Skin Cancer

The Dangerous Sun

Victor Borges remembers going to the beach as a teenager and asking for the tanning oil, never the sunscreen. Wearing sun protection never crossed his mind, even though he had fair skin.

“I was terrible with sunscreen,” he said. “We would go to the beach and I have pictures where I was chocolate brown and my hair looked white.”

The now 44-year-old landscape manager would’ve never thought he would be diagnosed with skin cancer, until the day came in 2000 when his dermatologist found a small cancerous lesion near his nose, and it was removed.

Borges said since his dermatologist really didn’t make a big deal out of it, he didn’t think anything of it. “They told me to be careful and it was like whatever,” he said.

Then five years later, he began coughing up blood.

Borges was diagnosed with stage four melanoma — the most aggressive form of skin cancer. It spread to his right lung first, then his left lung and his spleen. He had surgery to remove his spleen, two thirds of his right lung and one third of his left lung.

He was referred to Dr. Lynn Feun, a professor of medicine in the department of hematology and oncology at Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine, who was overseeing a study program for IL-2, a medication that stimulates the immune system to fight cancer.

The medication caused Borges to experience fatigue, weight loss, loss of appetite, dehydration and an itchy body rash. “It is one of the nastiest medicines,” he said. “It really breaks down your body and breaks down your cells to the point that it eliminates everything that is bad in your body. It worked cause I am here.”

For the past seven years, Borges has been cancer free and is very cautious about the sun he gets. He wears 50 SPF sunscreen on his face, neck and hands every day, along with a big hat and a long sleeve UPS shirt. His co-workers call it “the cancer suit.”

Feun said melanoma is the ninth most common cancer in the United States. It has the ability to spread and develop in different organs, especially if not detected early.

There is a classic ABCD rule of skin changes that individuals can use to check their bodies for any unusual lesions. A stands for asymmetry, B stands for border, C stands for color and D for diameter. If the lesion is bigger than the head of a pencil eraser, it is considered more suspicious.

“These are just rough guidelines,” Feun said. “Any growth or any change of a spot on the skin should be investigated.”

According to the Centers for Disease Control and Prevention, skin cancer is the most common form of cancer in the U.S. There are more than 3.5 million cases of basal and squamous cell skin cancer, and more than 76,000 cases of melanoma each year.

Basal cell and squamous cells are found at the base of the outer layer of the skin. According to the American Cancer Society, most basal and squamous cell cancers will develop on areas of the skin that are exposed to sunlight – the face, ears, neck, lips and the back of the hands.

Although these forms of cancer have the ability to spread to other parts of the body, it is rare. If found and treated early, basal and squamous cell carcinoma can be successfully removed and cured.

Melanoma is a progressive disease. The earliest stage, melanoma in situ, has a near 100 percent cure rate if detected. In this stage, the melanoma is found on the outer layer of the skin and has not invaded deeper layers. As melanoma begins to progress, it can become invasive and eventually metastasize. This can lead to major complications and death.

“What is exciting about melanoma is that in the past few years a lot of drugs have been approved for the treatment of the particular disease,” Feun said. “It used to be considered drug resistant, but over the past five years there have been several new drugs approved for melanoma.”

Confocal microscopy, dermoscopy and total body photos are all methods that can be used to catch melanoma at its earliest stages.

Confocal microscopy, an emerging technology, is an optical imaging technique that allows the skin to be examined without a biopsy. Through confocal microscopy, doctors are able to see the cellular structure and determine if something is wrong. With dermoscopy, doctors are able to examine skin lesions with a dermascope – a magnifying tool that is used to distinguish abnormal lesions on the skin’s surface.

Dr. James Grichnik, director of the Anna Fund Melanoma Program and professor in the department of dermatology at UM, is a leader in the early detection and treatment of melanoma.

According to Grichnik, learning how to identify a melanoma and catching it early is critical. There are about 200,000 moles for every melanoma and three out of four melanomas appear on normal skin.

“If you’re just someone who removes moles thinking that will reduce someone’s risk, it doesn’t really have an impact,” he said. “You have to know what the melanomas look like. By just paying attention, you can save lives.”

As melanoma gets deeper into the skin, it begins learning how to grow in different environments, which increases its chance of spreading. At its earliest stage, melanoma is just a tiny spot. As it gets larger, the spot begins to change and look suspicious.

“What you’re looking for is a pattern that just doesn’t match the other lesions on you,” he said. “And if you’ve got a spot that just doesn’t match the other spots, or a spot that is growing or changing, we should take a look at it.”

Grichnik suggests that once a month, people should examine the front and back of their bodies. He also emphasizes three key points when it comes to sun exposure: time of day, protective clothing and sunscreen.

Sunrays peak at the middle of the day so outdoor activities should be done during dawn and dusk, if possible. Clothing with a tight weave and protection such as hats and umbrellas are ways to keep your skin from being exposed to ultraviolet rays. Lastly, Grichnik recommends sunscreen products that are based on zinc oxide or titanium dioxide. He says these sunscreens don’t tend to break down as quickly and last longer. When it comes to strength of sunscreen, 30 SPF is fine for most people.

“People in the desert do not run around in bikinis and swim trunks,” he said. “They know better. They cover up. They reflect the sun away, and we should be doing the same thing.”

His advice on tanning booths: Don’t.

Grichnik says tanning booths can – and do – cause sun damage, skin damage, photo aging and skin cancer. Use “self tanners” or spray tans instead, he recommends.

Having fair skin, a family history of melanoma, a lot of moles or freckles and peeling sunburns increases your risk of getting melanoma. Also, people who have had a primary melanoma are at an eightfold greater risk of melanoma recurring.

“Skin cancer is not a joke,” Borges said. “You get a freckle or something like that and it can be a lot more severe than what you think it actually is. It can turn into something really ugly and people aren’t really aware of that too much.”

Mayra Wenig, one of Grichnik’s patients, was diagnosed with melanoma in situ – the earliest stage of melanoma– after a tiny dot, less than one millimeter, was found on her left thigh. Using confocal microscopy and dermascopy, Grichnik was able to catch it and the melanoma was excised the next day.

She said all the spots on her skin she thought would be – or could be melanoma – weren’t.

“I have become in this past year pretty much the ambassador for skin care protection,” she said. “I tell everybody, especially my family and friends, that it’s like smoking: Do you really think you’re going to be the lucky one that doesn’t get it? I’m emphatic about it. How could you be so arrogant? What makes you think you’re not going to get it? Look at me.”

Wenig admits that she was guilty of baking herself in the sun and putting baby oil all over her body prior to her diagnosis. The 61-year-old has been living in South Florida for more than 40 years, and she would dive and go to the beach without thinking twice about protecting her skin from the sun. Her fair skin never allowed her to tan. Instead, she would always burn and peel.

Now, her life has changed dramatically.

“I live with product on me, in my bag, in my bathroom, in my car,” she said. “I wear a 50 SPF hat. My umbrella is made by the people who are in the Melanoma Association and pretty much, I live away from the sun and don’t go out of my house typically between the hours of 10 a.m. and 4 p.m. if I can.”

Grichnik leaves one more piece of advice: “The bottom line is that we all have to pay attention because nobody is immune to the possibility of developing skin cancer. Enjoy life, but be smart about it. Cooking our skin with ultraviolet light is not ideal.”

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