1. Skin Cancer Prevention and Early Detection

2. What is Cancer?
Occurs when cells in a body part begin to grow out of control and crowd out normal cells.

3. What is Skin Cancer? Skin cancer is the most common of all cancers.
Most skin cancers are:
slow-growing
easy to recognize
relatively easy to treat when detected early
Most skin cancers are caused by too much exposure to ultraviolet (UV) rays, mostly from the sun but also from tanning beds.

4. The American Cancer Society Estimates
More than one million new cases of basal and squamous cell cancers occur annually in the United States.
The most serious form of skin cancer is melanoma.
This year approximately 68,720 people will be diagnosed with melanoma and approximately 8,650 will die.
Melanoma rates are more than 10 times higher in Caucasians than in African Americans.
Most of the more than 1 million cases of nonmelanoma skin cancer diagnosed yearly in the United States are considered to be sun-related.

5. Two Types of Skin Cancer
1. Non-Melanomas – (most common skin cancers)
Include Basal Cell and Squamous Cell Cancers
Can be fast or slow growing, but rarely spread
Found on sun exposed parts of body like the head and neck
This year approximately 2,940 people will die from non-melanoma skin cancer
Skin cancers are often divided into 2 groups – melanomas and non-melanomas. It is important for you to know what melanomas and non-melanomas look like. That way, you can find them at the earliest possible stage, when skin cancers are most easily cured.
Non-melanomas Non-melanomas include basal cell cancers and squamous cell cancers. They are the most common cancers of the skin. They are called non-melanomas because they develop from skin cells other than melanocytes (the cells that make the brown pigment that gives skin its color). Both basal cell and squamous cell cancers are found mainly on sun-exposed parts of the body such as the head and neck, and their occurrence is related to lifetime sun exposure.
Non-melanomas rarely spread elsewhere in the body and are less likely than melanomas to be fatal.

6. Types of Skin Cancer Melanomas Can occur anywhere on the body
Less common, but more serious
Almost always curable when detected early
More likely to spread to other parts of body
This year approximately 8,650 people will die from melanoma
Melanomas A melanoma is a cancer that begins in the melanocytes. Melanomas can occur anywhere on the skin, but are more likely to develop in certain locations. The trunk is the most common site in men. In women, the legs are most commonly affected.
Melanoma is much less common than basal cell and squamous cell skin cancers, but it can be far more serious. Like basal cell and squamous cell cancers, melanoma is almost always curable in its early stages. But it is much more likely than basal or squamous cell cancer to spread to other parts of the body, where it can be very hard to treat.

7. What is Ultraviolet (UV) Radiation?
Ultraviolet (UV) rays are a form of invisible energy given off by the sun
UV rays are divided into 3 wavelength ranges:
UVA Rays, causes long-term skin damage such as wrinkles, but also play a role in some skin cancers.
UVB Rays, direct damage to DNA, these rays cause sunburns, cause most skin cancers.
UVC Rays, do not penetrate atmosphere, not present in sunlight.
There are NO safe UV Rays!
Ultraviolet (UV) rays are a form of invisible energy given off by the sun. Ultraviolet radiation is divided into 3 wavelength ranges:
UVA rays are involved in the aging of cells and produce some damage to cells’ DNA. They are mainly linked to long-term skin damage such as wrinkles, but are also thought to play a role in some skin cancers.
UVB rays are mainly responsible for direct damage to the DNA, and are the rays that cause sunburns. They are also thought to cause most skin cancers.
UVC rays don’t penetrate our atmosphere and therefore are not present in sunlight. They are not normally a risk factor for skin cancer.
While UVA and UVB rays make up only a very small portion of the sun's wavelengths, they are primarily responsible for the damaging effects of the sun on the skin. UVB radiation damages the DNA of skin cells. Skin cancers begin when this damage affects the DNA of genes that control skin cell growth. Recent research has found that UVA also contributes to skin cancer formation.

