Learn the facts about skin cancer in Florida
There was a time when Dr. J. Matthew Knight, a practicing dermatologist in Orlando for about 15 years, would diagnose about one case of melanoma a week. Last week, he diagnosed six cases in one day.
“There’s no doubt that the new cases of skin cancer, especially melanoma, are absolutely rising. Big time,” said Knight.
The rates of new melanomas have doubled in the past three decades in the United States. And while Florida’s new melanoma rate is on par with the national average, it too rose by 37 percent, from 17.5 cases in 100,000 people in 1999 to 24 cases per 100,000 people in 2016, according to the latest data available from the Cen
ters for Disease Control and Prevention.
Skin cancer is the most common type of cancer in the United States. Basal and squamous cell skin cancers affect more than 5 million Americans each year. But they’re rarely deadly.
That’s not the case for the less common skin cancer type, melanoma.
More than 96,000 new people will be diagnosed with melanoma this year, and about 7,000 will die from it, according to the American Cancer Society.
In Florida, there were about 6,700 new cases of melanoma in 2016, according to the latest available data. That year, more than 600 Floridians died from the cancer.
The main risk factor for melanoma is exposure to ultraviolet radiation — UVA and UVB — from sunlight or tanning beds. Tanning beds, in fact, increase your risk of melanoma by 75%, according to the Melanoma Research Alliance.
The average age for melanoma diagnosis is 63. But melanoma is also the most commonly diagnosed cancer among young adults between 25 and 29 years old in the United States, especially young women.
“Melanoma is kind of a terrible actor. It acts unpredictably. It metastasizes readily. It’s just a bad actor,” Knight said.
We spoke with Knight and Dr. Bruce Haughey, a head and neck surgeon with an interest in malignancies at AdventHealth, to learn more about skin cancers and how to prevent them.
How do you know if you should go get your skin checked for cancer?
Knight: There’s no perfect answer to that. There are not enough doctors to screen everybody. But if you think you’re at risk, or you’re worried that you might be, it’s a simple task to get a skin exam at a dermatologist office. And certainly if you look anything like me, get your skin checked. I’m a native Orlandoan. I’m very fair-skinned. I got innumerable sunburns as a child. I play golf every day. I had my first skin cancer at age 25. If you grew up in Central Florida, you’ve had sunburns and have a lighter or medium pigmented skin, or a relative that has a history of skin cancer, then you owe it to yourself to have a skin exam at a dermatologist office. At least once.
Haughey: If in adulthood an area of the skin is undergoing change, that’s a red flag to get it checked by a qualified professional.
Why are skin cancer checks important?
Haughey: In its early stages, melanoma is pretty well controlled. If the early-stage cancer is completely removed, it’ll never come back. That’s the advantage of the early detection. But among skin cancers, melanoma has the greatest potential for very aggressive behavior. We’re talking about a tumor that can spread to not only lymph nodes in the area, but even through the bloodstream to vital organs like the brain, bones, liver and lungs.
Knight: It’s such a tragedy when a young person shows up and they say that they’ve had a funny looking mole for two or three years and they kind of never thought to go into the doctor and maybe a loved one made him come in finally, and you do the biopsy and it’s an invasive melanoma. Next thing you know, they’re on chemo.
The secret to preventing cancer death from melanoma, which is up to one person, every hour in this country, is to detect it at its earliest phase. And that’s what skin screening is all about. People don’t think about it, or say, ‘I never got sun there,’ but we’re forever picking up melanoma in weird and bizarre places. Bob Marley died of a melanoma on his toe. And when he died, he saved millions of lives, because everybody uses his example to say you don’t have to be a super-fair Caucasian and get melanoma on your neck. It doesn’t work that way.
Why is melanoma more common among older people?
Haughey: As each decade goes by, each of us gets more and more ultraviolet exposure, which increases what we call ‘the mutational burden’ in the skin cells and that predisposes us to skin cancer.
Knight: It’s kind of like smoking cigarettes. You don’t smoke a pack of cigarettes and then the next day get lung cancer. You get the DNA damage from heavy smoking and then 15, 20 years later is when you start to get the cancer. That’s just the way that cancer works.
What about squamous and basal cell skin cancers?
Knight: Basal cell cancer is not fatal. It doesn’t kill people. It’s a like a cavity in your tooth. It just sits there and gets bigger and festers. It can chew through parts of you as it grows. So if you had basal cell skin cancer and you didn’t treat it, it could destroy your eyelid or part of your nose or your ear. Squamous cell skin cancer is kind of that way too, but it can get into your lymph nodes. The main treatment for both is surgical removal.
Haughey: The commonest location for basal cells skin cancer is head and neck.
There are a lot of sunscreens out there. What should we buy?
Knight: If you really want to be safe, pick a sunscreen that’s SPF 30 and make sure it has zinc oxide in it and it’s broad spectrum, which means it also protects you from UVA. SPF only blocks UVB. So if you have a sunscreen with SPF one million that doesn’t provide UVA coverage, it’s not really protecting you against melanoma, as crazy as it sounds. You have to apply a whole shot glass of sunscreen every couple of hours, which not a lot of people do.
You don’t need sunscreen with more than SPF 30. Sunblocks with above SPF 30 are pretty much marketing hype. There are companies that market SPF 105 sunscreen for kids and the mom sort of squirts it on the kid and then up the kid goes in a bathing suit for three or four hours in the sun. That’s a setup for melanoma. That’s how you prime your kid to get skin cancer later in life.
How should you protect yourself from the sun?
Knight: It’s a multi-pronged strategy. People rely on sunscreen a lot, but sunscreen by itself isn’t going to cut it. Wear hats that cover your neck and ears. Wear long-sleeve shirts, sun shirts or rash guards, especially for kids. Wear sunglasses and make sure they say UV 400 on them and they’re providing UVA and UVB coverage, because you can get melanoma in your eye. And avoid the sun between 10 a.m. to 2 p.m. And guys always forget to put sunblock on their lips, so make sure you put sunblock on the lips and reapply it.
Haughey: Don’t forget to wear sunblock if you’re going to be out for an extended period of time and especially on the water, because you get not only rays coming directly at you from the sky, but the ultraviolet rays bounce off the water and come up at you from the water as well. A lot of boating is done in Florida, so that’s a very important piece.
How else can Floridians protect themselves?
Knight: Realize that you live in a place where the UV index is much, much higher than people think it is. Unfortunately, it’s not always the burning rays of the sun, or UVB, that are linked to melanoma. It’s UVA, which is present on a cloudy day and goes right through the windows in your car. So find a strategy to protect yourself from the sun everyday, even on a cloudy day, even in the wintertime.
Haughey: For people who have had skin cancer, watch that part of your body for changes in the skin and in the treatment field, because it’ll be a new normal around where the treatment has been done. If you’ve had melanoma, have regular complete skin surveys. That means every nook and cranny of your skin should be examined for a new one, because once you’ve had one melanoma, you’re more likely to form another one on another part of your body.