Thursday, January 30, 2014

Skin Cancer Rates Soar in US Hispanics

Sun & Skin News
Skin Cancer Foundation
Winter 2013

Skin Cancer Rates Soar in US Hispanics

Skin cancer rates among Hispanics are skyrocketing in the US. New research shows that in the past two decades alone, melanoma incidence among Hispanics has risen almost 20 percent.
Hispanics are the fastest-growing population in the US, with a 43 percent increase in their numbers from 2000 to 2010. It is estimated that by 2050, the Hispanic population will exceed 100 million, representing more than 24 percent of the total population. Unfortunately, as the number of Hispanics has risen, so have their instances of skin cancer: From 1992 to 2008, their annual melanoma incidence increased by 19 percent. Too little use of sun safety techniques (such as seeking shade, wearing protective clothing, and using sunscreen) may have contributed to this rapid rise in melanoma and other skin cancers among Hispanics.

The Risk Is Real
One reason for this underuse of sun protection strategies may be the widespread misconception that people with darker skin are not at risk of skin cancer, according to a recent survey by L’Oreal Paris. Other studies point to the lack of skin cancer education campaigns provided for Hispanics and the need for their dermatologists and general physicians to emphasize skin cancer dangers. The authors of a study published this June in JAMA Dermatology said their findings highlighted “the importance of developing culturally appropriate, tailored interventions to reduce the risk of skin cancer among Hispanics.” These studies all concluded that raising awareness among Hispanics will save lives. Culturally sensitive materials, customized interventions, and stronger public health messages were all suggested as ways to combat the growing skin cancer epidemic among Hispanics.

Deadly Results
Making matters worse for Hispanics, those with melanoma have poorer survival than non-Hispanic patients, often due to being diagnosed at a later stage. One study in JAMA Dermatology found that while initial melanoma diagnoses were late-stage in 16 percent of white patients, the number jumped to 26 percent for Hispanics. This trend towards later diagnosis among Hispanics reinforces the need for greater skin cancer education and awareness. These findings underscore the urgency for year-round sun protection, regular skin self-examinations, and annual visits to a dermatologist for everyone, no matter what their ethnicity or skin tone.

BCC or SCC? The Value of Pain
Pain is a potential diagnostic tool for non-melanoma skin cancers. In a study from Wake Forest University Baptist Medical Center in North Carolina, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) patients reported fairly comparable levels of itching at the cancer site. However, a far higher percentage of SCC patients (39 percent) than BCC patients (17 percent) reported pain at the tumor site. Thus, pain may be an important factor distinguishing the two cancers. Left untreated, SCC, in particular, can be fatal: About two percent of SCC patients—between 3,900 and 8,800 people—died from the disease in the US in 2012. It is therefore vital for dermatologists to differentiate SCC from BCC early in the lesion’s development to determine the best treatment.

Percentage of patients reporting itching or pain as a symptom
Dangerous Tanning Habits Persist in Young Women

Despite the now well-established dangers of indoor tanning, teenage and young adult women continue to use tanning beds at an alarming rate, according to the Centers for Disease Control and Prevention’s recent survey study of more than 15,000 subjects. In the 12 months before being surveyed, the study found:

  • Over 29 percent of non-Hispanic white female high school students engaged in indoor tanning at least once, and almost 17 percent did so at least 10 times.
  • Nearly 25 percent of non-Hispanic white women ages 18 to 34 engaged in indoor tanning at least once, and over 15 percent did so at least 10 times.
These findings reinforce past research, notes California dermatologist Melanie Palm, MD, spokeswoman for The Skin Cancer Foundation. “A disproportionate number of girls and young women use tanning beds,” she says. “There’s a cultural disconnect between the risk and the desire for a ‘healthy glow.’”
       The new study’s findings highlight the need for greater understanding among young women about the dangersof indoor tanning. Since physical appearance may mean more to them than long-range health effects, the study authors advise making teenagers and young adults aware that tanning causes not just skin cancer, but age spots, wrinkling, and other negative cosmetic affects. The FDA is also working to help solve the problem: in March 2013 it issued a proposal to raise the classification of tanning beds from Class 1 (low to moderate risk) devices to Class II (moderate to high risk) devices; that proposal is currently under review.
        The Skin Cancer Foundation recommends that people of all ages, genders, and ethnic backgrounds avoid indoor tanning and take precautions in the sun by limiting outdoor time between 10 am and 4 pm, seeking the shade when outdoors, using SPF 15+ sunscreen (SPF 30+ sunscreen for extended stays outdoors), and wearing protective clothing, including wide-brimmed hats and UV-blocking sunglasses.

New Breakthroughs In Melanoma Treatment
Two new oral drugs, dabrafenib (TafinlarTM) and trametinib (MekinistTM), have been FDA approved for stage IV melanoma patients. Like its predecessor vemurafenib, dabrafenib inhibits a defective gene called BRAF, thereby slowing or stopping production of melanoma cells. Trametinib is the first drug to inhibit another defective gene, MEK, also slowing or stopping production of melanoma cells. Both medicines have been found to hold back disease progression and increase survival by months or even years, and even greater results are expected when they are tried in combination with other drugs.

