The Skin Cancer Foundation Journal

MAY 2015

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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shley started tanning in high school with her mom, at first just for prom and to develop a "base tan" before vacations. In her early 20's her habit grew. She had begun working at Nordstrom, where she was a top salesperson, sometimes beyond the call of duty: a customer once wanted a dress that wasn't available in her size, and since Ashley had that same dress at home, she gave it to the customer. She was a people-pleaser—a great attribute for a sales- person—and her employers rewarded her with a $500 bonus for exceptional customer service. It wasn't just her work life that was going well. She also had a group of nine girlfriends who were like sisters. "People loved her," says her dad Bob. "She was very outgoing and had great relationships." INSECURITIES PERSIST But that didn't keep Ashley from obsessing about her looks. Like many young women, she struggled with self-esteem, and became increasingly concerned about her ap- pearance. "She was a vegan and watched her diet," says her mom Karen. "She was into look- ing good and being thin." Ashley was blessed with a radiant smile that lit up a room, but felt her fair skin was a detri- ment, so she began tanning habitually; her skin was dark year-round. Living in the dreary climate of the Pacific Northwest and inclined toward depression, she became hooked on the mood-boosting effects from frequent visits to ultraviolet (UV) tanning beds. Studies show that UV light from tanning can increase the level of feel-good chemicals in the brain, lead- ing to dependency, not unlike drug addiction. 1 When she was in her late 20's, her mom pleaded with her to stop tanning because one of her dad's uncles had died from melanoma, but she couldn't give it up. "I thought I was invincible and would never get skin cancer," wrote Ashley in a 2011 blog entry. Then in 2003 while she was living in Ari- zona away from her parents, her years of tan- ning caught up to her. First, a tiny lesion the size of a pencil point appeared on her right but- tock. She had it removed by a dermatologist, and the pathology report came back negative for cancer. THE TUMOR RECURS A year later, after Ashley moved back to Washington State, the lesion returned. This time, figuring it was benign again, Ashley ignored it. She was working as a barista at a coffee shop, and lacking health insurance, she didn't want to pay out-of-pocket to have it removed again. This proved to be a tragic mis- take. People with melanoma diagnosed in the early stages—before the cancer spreads to the lymph nodes or other organs—have a 98% five-year average survival rate, 2 but once the cancer spreads, the chances of long-term survival plummet. The lesion had grown to the size of a quar- ter and become painful, and only then did she see a dermatologist. At age 33, in 2006, she was diagnosed with melanoma. "I was scared and a complete wreck," Ashley wrote in a 2011 blog. A biopsy of the lymph nodes in her groin near the tumor showed that the mel- anoma had reached Stage III; melanoma cells had reached the nodes, and could easily spread through the lymphatic system throughout the body, so all the lymph nodes in that area had to be removed. The average 5-year survival rate for Stage III patients is 63%. 2 "She could have come to us earlier," Karen laments. "But she was very independent and too proud to ask for help." BUYING TIME Once the tumor and lymph nodes were removed, Ashley began receiving injections of the melanoma drug interferon alpha-2b, meant to delay recurrence for as long as possible. It was a grueling experience. Patients on this drug often have severe flu-like symptoms. "It was brutal, and I was miserable for two months," Ashley wrote in a blog. For 15 years, Ashley Trenner paid good money to work on her tan. Without knowing it, she was also working on melanoma. The beautiful, fit and well-loved young woman simply thought she looked better tan. A resident of rainy Washington State and naturally fair-skinned, she maintained her year-round bronze by visiting tanning salons almost every other day. She used to say: "I don't care if I die from tanning as long as I die tan." A ASHLEY TRENNER: TWO DECADES OF TANNING BEDS AND A LIFE CUT NEEDLESSLY SHORT 65

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