8. What is a tan?
Tanning, like sunburn, is literally a form of skin injury.
Ultraviolet radiation can damage your DNA at a cellular level, which can lead to cancer.
Although people with light skin are more susceptible, darker skinned people can also be affected.
People who tan are greatly increasing their risk of developing skin cancer. This is especially true if tanning occurs over a period of years because damage to the skin accumulates. Skin aging and cancer are delayed effects that show up many years after the exposure. Unfortunately, since the damage is not immediately visible, young people are often unaware of the dangers of tanning. It is estimated that cases of skin cancer will continue to increase as people who are tanning in their teens and twenties reach middle age.

9. What about tanning beds?
There is no evidence that tanning in a bed is any safer than tanning in the sun -- in fact, some tanning beds release much stronger UV light than the sun does.
There is a 75% increase in risk for melanoma among those who first use tanning beds in their teens and early twenties.
Here's what everyone should know about the risks of using a sun bed:
Overexposure to ultraviolet (UV) radiation is thought to be the primary risk factor for most skin cancers.
Indoor tanning beds deliver UV rays just as the sun does. In fact, high-pressure tanning bulbs can deliver as much as 15 times the UV radiation we receive from the sun.
Using a tanning bed before age 35 increases your risk of developing melanoma by 75%.
A 15-to-30-minute session in a tanning bed can equal an entire day at the beach.

10. What is My Risk For Skin Cancer?

11. Who is prone to sun damage?
Everyone!
Everyone's skin and eyes can be affected by the sun and other forms of UV rays.
Although people with light skin are much more likely to have sun damage, darker-skinned people, including African Americans and Hispanic Americans, also can be affected.
Everyone's skin and eyes can be damaged by the sun and other UV rays. Although people with light skin are more likely to have sun damage, darker skinned people, including African Americans and Hispanic Americans, also can be affected. People with darker skin tan more easily than others. But tanning is still a form of skin damage. Tanning occurs when UV radiation is absorbed by the skin, causing an increase in the activity and number of melanocytes, the cells that make the pigment melanin. Melanin helps to block out damaging rays up to a point, which is why darker skinned people burn less easily. Those with lighter skin are more likely to burn. Sunburns are thought to increase your risk of skin cancer, especially melanoma. But UV exposure can raise skin cancer risk even without causing a sunburn.

12. Factors that Increase Risk of Skin Cancer
Individuals who are lighter skinned, have freckles, and have blond, red, or light brown hair.
Individuals who work outdoors and or live in high altitudes (due to increased UV rays).
Prior treatment with immune suppressing medicine.
Excessive exposure to light from tanning lamps, booths or sunlight.

13. How Can I Protect Myself From Skin Cancer?
Some people think about sun protection only when they spend a day at the lake, beach, or pool. But sun exposure adds up day after day, and it happens every time you are in the sun. Following these practical steps can help protect you from the effects of the sun. These steps complement each other – they provide the best protection when used in combination.

14. Steps for Sun Protection
Limit your sun exposure during 10am-4pm
Cover up your skin, especially your arms and legs.
Wear a wide brimmed hat to protect eyes, ears, and face.
Wear wrap-around sunglasses.
Use sunscreen of SPF 15 or higher, and be sure to re-apply.
Avoid artificial sources of UV light (tanning beds)
Limit Direct Sun Exposure During Midday UV rays are most intense during the middle of the day, usually between the hours of 10 AM and 4 PM. If you are unsure about the sun's intensity, take the shadow test: If your shadow is shorter than you, the sun's rays are the strongest. Plan activities out of the sun during these times. If you must be outdoors, protect your skin. UV rays reach the ground even on cloudy days. UV rays can also pass through water, so don't assume you're safe if you're in the water and feeling cool. Be especially careful on the beach and in the snow because sand and snow reflect sunlight, increasing the amount of UV radiation you receive. Cover Up When in the sun, wear clothing to protect as much skin as possible. Clothes provide different levels of protection, depending on many factors. Long-sleeved shirts, long pants, or long skirts are the most protective. Dark colors generally provide more protection than light colors. A tightly woven fabric protects better than loosely woven clothing. Wear a Hat A hat with at least a 2- to 3-inch brim all around is ideal because it protects areas often exposed to the sun, such as the neck, ears, eyes, forehead, nose, and scalp. Use a Sunscreen With a Sun Protection Factor (SPF) of 15 or Higher A sunscreen is a product that you apply to the skin for some protection against the sun's UV rays, although it does not provide total protection. Experts recommend products with an SPF of at least 15. The SPF number represents the level of protection against UVB rays provided by the sunscreen -- a higher number means more protection. It is important to remember that sunscreen does not give you total protection. When using an SPF 15 and applying it correctly, you get the equivalent of 1 minute of UVB rays for each 15 minutes you spend in the sun. So, 2 hours in the sun wearing SPF 15 sunscreen is the same as spending 8 minutes totally unprotected. Wear Sunglasses That Block UV Rays Research has shown that long hours in the sun without eye protection increases the chances of developing eye disease. UV-blocking sunglasses can help protect your eyes from sun damage. The ideal sunglasses do not have to be expensive, but they should block 99% to 100% of UVA and UVB radiation. Check the label to be sure they do. Avoid Tanning Beds and Sunlamps Many people believe that the UV rays of tanning beds are harmless. This is not true. Tanning lamps give out UVA and frequently UVB rays as well. Both UVA and UVB rays can cause serious long-term skin damage, and both contribute to skin cancer.

