10-4 Magazine - For Today's Trucker

PROTECT YOUR SKIN
BY FAMILY NURSE PRACTITIONER NORMA STEPHENS HANNIGAN

Happy New Year! And what a great time to be learning how to care for the largest organ of your body—your skin! Skin is composed of layer upon layer of cells that serve different purposes; it keeps us warm and keeps us cool. It grows our hair and gives us our color. It protects the underlying structures of our body such as our muscles and bones. It stretches out to make room for babies to grow; it heals itself when it gets cut. Unfortunately, though, according to the Skin Cancer Foundation, more than one million people will be diagnosed with skin cancer and 7,900 Americans will die from it this year. More than 90% of all skin cancers are caused by sun exposure and the risk of developing the most dangerous type of skin cancer, melanoma, has doubled in the past ten years.

There are different types of skin cancer—basal cell carcinoma, squamous cell carcinoma and melanoma. There is a precancerous condition called Actinic Keratosis (also called solar keratosis because it results from sun exposure). Usually these lesions are seen in people as they age because sun damage accumulates, but may be seen in people as young as 20 if they are chronically exposed to the sun without using protective sunscreen. These actinic keratoses, or AKs as they are known, appear as brown or pink, scaly, rough spots in the most sun exposed parts of the body—backs of the hands, neck, face. It is believed that a person may have many more keratoses than are visible, and since these AKs are precursors to cancer, they are of concern. If you think you have them, talk to your health care provider. There are several treatments which can prevent them from developing into cancer.

Basal cell is the most common of the cancers, occurring mostly in men who have experienced long periods of sun exposure. Woman can and do get it, but less frequently than men. Lesions appear as crusty or scaly in some people, sometimes confused with psoriasis or eczema. A warning sign is non-healing of a sore or bleeding from an area.

Squamous cell is the second most common; again, it generally appears in areas exposed to the sun. The lip and rim of the ear are particularly susceptible to this type of cancer. Squamous cell cancer may also affect the mucous membranes—the nose, the mouth, etc.

Melanoma is the most dangerous of the skin cancers. The good news, however, is that if caught early, it is almost 100% curable. The skin cancers can be tricky, though, because sometimes they do not behave in the way that we expect them to. Most people have heard that they should get a changing mole checked out. Interestingly, sometimes a skin cancer will not be dark in color. Melanomas, which arise from the pigment cells that give our skin and eyes color, sometimes stop producing pigment and, therefore, don’t have that typical brown-black color we’ve been warned about. Sometimes they have more of a red or pinkish tinge to them. Women typically get melanoma on their legs, men on their trunks and both may get it on the upper back. But it is possible to develop a skin cancer in an area that never gets sun exposure as well.

Who gets skin cancer? Those at the greatest risk are fair-skinned, fair-haired, blue, green or gray eyed people, since they don’t have much skin pigment (melanocytes) to protect their skin from the sun. Those who work in the sun, or drive with one arm resting on the door of the truck, or lie around on the beach working on their tans are at increased risk. The ultraviolet rays of the sun, the ones that cause our skin to darken or burn with exposure, can penetrate the atmosphere even on cloudy days. About one third of adolescent girls and one tenth of adolescent boys have used tanning booths where the ultraviolet rays are very concentrated and harmful. Although rare, it is possible for Latinos and African Americans to get skin cancer, and when it does happen, it tends to be more deadly in these populations. The type of melanoma that occurs under the finger and toe nails affects Latinos and African Americans more than lighter skinned people. Dark skinned people who develop squamous cell cancer usually notice it in a place that has been chronically inflamed or scarred. It is believed that those fair skinned people who had sunburns as children and adolescents are more at risk for developing skin cancer later in life.

What should you be looking for? Many health education sources use the ABCD’s of melanoma—Asymmetry, Border, Color and Diameter. Asymmetry: means that is does not look the same on each half of the lesion. Border: may have a scalloped appearance. Moles usually have a smooth round border. Melanomas are irregular around the edge. Color: generally moles have a single color. Melanomas will often be a mixed black/tan/brown color. If it has been there for a while, it may even have a reddish/bluish/purplish color. Diameter: Melanomas will be at least the size of a pencil eraser, or about 1/4-inch across.

How do you look for these lesions? It’s a good idea to take a mirror and check yourself out about once a month or have a partner do it. It’s important to look in the places that are not so obvious, because remember that skin cancers may develop in places that are not exposed to the sun. At least once a year you should have a thorough exam by a health care provider. Dermatologists are physicians who specialize in the diagnosis and treatment of skin disorders. Meanwhile, if you see something suspicious, get it checked out.

How do you prevent skin cancer? I often say that the most significant invention of the 20th Century was sunscreen. Use it daily. Cover up as much as possible if you need to be outside working in the sun—hats, long sleeves, long pants. I’m sweating just writing this, so if covering up is not practical because the temperature is high, make sure you keep the sunscreen coming. Use the kind that is sweat proof and reapply it as often as necessary. What if you still haven’t prevented it? The trick, as with any illness, is to catch it early before it spreads deeper into the tissues around the lesion and to other parts of the body. If that happens, the skin cancer may be fatal. So, know what to look for, check for it regularly and then see your health care provider if you find something suspicious. Remember, it’s important to keep your disposition sunny, but not your skin!