant melanoma. Malignant melanoma is the type of skin cancer arising from the melanocyte cells. It is the rarest but most deadly form of skin cancer. Its increased ability to spread/metastasize is what makes this type of skin cancer much more dangerous than other types (“Skin”).
There are four primary types of malignant melanoma which are classified by the way they look. They are: superficial spreading, nodular, lentigo maligna, and acral lentiginous (McCartney and Frey 2325-26).
Superficial spreading is the most common type of melanoma, occurring in about 70% of all cases. This type can develop anywhere on the body and is found most often on middle aged people. It usually starts off as a flat brown colored mole/lesion which is raised around the edges with some traces of pink, white, gray and blue. It tends to grow outwards and if removed at this stage there is a good chance of recovery (“Melanoma”).
Nodular also is more common in middle aged people. Although it can appear anywhere on the body it usually is found on the chest or back. It starts as a small dark brown or black lump on the skin’s surface but it can grow vertically very deep and very quickly (“Melanoma”).
Lentigo maligna is a form of melanoma which usually develops on the face of older people as a tan or brown flattish mole or lesion with an irregular border. It is a very slow spreading type of skin cancer and can take several years to develop (“Melanoma”)
Acral lentiginous is commonly found on areas of the body that aren't normally exposed to the sun such as the soles of the feet or the palms of the hands and in nail beds. It appears as flat, brown or black tumors (“Melanoma”).
Except for the nodular type, there is usually radial or lateral spreading of these tumors. Because vertical invasion beyond the original site and into the lymph nodes, blood vessels and into other organs of the body increases the malignant nature of this type of skin cancer, the nodular type is the most dangerous (McCartney and Frey 2325).
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. The basic ABCDE rules to determine whether a mole is a melanoma are: Asymmetry – one side does not match the other; Border irregularity - jagged or blurred borders; Color – not uniform, there are different shades of black, brown, or tan with possible white, red, or blue splotches; Diameter – greater than 6mm; Evolution – changes in shape, size or color (McCartney and Frey 2326-27; “Skin”).
Unlike many types of cancer where there is no clear scientific evidence of the specific causes of the disease and thus no specific measures defined on how to prevent them, the primary cause for skin cancer has been well researched. The scientific community agrees that overexposure to ultraviolet radiation from the sun or to the artificial type UV radiation produced by tanning beds is the principal cause of skin cancer (Wright and Frey 1864). Knowing this makes skin cancer very preventable if people are properly educated and exercise the proper protective practices.
The intensity of the radiation, the length of time the skin was exposed, and whether or not the skin was protected with clothing and sunscreen are all major influences which contribute to the risk. Many individuals are exposed to sunlight during their daily lives and certain outdoor activities elevate a person’s chance of developing skin cancer. For example, athletes who spend countless hours training and competing in the sun, workers whose job requires them to be exposed to the sun most of the day and children who play outside for countless hours in a day are more prone to developing sin cancer. Exposure to UV radiation during childhood plays a major role in the future development of skin cancer. Many studies have determined that even infrequent but intense exposure to sunlight during childhood and adolescence greatly increases one’s risk of developing melanoma. More than one half of a person's lifetime UV exposure occurs during childhood and adolescence. If a person has a history of 1 or more blistering sunburns during childhood or adolescence then they are two times more likely to develop melanoma than those who did not have such exposures (Glanz, Saraiya and Wechsler 1)
Ultraviolet radiation is divided into 3 wavelength ranges however; only 2 of the ranges actually penetrate our atmosphere, UVA and UVB.