2013 Road to Healthy Skin Tour: More Skin Cancers Found, More Lives Saved
The Skin Cancer Foundation’s annual Road to Healthy Skin Tour, presented by Rite Aid, has wrapped up its sixth cross country journey, bringing free skin cancer screenings and prevention information to communities across America.
Over a four-month period, the 2013 Tour traveled 14,000 miles and held 53 events in 13 states. Seventy dermatologists donated their time to perform exams in the Tour’s customized 38-foot RV, equipped with two private exam rooms.
During this year’s Tour, volunteer dermatologists detected 788 suspected precancers and cancers, including 29 suspected melanomas. Since 2008, the Foundation’s volunteer dermatologists have potentially saved 324 lives; 324 melanomas have been detected since the Tour began. By finding suspected skin cancers, often in early stages, the Tour and its volunteer dermatologists have made a vital contribution to communities across the country.

A Message From the President

    With winter just around the corner, do we still have to worry about skin cancer prevention? In a word—yes. While the sun’s ultraviolet B (UVB) rays (the sunburn-causing rays) are strongest in summer, UVA rays remain constant throughout the year. UVA can penetrate into deeper layers of the skin, causing wrinkles, brown spots, and other signs of skin aging. It also can cause skin cancer.
     Winter vacations add to your skin hazards. Snow and ice reflect up to 80 percent of UV rays, meaning that the rays hit you a second time. Furthermore, at higher altitudes (if you’re skiing in the mountains, for example), UV radiation exposure increases 4 to 5 percent with every 1,000 feet above sea level. Even in winter outerwear, your face and neck—where the majority of skin cancers occur—remain at least partially exposed. If you vacation in a sunny climate this winter, beware—intense sun exposure, the kind of exposure that typically leads to sunburn on a sunny vacation, greatly increases your risk of developing melanoma.
With these risks in mind, here are some key items you’ll need to stay sun-safe this winter:
Sun-protective clothing: Long sleeves, long pants, and gloves not only keep you warmer, but protect your arms, legs and hands against UV. A winter hat also pulls double duty, keeping your head warm and protecting your scalp, ears, and part of your face from the sun.
Sunglasses: Skin cancers of the eyelids account for 5-10 percent of all skin cancers, so sunglasses are essential. Look for a pair that locks 99-100 percent of UV rays, in a wraparound style that also offers protection on the sides. Try them on in the store to ensure a close fit so they don’t end up slipping down your nose, allowing UV rays to creep in.
Sunscreen: Clothing doesn’t protect all of your face, so keep a bottle of broadspectrum (UVA/UVB) sunscreen with an SPF of 15 or higher (SPF 30+ for extended outdoor exposure) where you’ll remember to use it all winter. Additionally, a significant percentage of all cancers are on the lips, so use a lip balm with a comparable SPF.
       One thing not to do when the weather turns cold is turn to tanning beds. Recent research shows that more than 170,000 cases of non-melanoma skin cancer in the US each year are linked to indoor tanning. If you simply must have darkened skin, use a self-tanning product. Better yet, embrace the healthy, natural glow and radiance of your own skin. Remember to protect your skin throughout winter—while driving, playing with your children, skiing, or shoveling snow. Even though the seasons are changing, your commitment to skin cancer prevention should remain the same.

By Laurie Jacobson,MD
Laurie Jacobson, MD is a fellowship-trained Mohs surgeon and a member of the American College of Mohs surgery, Dr. Jacobson practices in Seattle, WA. She specializes in Mohs surgery, dermatologic and laser surgery, cosmetic surgery and skin cancer surveillance. Dr. Jacobson has authored textbook chapters and published widely in peer-reviewed journals. She is contributing editor for the peer-reviewed journal Dermatologic Surgery.

Q: Why is seeing a dermatologist for annural skin screening so important?
A. An early skin cancer diagnosis can be the difference between life and death. Early-stage skin cancers are almost always curable; those found later are harder to treat.

Q: Will have to undress completely? What does a full body exam entail?
A. You will fully undress but wear a gown. Ask a nurse or assistant to be present if you’re uncomfortable undressing with just your doctor in the room. Sometimes my patients leave socks on, or have their hair in an up-do where I can’t access their scalp. But you can develop skin cancer anywhere you have skin—between toes, behind your ears, on your buttocks, groin, or genitalia. Women should not wear makeup or nail polish to the appointment. Wear your hair loose so that your doctor can access your scalp. Your visit should take 15 to 20 minutes. The doctor will examine each part of your skin, and may use a special magnifying glass with a light—called a dermatoscope—to examine certain marks or lesions.

Q: What questions will I be asked?
A. The doctor will want to know if you or any close family members have a history of skin cancer, which would increase your risk of developing the disease. You might also be asked if you’ve ever used tanning beds and how frequently, as well as how regularly you use sunscreen and other sun protection. You might be asked what medications you take, since some increase sun sensitivity and sunburn risk, or suppress the immune system, predisposing you to skin cancer. The more honest you are, the more you’ll get out of your exam.

Q: What happens if the doctor sees something out of the ordinary? Will he/she automatically do a biopsy?
A. When you come for your exam, be prepared for the possibility of a biopsy that day. It’s a quick, simple procedure. We use local anesthetic and take a small tissue sample, which is then examined under a microscope. The purpose is to diagnose the condition, not treat it, so once the biopsy site heals up, if the biopsy revealed skin cancer, the remainder of the growth will beremoved. If any atypical cells are found, they will be removed if deemed necessary, or the doctor might photograph them and have you come back weeks or months later to see if they have grown or changed in any way. 

Q: What can I do at home to make sure I catch skin cancers early?
A. We recommend that you perform a self-skin check once a month to look for any new or changing moles or marks. Have a partner help if possible: my friend’s nine-year-old daughter helped her examine her back, and discovered a basal cell carcinoma.
       Learn more about self-skin exams at