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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AMY ROSE, MD, practices dermatology in Greenvale, New York. She is a Clinical Instructor of Dermatology in the Ronald O. Perelman Department of Der- matology at New York University in New York City. Dr. Rose is a Fellow in The Skin Cancer Foundation's Professional Membership program. 86 Table 1. Melanoma risk factors recently receiving greater recognition. The MC1R Gene • Critical for the control of skin, hair, and eye pigmentation. • Over 80 known variants of the gene exist. • Variants associated with red hair confer approximately twofold increased risk of melanoma. 1 Childhood history of cancer • Increased risk seems related to radiation treatment. • Adult survivors are advised to seek yearly skin examinations. 2 Organ transplant patients • Increased risk related to chronic immune suppression necessary to prevent rejection of transplanted organ. • Studies show approximately 3.6X increased risk of melanoma. 2 Parkinson's disease • The biologic link with melanoma has not been established, but studies show an approximate 1.5-3X increased risk. 2 Indoor tanning • Recent evidence has more and more convincingly proven the link between indoor tanning and melanoma risk, especially for young patients. • A study in Australia suggested that 76 percent of melanomas in study participants aged 18 to 29 were related to indoor tanning. 2 • Associated with a 59-75 percent increase in melanoma risk when exposure occurs before age 35. 3 LIFESTYLE FACTORS Sun Exposure and Sunburn Sun exposure is the single most important risk factor for melanoma; about 86% of all melanomas can be linked to the sun's harmful UV rays. 6 Particularly dangerous is intense, intermittent sun exposure, like you might experience on a beach vacation, which can lead to blistering sunburn. Living in a tropical region with year-round intense sun expo- sure increases anyone's risk of skin cancer, but living elsewhere and then experiencing extended intense exposure and sunburn when visiting a tropical region especially increases melanoma risk. 7 Children's vulnerable skin puts them at extra risk; sustaining five or more sunburns in youth increases lifetime melanoma risk by 80%. 8 And people with pale white Type 1 Celtic skin, who always burn within minutes, should limit time in the sun and always practice scru- pulous sun protection. Tanning Bed Use A wave of recent research has clearly linked indoor tanning to mel- anoma. Just last year, a meta-analysis of dozens of studies found that more than 419,000 cases of skin cancer in the US each year are linked to indoor tanning, including 6,200 melanomas. 9 The U.S. Food and Drug Administration responded to all this research by reclassifying UV tanning devices from class I (low to moderate risk) to class II (moderate to high risk) devices. 10 The takeaway is simple: everyone should stay out of tanning beds. For people whose skin can't tan and always burns, using them is dangerously self-destructive. Personal History of Melanoma Melanoma survivors are about nine times likelier than the general population to develop a new melanoma. 11 In addition, anyone who has had a skin cancer is at increased risk of developing any other form of skin cancer. Children who have had radiation treatment for cancer seem to be at special risk. People with Immune Suppression Individuals whose immune systems are suppressed or weakened, such as HIV or transplant patients [Table 1], may be at extremely height ened risk. Organ transplant patients are up to 250 times more likely than the general public to develop squamous cell carcinoma (SCC), as well as at higher risk of melanoma. 12 WHAT DO I DO? When all these factors are weighed, it can paint a powerful picture of someone's melanoma risk. One recent study of 875 patients with melanoma and 765 control subjects without melanoma showed that a risk model combining traditional factors such as hair color, eye color and number of moles with their history of indoor tan- ning and genetic information such as the status of their MC1R variant provided a much more accurate assessment of their overall melanoma risk. 4 [See pg. 85.] So, what do you do if you are at high risk? If you have red hair, blue eyes and a family history of melanoma, should you avoid going out- side? Of course not! To paraphrase a recent Skin Cancer Foundation PSA campaign: "Go ahead, live fabulously. Just protect yourself." If possible, do outdoor activity before 10 AM or after 4 PM, when the sun is less intense; find shade; wear sun-protective clothing, and use an SPF 15+, or better yet 30+, sunscreen on all exposed body areas, reapplying every two hours and after swimming or heavy sweating. Just as important, examine your skin head-to-toe monthly and see your physician annually for a head-to-toe skin exam. Cancer survivors and others at high melanoma risk should be able to relish every moment of life and all the beauty the world has to offer – much of which happens to be outside. Just protect yourself. For the latest information and updates go to: SkinCancer.org References on pages 105-107.

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