Skin cancer: Staying on guard

Campaign urges people to pay more attention to abnormalities.

“If you see something, say something,” a catchy warning from the Department of Homeland Security about possible terrorist threats, applies as well to skin lesions that, if ignored, could become fatal.

Susan Manber, now a 55-yearold from Cortlandt Manor, New York, knows this well. She credits her astute daughter with having saved her life nearly six years ago when Sarina, then 13, remarked, “Mom, what’s that thing on your nose?”

That “thing” was a tiny white nodule on the rim of one nostril, a weird place, Manber thought, for a pimple.

In a few weeks this seemingly innocent pimple had developed a tiny purple center, prompting her to see a dermatologist, who thought it wasn’t anything to worry about but sent her to a specialist to have it removed and biopsied.

The report that came back on New Year’s Eve 2013 could not have been more shocking: a very rare and aggressive form of skin cancer called Merkel cell carcinoma. It’s a diagnosis made only 2,500 times a year in the United States, and until recently had a life expectancy of five months from diagnosis.

Manber endured seven surgeries, including removal of the left side of her nose (which was rebuilt using ear cartilage) and cancer-containing lymph nodes in her neck, combined with radiation and chemotherapy.

Treatment with immunological agents available since 2016 has improved the prognosis for this cancer, though it is still three times more deadly than melanoma.

Manber, who was finally able to return to work as a health communications specialist two years ago, now advocates for the Skin Cancer Foundation’s new, simplified campaign to get people to take skin cancer more seriously. In honor of the foundation’s 40th anniversary, it has a new alert message: “The Big See” — “see” as in look, and “C” as in cancer. If you see something anywhere on your skin that is new, changing, not healing or doesn’t seem right to you, Dr. Deborah S. Sarnoff, the foundation’s president, urges you to get it checked out as soon as possible.

While all forms of skin cancer, including basal cell carcinoma, can be fatal if ignored long enough, the most common life-threatening form is melanoma, which is diagnosed 192,000 times a year in the United States and claims 9,000 lives. For many years, the “ABCDE” test for worrisome lesions was used to alert people to this dangerous disease: A for asymmetry, B for irregular border, C for color (tan, brown or black), D for diameter (usually larger than ¼-inch) and E for evolving.

Perhaps, the foundation realized, the alphabet warning was too complex and limiting. “Many melanomas and most nonmelanoma skin cancers don’t fall under the ABCDE pattern,” the foundation reported recently in its journal. “When we educate people about the warning signs of skin cancer, we often hear from them, ‘Mine didn’t look like that.’”

The Big See message can alert people to all forms of skin cancer, often unnoticed for many months or years and dismissed as “no big deal.” Last year, for example, I had a small sore on my leg that never healed, but waited six months to find out it was a basal cell carcinoma that required surgical removal.

More than 5 million nonmelanoma skin cancers are diagnosed annually in America, and every hour more than two people die from skin cancer even though it is the cancer everyone can see. No scans or special or invasive detection tests are required, just your eyes or those of a friend or companion who, if they see something, should say something.

Complementing the foundation’s new Big See message is a “What’s that?” alert and a talking mirror being placed in retail locations nationwide in which a lively comedian tells people about skin cancer.

As Manber said in an interview, “Most people don’t realize that just five sunburns can double your chances of developing melanoma. They don’t know that one person in five will get skin cancer.” Now determined to raise awareness about detecting this disease, she joins skin cancer specialists in urging people to install a full-length mirror in their home to facilitate frequent skin checks. By standing with your back to the full-length mirror and holding a hand mirror, I’ve found that even a person who lives alone can do a full body self-exam.

Manber is equally passionate about the importance of protecting one’s skin from the damaging rays of sunlight, which can penetrate all windows (except windshield glass in cars), pass through cloud cover and be reflected by water, sand and concrete. Thus, shade is not completely protective. The damage to DNA caused by ultraviolet A (UVA) and ultraviolet B (UVB) rays starts within minutes of sun exposure, and the body’s immune defenses do not repair all of it, which can result in cancer-causing mutations over time.

UVB causes sunburn, and UVA, in addition to causing sunburn and tanning, ages and wrinkles the skin, creating what my husband called elephant hide.

People with fair complexions, blue eyes, freckles or a family history of skin cancer are especially susceptible to the cancer-inducing rays of sunlight. They and anyone spending many hours outdoors in daylight are advised to always use a broad-spectrum sunscreen with an SPF of at least 30 and reapply it every two hours and after swimming. They are also urged to wear protective clothing and a hat when out during the day, and be particularly careful about avoiding sun exposure when it is most intense — from 10 a.m. to 4 p.m.

Protecting babies and children is especially important. Before 6 months of age, they should be kept out of the sun by using clothing, hats, blankets and stroller shades; after 6 months, add sunscreen to the mix. And don’t forget sunglasses for toddlers on up.

Needless to say, tanning beds are a major no-no for everyone; their use before the age of 35 can increase the risk of melanoma by 75%, the foundation reported.

But as you might guess, extreme sun avoidance can have its own risks: a decrease in the body’s ability to form biologically active vitamin D, which is critical to bone health and, according to a Swedish study that followed nearly 30,000 women for 20 years, is tied to a small but significant increase in deaths from cardiovascular disease and other noncancer-related disorders. Compared with the women in the study who were most exposed to sun, the life expectancy of sun avoiders was 0.6 to 2.1 years shorter. Also, as you might expect, not every expert endorses this finding.