Scientists initially believed that only UVB rays played a role in the formation of skin cancer. UVB light does cause harmful changes in skin cell DNA. UVB rays are responsible for sunburn and for many basal cell and squamous cell cancers. (“Skin”) However, there are no safe UV rays. UVA rays also contribute to skin cancer. These rays penetrate the skin more deeply than UVB does, weakens the skin's immune system and increases the risk of cancer, especially melanoma. Tanning lamps and tanning beds deliver high doses of UVA, which makes them especially dangerous. (“Skin”) A study from Dartmouth in 2002 showed tanning bed users had 2.5 times the risk of SCC and 1.5 times the risk for BCC (“Skin”)
Certain people are more predisposed than others to the damaging affects of UV radiation. Several individual risk factors for the various types of skin cancer have been identified and people who possess one or more of these factors should be extra cautious.
For melanoma, major risk factors include a personal or family history of the disease and the existence of several or large moles (Goldstein and Goldstein 1360-62;”Skin”). For all types of skin cancer, risk factors include light or fair skin color, natural blond or red hair, sun sensitivity, immune suppression disease, occupation and geographic location (Goldstein and Goldstein 1360-62;”Skin”).
For instance, people who live in areas with year-round, bright sunlight have a higher risk. In a recent study published ranking the most to least dangerous skin cancer 100 cities in the United States, Anaheim ranked as the most dangerous city while Buffalo was the 2nd least dangerous city (Shaheen 102). Spending a lot of time outdoors for work or recreation without protective clothing and sunscreen increases your risk.
Also, people who spend a significant amount of time driving in their cars have a higher risk of skin cancer. In a recent study, it was shown that individuals who spend considerable time driving an automobile have a higher incidence of left-sided skin cancers and if they frequently drive with their windows open this further increases the risk (Burfiend 218).
With respect to treatment, both surgical and non surgical methods are used. The specific treatment is determined by the doctor based upon several patient specific factors.
The most common treatment is surgery which is used about 90 percent of the time. The various surgical methods include: Cryosurgery (freezing the tumor with liquid nitrogen to kill the cancer cells); Electro-desiccation and curettage (burning the lesion and removing it with a sharp instrument); Laser therapy (using a laser beam to remove and destroy the cancer cells; Simple excision (simply cutting the cancer from the skin along with some of the healthy normal tissue around it); and Mohs micrographic surgery (removing the cancer with a surgical knife and then using a microscope to ensure that no cancer cells remain) (Goldstein and Goldstein 1365-66; “Treatments”).
There are also several other non surgical methods employed in the treatment of the various types and for various stages of skin cancer, they include: Radiation therapy (using x-rays to kill cancer cells and shrink tumors); Electro-chemotherapy (using a combination of chemotherapy and electrical pulses to kill the cancer cells); Topical Chemotherapy (chemotherapy given as a cream or lotion placed on the skin to kill the cancer cells); Systemic chemotherapy (chemotherapy taken by pill, or injection to kill the cancer cells); Biological therapy ( attempts to get your own body to fight cancer by using materials made by your own body, or made in a laboratory, to boost the body's own natural defenses); Photodynamic therapy (uses a type of light and a special chemical to kill cancer cells); and Immunotherapy (injecting a interferon to boost the body’s own immune system to slow growth of the cancer) (Goldstein and Goldstein 1365-66; “Treatments”).
Of course, notwithstanding how successful the current methods of treatment are, in the final analysis the highest priority must be on educating the public on prevention. Skin cancer is one cancer which is preventable. The primary cause is something which is known and avoidable - natural and artificial UV rays. As a result, the 2 primary prevention methods are simple to remember, teach and implement – they are tried and proven (“Skin”):

