Time to Take Precautions to Prevent Skin Cancer Posted Monday, May 31, 2004 by arjuna

May 23, 2004 Sarah Treffinger Plain Dealer Reporter

Debbie Keppler didn't think much of the beauty mark on the side of her head until after it had grown to the size of a silver dollar.

In the 25 years since, the Parma resident has had more than two dozen melanomas removed. She also has made a habit of examining her body for further signs of melanoma, the most serious form of skin cancer.

"It's scary," said Keppler, 52. "People don't understand. They just think, 'Oh, you have a mole. It's like a freckle.' "

Not when it's actually melanoma, which will kill an estimated 7,910 people this year, accord ing to the American Cancer Society's "Cancer Facts & Figures 2004." And more than 1 million new cases of skin cancer will be diagnosed. In addition to melanoma, that number includes diagnoses for the more common cancers of the skin, basal cell and squamous cell carcinomas, which are usually highly curable.

"Skin cancer affects about one in five Americans," said Dr. Marlene Willen, chair of dermatology at MetroHealth Medical Center. "It's definitely an epidemic."

Anyone can develop skin cancer, but some people are more prone to it than others. Risk factors outlined by the American Cancer Society include excessive exposure to ultraviolet (UV) radiation from the sun, fair complexion, family history, multiple or atypical moles and severe sunburns in childhood.

As summer approaches, experts say we can prevent most types of skin cancer by protecting ourselves and limiting our time in the sun.

But for adults, much of the damage is already done. Willen said 80 percent of sun damage occurs by the time we turn 18.

And melanoma is the No. 1 form of cancer in women ages 25 to 29, said Dr. Allison Vidimos, a Cleveland Clinic dermatologist.

"If we teach children early to make a habit of sunscreen use, we're really going to help them," Vidimos said.

Such a habit should include applying sunscreen 30 minutes before going outside and reapplying it every two hours, said Dr. Elma Baron, director of the Skin Study Center at University Hospitals of Cleveland and Case Western Reserve University. She added that it is important not to miss any areas, such as your ears and the middle of your back.

Vidimos said six teaspoons of a "broad-spectrum" sunscreen with a sun protection factor, or SPF, of 15 or higher will usually do the trick.

That breaks down to a teaspoon on your face and neck, a teaspoon on each arm, a teaspoon on each leg and a teaspoon on your back.

Of course, Willen noted, "There is no sunscreen that's a suit of armor." So she tells her patients to cover up.

The American Cancer Society also suggests regular self-examinations to identify skin cancer.

This year's facts and figures publication notes that basal cell and squamous cell carcinomas "often take the form of a pale, waxlike, pearly nodule, or a red, scaly, sharply outlined patch." Meanwhile, melanomas "often start as small, molelike growths that increase in size and change color."

The ABCD rule - A for asymmetry, B for border irregularity, C for color variation and D for diameter greater than 6 millimeters - outlines the warning signs of melanoma, which can quickly metastasize, or spread, to other parts of the body, if not detected early and treated properly.

Vidimos said men and women should look once a month at their skin, including the bottoms of their feet, underarms and scalp, and report to a doctor any changes in the size, shape, texture or color of a mole.

Sometimes, melanoma cases are discovered by a spouse or friend.

Keppler said that's what happened to her daughter, Gemma. During a haircut, a beautician noticed on Gemma's scalp what turned out to be a melanoma. Gemma now sees a dermatologist regularly.

Keppler said she tries to make sure her kids do not sunbathe and doesn't allow them to sit by their pool without the shade of two huge umbrellas.

She has every reason to be vigilant.

Her husband, Wayne, had melanoma that metastasized. He died of bone cancer in 1998.

To reach this Plain Dealer reporter:

streffinger@plaind.com, 216-999-3906
© 2004 The Plain Dealer.