15. What About Tanning Products?
Tanning Pills
The additives are distributed throughout the body, especially the skin, turning it an orange-like color.
They are not approved for use as tanning agents and may be harmful.
Tanning Accelerators
Such as lotions or pills that contain the amino acid tyrosine or its derivatives, are not effective and may be dangerous.
Bronzers and Extenders
Not considered harmful when used properly. These products do not protect against UV exposure.
Several products claim to give a tan without UV radiation. Tanning pills contain color additives similar to beta-carotene, the substance that gives carrots their orange color. The additives are distributed throughout the body, especially the skin, turning it an orange-like color. Although the Food and Drug Administration (FDA) has approved some of these additives for coloring food, they are not approved for use in tanning agents. At the high levels that are consumed in tanning pills, they may be harmful. The main ingredient in sunless tanning pills, canthaxanthin, can deposit in the eyes as yellow crystals, which may cause injury and impaired vision. There have also been reports of liver and skin problems, as well as one reported case of a woman who died from aplastic anemia, which her doctor attributed to her use of tanning pills. Tanning accelerators, such as lotions or pills that contain the amino acid tyrosine or its derivatives, are not effective and may be dangerous. The FDA considers them unapproved new drugs that have not been proven safe and effective. No tanning pills have been approved by the FDA. Two other sunless tanning products, bronzers and extenders, are considered cosmetics for external use and are not thought to be harmful when used properly. Bronzers, made from color additives approved by FDA for cosmetic use, stain the skin for a short time when applied and can be washed off with soap and water. Extenders, also known as sunless tanners or self-tanners, are applied to the skin as lotions or creams, where they interact with protein on the surface of the skin to produce color. The color tends to wear off after a few days. The only color additive FDA approved for extenders is dihydroxyacetone (DHA).

16. What Should I Know About Early Detection of Skin Cancer?

17. When Should I be Screened?
Get a cancer-related checkup by a doctor, including skin examination, every three years between ages 20 and 40 and annually for those 40 and older.
See a doctor immediately if you notice any warning signs.
It’s important to check your own skin, preferably once per month.
Skin Cancer can often be found early. Everyone can do things to find this cancer early, when it is curable. Skin Cancer can often be found early. Everyone can do things to find this cancer early, when it is curable. It’s important to check your own skin about once a month and get a skin exam by a doctor or trained health professional as part of your routine cancer check-up.

18. What Should I Look For?
Basal cell cancers and squamous cell cancers are most often found in areas that get exposed to a lot of sun, such as the head, neck, and arms, but they can occur elsewhere.
Look for new growths, spots, bumps, patches, or sores that don't heal after 2 to 3 months.
Basal cell carcinomas often look like flat, firm, pale areas or small, raised, pink or red, translucent, shiny, waxy areas that may bleed after a minor injury. They may have one or more abnormal blood vessels, a lower area in their center, and/or blue, brown, or black areas. Large basal cell carcinomas may have oozing or crusted areas.
Squamous cell carcinomas may look like growing lumps, often with a rough, scaly, or crusted surface. They may also look like flat reddish patches in the skin that grow slowly.
Both of these types of skin cancer may develop as a flat area showing only slight changes from normal skin.

