Skin Cancer: Knowing the Truth and Protecting Yourself
Leyna O'Dell
Spokane Coeur d' Alene Living
April 30, 2008

After the long, snowy winter, the clear blue skies and the sun that typically come with spring weather is a welcomed sight in the Inland Northwest. We have spent the winter inside, and are ready to start gardening or go out to the lake and enjoy the fresh air and warm weather. While taking advantage of the weather however, it is important to make sure you are also protecting your skin.

What is Skin?
The integumentary system (which is your skin and its accompanying structures, such as hair and nails) is the most extensive organ on the body and can account for 16% of a person’s total body weight. The skin has many functions that are vital to a person’s ability to stay alive. For instance, the skin absorbs and helps store Vitamin D and also allows the body to control temperature through the release of water and waste through perspiration. The skin is separated into three layers: the epidermis, the dermis, and the subcutis. These three layers of skin each perform different functions and contain different structures.
The epidermis, the upper-most layer of the skin, is what most people think of when they think of skin. Within the epidermis, you will find basal cells. These basal cells divide and form keratinocytes. The keratinocytes, which are also known as squamous cells, produce keratin. Keratin is what keeps our skin strong, yet flexible and helps to water-proof the skin. Also found in the epidermis are melanocytes. The melanocytes produce melanin, which is the substance that gives the skin color. Melanin also has a second function: to help shield the deeper layers of the skin from harmful UV rays.
The dermis is the next deeper layer of skin and is commonly referred to as the “true skin.” It is in the dermis layer of the skin that your fingerprints are formed. The dermis contains collagen and elastin which help keep the skin elastic and youthful in appearance.
The subcutis layer, also known as the hypodermis, is the deepest layer of the skin. This layer of the skin is mainly composed of a fatty layer and serves to protect other anatomical structures, such as muscles and internal organs, from impact and also conserves body heat. The subcutis layer is the layer where your hair follicles and sweat glands have their bases implanted.

The Dangers of Skin Cancer
Skin cancer occurs when there is uncontrolled growth of skin cells. Skin cancer is the most common form of cancer, and has the potential to be deadly. According to the American Cancer Society, more than 1 million Americans will be diagnosed with skin cancer this year. Of those diagnosed, 8,000-10, 000 will die. The good news is that, according to the American Academy of Dermatology, if skin cancer is detected early, it is 95% treatable. There are two categories of skin cancer: keratinocyte carcinomas and melanoma. There are many types of keratinocyte carcinomas. The two most common types are basal and squamous cell carcinoma.
Basal cell carcinoma is the most common form of skin cancer, and squamous cell carcinoma is a close second. According to the American Cancer Society, 3 out of 4 skin cancers are basal cell carcinoma and 1-3 out of 10 are squamous cell carcinoma. The reason for this is that people are spending larger amounts of time in the sun without using any form of protection from the sun’s harmful UV rays. Both basal and squamous cell carcinomas are generally believed to be caused by exposure to UV rays from the sun or tanning beds. Because of this, these carcinomas are typically found on areas of the body that are exposed frequently to the sun, such as the head, face and neck.
Squamous cell carcinoma is more likely than basal cell carcinoma to metastasize (spread to other parts of the body). It is still rare that squamous cell carcinoma will spread, but there is an increased risk for the cancer to metastasize. The good news about basal cell carcinoma is that it does not usually metastasize. However, that does not mean that this type of cancer should go untreated. This skin cancer, like all skin cancers, should be reported to your health care provider in order for a good prognosis. If the cancer goes untreated, it can cause damage to the skin, nerves and bone that lie below the skin’s surface.
Melanoma is the second category of skin cancer. This form of skin cancer begins at melanocytes, which are the pigment producing structures found within the skin. When melanoma strikes, it continues to produce pigment. This means that the melanoma might appear brown, red, black, or yellow. Melanoma is diagnosed less often than keratinocyte carcinomas, yet is the most serious form of skin cancer. Melanoma has a greater chance to metastasize than other forms of skin cancer, but with early detection and treatment melanoma patients have a very good prognosis.

Protecting Yourself
The American Cancer Society reveals that gender plays a large role in skin cancer. Men are two times more likely to be diagnosed with basal cell carcinoma than a woman, and three times more likely to be diagnosed with squamous cell carcinoma than women. However, there are certain characteristics that are more likely to be at risk for skin cancer, regardless of their gender. The following list is a list of populations that are at an increased risk for skin cancer. If you fall into any of these categories, make sure to take protective measures against skin cancer:
• Fair skin
• Blonde or red hair
• Burn easily
• Family history of skin cancer
• Have had frequent sunburns in the past
• Smoke tobacco products
• Use tanning beds

Some people are at a greater risk for developing skin cancer than others, but it is important that everyone take preventative measures that can greatly reduce their risk for developing skin cancer. To reduce your risk for skin cancer, limit your time in the sun. If you are planning to be outdoors, use sunscreen with an SPF of 15 or higher, wear a wide brimmed hat and sunglass with a UV protectant. You will need to reapply sunscreen every two hours.
Since early detection is key to having a good skin cancer outcome, it is important that you perform monthly self-skin cancer checks and have a physician check your skin annually. To perform a self-skin cancer check, it is best to stand in front of a full length mirror. Using the mirror, check for any moles, freckles or areas of the skin that appear irregular; to view hard to see areas, such as your back, use a hand mirror. When checking for irregularities, use the ABCD’s of skin cancer from the American Academy of Dermatology as a guide:
A – Asymmetry: One half does not match the other half in size, shape, color or thickness.
B – Border Irregularity: The edges are ragged, scalloped or poorly defined.
C – Color: The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white and blue add to the mottled appearance.
D – Diameter: While melanomas are usually greater than 6mm in diameter (the size of a pencil eraser) when diagnosed, they can be smaller. If you notice a mole different from others, or which changes, itches or bleeds (even if it is small) you should see a dermatologist.

Skin cancer does not discriminate. It is important that everyone be vigilant when performing skin cancer screenings. Watch for any irregularities, and report them to your health care provider immediately. It could save your life!

Leyna Odell is a health educator with Community Health Education and Resources (CHER), a service of Inland Northwest Health Services (INHS). She coordinates CHER’s annual skin cancer screening and is a member of the Eastern Washington Comprehensive Cancer Control Partnership’s Skin Cancer Taskforce. Leyna has a B.S. in Community Health Education from Eastern Washington University, and is currently a candidate in the Masters in Public Administration program at Eastern Washington University.

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