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Dr. Evans Discusses Skin Cancer on Good Morning America Health
Intro: Bronzed, tanned, sun-kissed skin. Is this truly a sign of beauty or simply a cover up for something much more ominous just below the Surface. Once a beautiful bronze now a suspicious blemish has pulled the shades over our skin’s radiating resonance. More than 1 million people are diagnosed annually with skin cancer and one in five Americans will develop skin cancer in their lifetime. So what should we do to avoid this fate? Joining us with the latest breakthroughs and recommendations for skin cancer is. Dr. Susan Evans, Cosmetic Dermatologist.

1) Dr. Evans, the Statistics for Skin cancer are alarming. Will you please share some of the facts from the American Cancer Society.

  • Skin cancer is the most common form of cancer in the United States. More than one million skin cancers are diagnosed annually.
  • Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.
  • One in five Americans will develop skin cancer in the course of a lifetime.
  • Basal cell carcinoma (BCC) is the most common form of skin cancer; about one million of the cases diagnosed annually are basal cell carcinomas. Basal cell carcinomas are rarely fatal, but can be highly disfiguring.
  • Squamous cell carcinoma (SCC) is the second most common form of skin cancer. More than 250,000 cases are diagnosed each year1, resulting in approximately 2,500 deaths.
  • Basal cell carcinoma and squamous cell carcinoma are the two major forms of non-melanoma skin cancer. Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.
  • About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.
  • Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.
  • Contrary to popular belief, 80 percent of a person’s lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.

2) What about the new FDA concerns over Tanning beds?
The FDA wants consumers to know that UV radiation in tanning devices poses serious health risks. including :skin cancer, skin burns,premature aging,cataracts,and suppression of our immune system. The FDA further proposes that these warning signs should be prominently displayed at all tanning bed facilities with much stricter regulations on the frequency of use Here are some additional facts on tanning beds:

  • Ultraviolet radiation (UVR) is a proven human carcinogen, according to the U.S. Department of Health and Human Services.
  • Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.
  • Nearly 30 million people tan indoors in the U.S. every year; 2.3 million of them are teens.
  • On an average day, more than one million Americans use tanning salons.
  • Seventy one percent of tanning salon patrons are girls and women aged 16-29.
  • First exposure to tanning beds in youth increases melanoma risk by 75 percent.
  • People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.

So you can see that frequent tanning bed use is clearly not in or best interest
3)I understand there are 3 different types of Skin cancer: Basal, Squamous (pronounced skwaymus) Cell and Melanoma. How worried should we be about each one?
There are three basic types of skin cancer:
Basal Cell Cancer – BCC is the most common form of skin cancer that is detected. It usually presents as a pearly raised bump with a hard edge. It doesn’t ever heal or go away. While it is a skin cancer, it is not considered to be metastatic. If you have had a single diagnosis of a BCC, you are at a greater risk of developing more of them in the future.
Squamous Cell Cancer – SCC is less common than basal cell carcinoma, roughly by two-thirds. Men are four times more likely to present with a SCC than women are. This type of cancer is directly related to sun exposure. Most people who experience sun damage develop a precancerous lesion called an actinic keratosis. This is a rough, red, scaly patch that appears on sun-exposed areas of your skin. It may seem to go away, but it will always reappear. This is your warning sign! Do NOT ignore it! With treatment, SCC is completely curable. Without treatment, it is often fatal.
Melanoma – These are the most dangerous skin cancers of all, occurring only about one tenth as often as BCC. This type of skin cancer is deadly. This erupts from the melanin producing cells of your skin and presents as a dark, uneven colored freckle or mole with ragged edges. Usually this type of cancer is asymmetrical, meaning that one half of the dark spot does not match the other half. There will be some mottling of color, and one side can be larger than the other. Melanoma is deadly, even if it is smaller than an eraser, not raised, not painful. If you suspect that you have a suspicious lesion, get to a dermatologist today! The longer you wait, the more chance this lesion can metastasize, meaning a single cell breaks apart and travels to another area of your body. When this happens, you will die of this disease. Once you have been diagnosed with a melanoma, you are considered a cancer patient.
4) Dr Evans, is there any thing I can look for at home before I visit my Physician?
I always encourage my patients to do self examination and include their partner for potential back lesions. This should never be a substitute for visiting their physician.
But I recommend everyone do an abc check…
A area
B border
C color
D diameter
E evolving

5) Dr. Susan, Does one’s ethnicity or skin color have any impact on skin cancer incidence?
Avoiding the obvious things that will do the most harm such as tanning beds, frequent tanning without sunscreen or sunblock will do harm for all ethnic groups.
However, studies have shown that the distribution of different types of skin cancer does show a variance among ethnic groups.

  • Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.
  • The average annual melanoma rate among Caucasians is about 22 cases per 100,000 people. In comparison, African Americans have an incidence of one case per 100,000 people. However, the overall melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.
  • While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations6.
  • Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.
  • Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese, and Japanese, and other Asian populations.
  • Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians.
  • Among non-Caucasians, melanoma is a higher risk for children than adults: 6.5percent of pediatric melanomas occur in non-Caucasians.

6) Ok these suggestions are great,but what do you do when you suspect you may have skin cancer?
BCC and actinic keratoses can often be treated in the office of your dermatologist either by freezing off the precancerous or cancerous lesion. You may be given the choice of cryotherapy (freezing) or a topical chemotherapy .For bigger lesions that will not respond to either cryotherapy electrosurgery,or topical chemotherapy, you may undergo in-office simple surgical excision.
Melanomas are almost always treated with Mohs surgery. This is a microscopically controlled surgery that is used to ensure that you have completely free margins all around the cancer. Small sections of your skin are taken examined under a microscope. If there are still any cancer cells present, another section will be taken until there are no cancer cells seen. In this way your dermatologist can tell you that all the cancer has been removed.
Any cancers that have progressed will require the attention of a surgical oncologist, to ensure adequate resection and removal with any associated adjuvant therapy that may be required. Whatever you do, do not delay if you suspect you have a cancerous or precancerous spot on your skin. The sooner it is examined, the better the outcome.
5) you’ve brought with you several interesting items.
[move over to set display]

OK lets begin with our sun protection display I will discuss the advantages of each one…
6) Now Dr Susan you have brought your patient along, what can we do to address her concerns.
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