19. Use ABCD Rule to Spot Melanoma
A (Asymmetry) one portion of the mole does not match the other
B (Border) edges are irregular, notched, or blurred
C (Color) different shades of black or brown, patchy colors
D (Diameter) spot is 6 millimeters across, or growing larger A B C D
What to Look For During a Self-exam
Melanomas: The “ABCD rule” is an easy guide to the usual signs of melanoma.
A is for ASYMMETRY: One half of a mole or birthmark does not match the other.
B is for BORDER: The edges are irregular, ragged, notched, or blurred.
C is for COLOR The color is not the same all over and may include shades of brown or black, sometimes with patches of red, white, or blue.
D is for DIAMETER: The spot is larger than 6 millimeters across (about ¼ inch — the size of a pencil eraser) or is growing larger.
Be on the lookout and tell your doctor about any spots that match the following description:
Another very important sign of possible melanoma is a change in the size, shape, or color of a mole or the appearance of a new spot. Some melanomas do not fit the ABCD rule described above, so it is very important to tell your doctor about any changes in skin markings or new spots on your skin.
Other warning signs are:
a sore that does not heal
spread of pigment from the border of a spot to surrounding skin
redness or a new swelling beyond the border
change in sensation -- itchiness, tenderness, or pain
change in the surface of a mole -- scaliness, oozing, bleeding, or the appearance of a bump or nodule
a mole that looks very different from your other moles

20. Signs and Symptoms of Melanoma
Change in the size, shape or color of a mole, such as:
Signs that a mole’s border is becoming more ragged
Spread of pigmentation beyond its border
Scaliness, bleeding or change in the appearance of a bump or nodule
Change in sensation, itchiness, tenderness or pain in a mole or other growth
It's important to know the difference between melanoma and a harmless mole. A normal mole is most often an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised. It can be round or oval. Moles are usually less than 1/4 inch across, or about the width of a pencil eraser. Moles can be present at birth or they can appear later. Several moles can appear at the same time.
Once a mole has developed, it will usually stay the same size, shape, and color for many years. Moles may fade away in older people.
Most people have moles, and almost all moles are harmless. But it is important to recognize changes in a mole -- such as its size, shape, or color -- that suggest a melanoma may be developing.
Be sure to show your doctor any area that concerns you. A qualified doctor should be able to identify any suspicious areas you may have. If your doctor suspects you might have skin cancer, he or she will use one or more of the following methods to find out.

21. How to Check Your Skin: Face the mirror:
Check your face, ears, neck, chest, and belly. Women will need to lift breasts to check the skin underneath.
How to Check Your Skin
It's important to check your own skin, preferably once a month. A self exam is best done in a well-lit room in front of a full-length mirror. A hand-held mirror can be used for areas that are hard to see.
The first time you inspect your skin, spend a fair amount of time carefully going over the entire surface of your skin. Learn the pattern of moles, blemishes, freckles, and other marks on your skin so that you'll notice any changes next time. Any trouble spots should be seen by a doctor. Follow these step-by-step instructions to perform your skin self-exam.

22. Face the Mirror
Check the underarm areas, both sides of the arms, the tops and bottoms of your hands, in between your fingers, and fingernail beds.

23. Sit Down
Check the front of your thighs, shins, tops of your feet, in between your toes, and toenail beds.

24. You will need a hand mirror for your thighs, back, and scalp
You will need a hand mirror for your thighs, back, and scalp. Now look at the bottoms of your feet, your calves, and the backs of your thighs, first checking one leg and then the other.

25. Use the hand mirror to check the buttocks, genital area, lower back, upper back, and the back of the neck.
Or it may be easier to look at your back in the wall mirror using a hand mirror.

