“It started out like small lesions below my sideburns and ear lobes,” remembers David Dumler, retired engineer out of Fire Station 23. “One after another they appeared. Concerned, I went to my dermatologist and discovered they were pre-cancerous lesions, easily treatable; however, the melanoma on my back was a different story.” In a sense, Dave was lucky. What was thought at first to be a simple skin irritation, lead the doctor to perform a full body examination. This is when it was discovered that Dave had one of the deadliest skin diseases—melanoma.
Dave is doing fine now. Treated and monitored on a regular basis, he is living the dream of retirement while traveling across the country. Others have not been as fortunate. In 2018 over 90,000 people will be diagnosed with melanoma, with 10 percent of those dying from the disease. Skin cancer is the most commonly diagnosed cancer and, in most cases, it is not life-threatening nor does it spread to other parts of the body. The exception to this is melanoma.
What is skin cancer?
Skin is the largest organ of the body. Its main function is to protect the internal organs. It does this by protecting the body from ultraviolet radiation from sources such as the sun. Though it protects us from the sun, your body is designed to get the vitamin D it needs by producing it when the bare skin is exposed to sunlight. This love/hate relationship is the most natural way to get the needed mineral; however, too much sun means increased radiation exposure, which causes skin cancer to develops. Whether it be from the sun or another source such as a tanning bed, abnormal cells in the skin’s layers start to grow uncontrollably, leading to the disease.
Types of skin cancer
The most common types of skin cancer are basal cell and squamous cell carcinomas. These treatable conditions rarely metastasize or become life threatening, especially if caught early. They tend to appear on areas of the body exposed to the sun, such as the face, neck, ears, and hands. Basal cell generally shows up like a small pearly bump that looks like a flesh colored mole or pimple that doesn’t go away. It can also present like a shiny red or pink patch that is slightly scaly. Squamous cell carcinomas may appear as flat reddish or brownish patches in the skin and tend to grow slowly. This is not to say that they are not scary or dangerous. The key is to catch them early before they grow large enough to where the chance of metastasizing increases.
Though basal and squamous cell cancers are not to be taken lightly, the next item on topic should scare you to death, because it can, if not treated early, kill you. I know these are harsh words, but melanoma is the most aggressive form of skin cancer and is the most dangerous of the three. Melanoma is a form of skin cancer that occurs when melanocytes, the pigment-producing-cells that give you the color of your skin, mutate and become cancerous. Though most pigment cells are common to the skin, they are also found in the eyes and other parts of the body, such as the intestines. This skin pigmentation acts as a shield against harmful ultraviolet light exposure from the sun, which can lead to mutations in DNA. With enough DNA damage in critical genes, the cells of the skin, including melanocytes, begin to grow uncontrollably and spread locally and to distant organs. Melanoma can also develop in non-sun exposed areas, such as the membranes of the mouth, gastrointestinal tract, and female genital tract.
“The best way to avoid skin cancer, according to Dr. Peter Grossman, is sunscreen, sunscreen, sunscreen!”
Signs & Symptoms and Risk Factors
In early skin cancers the tumors are small, contained within the top layers of skin, and have not spread to distant organs. As the cancer progresses, the tumor grows larger and more deeply into the skin layers, spreading to lymph nodes and blood vessels and, potentially, distant organs. Skin cancer signs and symptoms are different for everyone and, for this reason, difficult to detect. Doctor Peter Grossman of the Grossman Burn Center writes that, “causes of melanoma include excessive exposure to sunlight. It is more frequently associated with fair-skinned patients who are more prone to sunburn. Signs and symptoms of melanoma include a pigmented lesion that enlarges or becomes inflamed or sore, and may itch, ulcerate, bleed, or undergo textural changes. Diagnosis is usually made with a skin biopsy, and treatment includes wide surgical resection to remove the melanoma, and if appropriate removal of the regional lymph nodes, immunotherapy or chemotherapy and radiation.”
“For basal cell carcinoma, squamous cell carcinoma, and melanoma, early detection is the key to minimizing potential morbidity. For this reason, it is important to have routine skin checks by your internist or dermatologist, and unless contraindicated by your physician, sunscreen, sunscreen, sunscreen!” Dr. Peter Grossman—Grossman Burn Center
Being a firefighter only increases our exposure to such because we are outside so much during the day in the performance of our duty. We are also being exposed to large amounts of toxic substances, such as paraffin oil, coal tar, and arsenic compounds when we fight fires. These chemicals also increase our chances of developing skin cancer. There are, however, other factors that can contribute to the development as well. Artificial light, from sources such as tanning beds and sun lamps, is just as harmful and may even be worse than mother nature when it comes to the development of the disease. Having a history of blistering sunburns or having a lot of unusual moles can also be contributing factors. A family history of skin cancer may make you prone to the disease, along with being older or having a compromised immune system; and, although we can’t change it, the color of our skin plays a major role in who gets skin cancer. This is especially true when it comes to melanoma. People with darker complexions have a much lower risk of most types of skin cancer, whereas being a blonde or redhead or having fair skin that easily freckles or sunburns increases your risk of the disease. Darker skinned people can still develop melanoma, which can include rare types such as acral lentiginous melanoma, a very aggressive type that affects the palms of your hands, nail beds, and soles of the feet.
An estimated 9,320 people will die of melanoma in 2018. Early detection is essential to survivability. The sooner the condition is discovered, the less of the chance it has to spread to other parts of the body which, in turn, can lead to death. Survival rates only worsen with later detection. The five-year survival rate of Stage 1 melanoma is 98 percent; five-year survival rate for Stage 3 is 63 percent; and for Stage 4 the survival rate drops to 17 percent. This is why it is so important to get annual checkups. Catching the disease before it has a chance to grow and spread can mean the difference in not only treatment options but survivability as well.
By John Hicks
Simply staying in the shade is one of the best ways to limit your UV exposure. If you are going to be in the sun, “Slip! Slop! Slap!® and Wrap” is a catchphrase that can help you remember some of the key steps you can take to protect yourself from UV rays:
• Slip on a shirt.
• Slop on sunscreen.
• Slap on a hat.
• Wrap on sunglasses to protect the eyes and skin around them.