1. significantly limit exposure to the sun by seeking shade between the hours of 10 am and 4 pm, using a sunscreen with an SPF of 15 or higher at all times each day, cover your skin with clothing, wear a hat and use sunglasses; and
2. say NO to all other sources of UV radiation such as tanning beds and tanning lamps.

Therefore, the next time you see someone exiting the tanning salon, relaxing midday in the direct sun at the beach or walking around with a obvious tan, do not be envious. Instead, view this person as you would a person smoking a cigarette. They are acting recklessly and risking their lives in an attempt to imitate what they see in the media daily. Remember, despite what the media may lead you to believe, you do not need a tan to look good.
Tanning can kill! Be UV smart and pass the word!

Works Cited

“2007 Skin Cancer Facts”. Skin Cancer Foundation Web Site. 7 November 2007.
< http://www.skincancer.org/skincancer-facts.php>

“Anatomy of the Skin”. Emory University Cancerquest. 19 April 2007. 31 October 2007
<http://cancerquest.net/index.cfm?page=3004>

“Burden of Skin Cancer”. Centers for Disease Control and Prevention, Healthy Youth.
27 March 2006. 7 November 2007.
<http://www.cdc.gov/HealthyYouth/skincancer/facts.htm>

Burfeind, D. B. “Skin cancer update. New study finds time spent driving an automobile may increase skin cancer risk”. Dermatology Nursing. 19.2: (2007) 217-8

“Cancer”. MedicineNet.com. 17 August 2006. 8 November 2007 <http://www.medicinenet.com/cancer/article.htm>

“Common Cancer Types”. National Cancer Institute Web Site. 18 January 2007.
9 November 2007. <http://cancer.gov/cancertopics/commoncancers>

English III, Joseph C. M.D., Daniel R. Canchola, M.D., and Eric M. Finley, M.D.. “Axillary Basal Cell Carcinoma: A Need for Full Cutaneous Examination”. American Family Physician. 57.8 (April 15, 1998): 1860-64

Glanz, Karen Ph.D., M.P.H., Mona Saraiya, M.D.,M.P.H. and Howell Wechsler, Ed.D., M.P.H.. “Guidelines for School Programs To Prevent Skin Cancer”. Morbidity and Mortality Weekly Report. 51.4 (April 26, 2002): 1-16 HTMLCONTROL Forms.HTML:Hidden.1
Goldstein, Beth G. M.D., and Adam O. Goldstein, M.D.. “Diagnosis and Management of Malignant Melanoma”. American Family Physician. 63.7 (1 April 2001):1359-68

Works Cited (cont.)

McCartney, Richard, MD, and Rebecca Frey, Ph.D. "Malignant Melanoma." Gale Encyclopedia of Medicine. Vol. 3. 3rd ed. Detroit: Gale, 2006. 2325-2331. 5 vols. Gale Virtual Reference Library. Thomson Gale. Utica College Library. 11 Nov. 2007

“Melanoma”. Skin Cancer Foundation Web Site. 7 November 2007. < http://www.skincancer.org/melanoma/melanoma_3.html>

Shaheen, C. “ HYPERLINK "http://web.ebscohost.com.ezproxy.utica.edu/ehost/viewarticle?data=dGJyMPPp44rp2%2fdV0%2bnjisfk5Ie46bZLsaeySbOk63nn5Kx95uXxjL6nr0evqa1Krqa1OLawsE%2b4qrE4zsOkjPDX7Ivf2fKB7eTnfLujtU2yq7ZMsqy2PurX7H%2b72%2bw%2b4ti7e%2bfksEik6t9%2fu7fMPt%2fku0quprdOrquwT7Gc5Ifw49%2bMu9zzhOrK45Dy&hid=108" \o "Capitals of skin cancer."
Capitals of skin cancer”. Men's Health. 22.5 (2007): 102

“Skin Cancer Curriculum”. Emory University Cancerquest. 27 October 2007. 31 October 2007 <http://cancerquest.net/index.cfm?page=3329>

Spickler, Anna, D.V.M., Ph.D., and Rebecca Frey, Ph.D. " Squamous Cell Carcinoma." Gale Encyclopedia of Cancer. Ed. Jacqueline Longe. Vol. 1. 2nd ed. Detroit: Gale, 2006. 1132-1137. 2 vols. Gale Virtual Reference Library. Thomson Gale. Utica College Library. 11 Nov. 2007

Spickler, Anna, D.V.M., Ph.D., and Teresa Odle. "Basal Cell Carcinoma." Gale Encyclopedia of Cancer. Ed. Jacqueline Longe. Vol. 1. 2nd ed. Detroit: Gale, 2006. 117-122. 2 vols. Gale Virtual Reference Library. Thomson Gale. Utica College Library.
11 Nov. 2007
Treatments for Skin Cancer”. University of Maryland Medicine. 16 May 2003.
2 November 2007. <http://www.umm.edu/skincancer/treatmen.htm>

Wright, Kathleen, and Rebecca Frey, Ph.D. "Skin Cancer." Gale Encyclopedia of Alternative Medicine. Ed. Jacqueline Longe. Vol. 4. 2nd ed. Detroit: Gale, 2005. 1864-1867. 4 vols. Gale Virtual Reference Library. Thomson Gale. Utica College Library.
9 Nov. 2007