Spot Check

"I diagnosed four cases of melanoma this week.”

Chilling words. But, unfortunately, an all-too-common occurrence these days.

Sunshine may mean vacation time and relaxation to some, but it also is an ominous reminder of something much more serious and often deadly — skin cancer.

As a dermatologist, Ringling native Dr. Creed Stewart sees plenty of skin cancer cases at the Texoma Dermatology Clinic in Sherman, Texas, where he works. Stewart said he was drawn to dermatology because it presented him a variety of options as a doctor.

“I like dermatology because you can do surgery and you can do the medical part of it,” he said. “Family doctors get to practice the medicine side, but they don’t do surgeries. And surgeons don’t do the medical side. This gives me a chance to work in both of those areas. And I get to treat kids, I get to treat old people and I get to treat middle-aged people.”

Stewart has practiced dermatology for the past 10 years. Skin cancer is a significant part of his practice and affects a growing number of people. Stewart said it’s estimated that roughly one in five Americans will develop skin cancer during their lifetimes.

“It’s not like skin cancer is more common now. Fifty years ago, the life expectancy for a guy was 54 years old. Skin cancer most often occurs after age 55,” Stewart said. “People are living a lot longer now. There are more 70-year-olds now and skin cancer is showing up simply because they don’t die as early as people used to.”

While young people think they’re immune to skin cancer because it’s an “old-people disease,” catching some rays now could signal trouble for them in the future.

“What people don’t realize is that 85 percent of sun damage happens to the body before you turn 25,” Stewart said. “Guys or women who have skin cancer at age 45 got that skin cancer lying on the beach when they were 19.”

Stewart said there has been an increase in girls age 25 to 40 with melanoma, most likely caused by tanning.
Skin cancer is more common in people who have blond or red hair, green or blue eyes, light skin and who are 40 or older. But Stewart said it’s never too early to start checking the body for changes in the skin or moles that might signal the beginning of skin cancer. The American Cancer Society recommends a skin cancer-related checkup for men and women beginning at age 20.

Stewart said there are three main types of skin cancer:

• 80 percent of skin cancers are basal cell carcinoma.

Basal cell carcinoma can appear as a skin bump or growth that looks pearly or waxy. It’s usually light-colored and in some cases may be just slightly raised or even flat. BCC can be a skin sore the won’t heal or bleeds easily, and can appear as a sore that is sunken in the middle.

• 15 percent of skin cancers are squamous cell carcinoma.

Squamous cell carcinoma starts as a small bump that enlarges and expands. It can appear as rough, scaly patches on the skin and usually occurs in areas that are frequently exposed to the sun.

• 5 percent of skin cancers are melanoma.

While it represents the least common type of skin cancer, melanoma is by far the deadliest type.  Melanoma diagnosis rates have been on a steady incline for 30 years.

Melanoma often begins in or near an existing mole. A change to the shape, color or diameter of a mole can be a warning sign of melanoma, as is a mole that becomes painful, begins to bleed or itch.

Stewart said melanoma kills approximately 8,700 people per year in the United States. The American Academy of Dermetology declares that one American dies of melanoma almost every hour.

Together, squamous cell and basal cell carcinoma skin cancers kill more than 2 million people.

“For melanoma, surgery is about the only good option,” Stewart said. “We will only do chemotherapy on people when the melanoma’s moved inside. Basal cell and squamous cell carcinomas both respond well to radiation and chemotherapy.”

The most obvious ways to protect yourself from skin cancer is to limit your time in the sun and always wear a sunscreen when outdoors.

When choosing a sunscreen, Stewart said to go for a 15 to 30 SPF (sun protection factor) and make sure it blocks both UVA and UVB rays. For sunscreen to work best, it should be applied at least 20 minutes before going outside and reapplied often after swimming or sweating.

There’s a new movement afoot that urges people to get more Vitamin D into their bodies and many have interpreted this as “get more sun.” It’s true that the sun is a source of Vitamin D, but not the best one. In fact, it’s not even a very effective one.

“There is no reason ever to go out in the sun to get Vitamin D,” Stewart said. “We get plenty of Vitamin D in our diet and you don’t get enough Vitamin D from the sun to make it worth the risk.”

— Information in this story was also found on the American Academy of Dermatology Web site at aad.org, from the American Cancer Society Web site, and The Skin Cancer Foundation site.