26. Use a comb or hair dryer to part your hair so that you can check your scalp.

27. How is Skin Cancer Diagnosed?

28. History and Physical Exam Dermascopy Skin Biopsy
Skin Cancer Diagnosis
History and Physical Exam
Dermascopy
Skin Biopsy
If there is any chance that you have skin cancer you should see a dermatologist. He or she will look at the area closely and determine what steps to take next.
Some dermatologists use dermoscopy to help determine if a spot might be a melanoma. This involves using a special microscope and light source to see the spot on the skin more clearly. Sometimes a thin layer of oil will be used with this instrument. The spot may be recorded as a picture or computer image.
Skin Biopsy
If the doctor thinks that an area of skin might be cancerous, he or she will take a sample of skin from the suspicious area to look at under a microscope. This is called a skin biopsy. Different methods can be used for a skin biopsy. The choice depends on the type of skin cancer, where it is on the body, and the size of the affected area.

29. How Is Skin Cancer Treated?

30. Treatment Options Surgery Chemotherapy Radiation Therapy Cryosurgery
Laser Surgery
Skin Grafting & Reconstructive Surgery
Chemotherapy
Radiation Therapy
Surgery
Cryosurgery: In this treatment liquid nitrogen is used to freeze and kill cancer cells. After the dead tissue thaws, blistering and crusting may occur. The wound may take several weeks to heal and will leave a scar. The treated area may have less color after treatment.
Laser surgery: This newer approach uses a beam of light to kill cancer cells. It is useful for squamous cell cancer that hasn’t spread and for some basal cell cancers.
Skin grafting and reconstructive surgery: If a large nonmelanoma skin cancer has been removed, it may not be possible to stretch the nearby skin enough to sew the edges of the wound together.
Surgery is the main treatment for most cases of melanoma. It can often cure early stage melanomas.
Once it looks like the melanoma has spread from the skin to distant organs (such as the lungs or brain), the cancer is very unlikely to be cured by surgery. Even so, surgery is sometimes done because removing even a few areas of spread could help some people to live longer or have a better quality of life.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Topical chemotherapy means that the medicine is placed directly onto the skin rather than being given by mouth or injected into a vein. Because this treatment only reaches cells near the surface of the skin, it is used most often for pre-cancers.
Systemic chemotherapy (use of drugs that are injected into a vein or given by mouth) may be used to treat squamous cell or Merkel cell cancer that has spread to other organs.
Radiation Therapy
Radiation therapy is treatment with high-energy rays to kill or shrink cancer cells. External beam radiation focuses radiation from outside the body on the skin tumor. This may be used to treat some patients with melanoma. Radiation therapy is not often used to treat the original tumor that started on the skin. But it may be used to treat cancer that has come back, either in the skin or lymph nodes, if it cannot all be removed by surgery.

31. Why Is It So Important To Get REGULAR Skin Cancer Screenings?

32. Survival Rates for Melanoma
Five-year survival rate when melanoma is found early at its earliest stage…..99%
Five-year survival rate when melanoma is found after it has spread……..18%
The five year localized survival rate is 99% and the five year overall survival rate is 91%. Most basal and squamous cell cancers can be cured if the cancer is detected and treated early. If detected in its earliest stages and treated properly, melanoma is also highly curable.

33. Three Things To Remember
Nearly all skin cancers are preventable by limiting unprotected exposure to the sun.
Most skin cancers can be treated successfully if detected early – even melanoma.
When out in the sun, seek shade and “Slip! Slop! Slap! Wrap!”
Slip on a shirt
Slop on SPF 15+ sunscreen
Slap on a hat
Wrap on sunglasses
Nearly all skin cancers are preventable by limiting unprotected exposure to the sun.
Most skin cancers can be treated successfully if detected early – even melanoma.
When out in the sun, seek shade and “Slip! Slop! Slap! Wrap!”
Slip on a shirt
Slop on SPF 15+ sunscreen
Slap on a hat
Wrap on sunglasses

34. If you are affected by cancer
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35. How to get involved with ACS
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36. Call 1-800-ACS-2345 or visit www.cancer.org for more information
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37. Questions?