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In a survey of primary care physicians from all 50 states, 68% said they didn't routinely perform whole-body skin exams on their patients at average risk. Most cited lack of time. Yet this is no minor omission: According to a recent study, doctors are four times more likely than a patient to detect a melanoma when it's "thin"—a sign that it has been spotted early and has an excellent chance (over 90%) of being cured.
What You Should Do: Ask your doctor to look for any abnormal-looking moles whenever you have a routine checkup. There are no standard guidelines on how often you should get skin exams, but if you're at high risk experts typically recommend seeing a dermatologist once a year. And if something suspicious is spotted, remember that not all skin cancers are melanomas. Almost 90% are basal cell carcinomas, which seldom spread to internal organs (although they can grow large and destroy surrounding tissue). Another type, squamous cell carcinoma, also rarely metastasizes.
"Evidence is mounting that occasional sun exposure increases the risk of melanoma far more than the kind of daily dose a farmer or construction worker might get," says Marianne Berwick, Ph.D., professor of epidemiology at the University of New Mexico. One theory is that skin can't adapt fast enough—that is, after being exposed only to weak winter rays, skin has no mechanisms to protect itself against a sudden blast of UV radiation. Even a moderate vacation tan may be harmful, Berwick says.
What You Should Do: Enjoy the sun safely. When going somewhere sunny, pack sunscreen with an SPF of at least 15, a broad-brimmed hat, and lightweight long-sleeved shirts, long pants or long skirts that have either been laundered in an additive that washes in sun protection (such as Rit SunGuard) or are from a company that makes sun-protective clothing (such as items sold at sunprecautions.com or coolibar.com). One thing you shouldn't do: Prep your skin for vacation by getting a "base tan" at a tanning salon. "The mix of artificial ultraviolet light you get in a tanning booth won't protect your skin from exposure to real sunlight, but it will damage your skin and increase your risk of melanoma," says Berwick.
It's well established that people with fair skin have a much greater chance of developing skin cancer. But although Hispanics, Blacks, Asians, Native Americans, and native Hawaiians develop fewer skin cancers overall, when the disease does occur, it's diagnosed later and is often deadlier. "There's a belief that you don't have to worry about skin cancer if you have dark skin," says Hugh M. Gloster Jr., M.D., professor of dermatology at the University of Cincinnati. "Unfortunately, because of this false perception, many cases are spotted only after they've become advanced."
What You Should Do: In dark skin, melanoma often lurks in areas that aren't sun-exposed. "Check between your toes, on the bottoms of your feet and the palms of your hands, and under your nails for new dark spots or streaks," says Dr. Gloster. And don't forgo sunscreen.
Fewer than half of adults ever bother to check their skin for suspicious moles. But taking a look could save your life. The risk for lethal melanoma is reduced by 34% in those who regularly practice skin self-examination.
What You Should Do: Keep mirrors handy and you're more likely to perform skin self-exams, according to recent studies. Mount a full-length mirror and keep a handheld one near where you dress and undress. Check the backs of your legs, where some 20% of cancers hide in women. "Get familiar with how your moles normally look so you'll notice any changes," says Stephen Q. Wang, M.D., author of Beating Melanoma (Kindle edition) and director of dermatologic surgery at Memorial Sloan-Kettering Cancer Center in Basking Ridge, New Jersey. If you're at high risk, do head-to-toe exams monthly, use reminder software on your computer, or make it a habit to look over your skin the first day of every month or the first day of your period.
While putting on sunscreen is a good thing, women who slather it on and then sunbathe all day end up staying out in the sun up to 39% longer than users who aren't seeking a "healthy tan." And this extra time in the sun may explain why some research has linked sunscreen use to a higher risk of melanoma and other skin cancers. "Using sunscreen doesn't take the place of limiting your exposure to the sun," says Jeffrey S. Dover, M.D., president of the American Society for Dermatologic Surgery. "Although a very high SPF sunscreen may prevent burning, it doesn't provide foolproof protection from the full spectrum of the sun's damaging UV radiation."
What You Should Do: Never bask in the sun—and use 1 ounce (about 2 tablespoons) of sunscreen to adequately cover your entire body. Apply it 30 minutes before going outside and reapply every 2 hours.
What you eat can raise—or lower—your skin cancer risk. Research shows that adults whose diets were rich in red meat, processed foods, full-fat dairy products, and sweet drinks had an 83% greater risk of squamous cell carcinoma, while those who ate more fruits, veggies, whole grains, fish, and low-fat dairy cut their risk by 54%.
What You Should Do: Follow the same healthy eating pattern shown to protect against heart disease and diabetes—cut down on fatty meats and refined foods and eat more fresh produce, lean poultry and fish, low-fat dairy, and whole grains. Consider a vitamin D supplement, says Kathleen M. Egan, senior scientist at the Moffitt Cancer Center and Research Institute in Tampa. "Recent evidence shows that in melanoma patients, those with the highest levels of D develop less aggressive tumors and survive longer."
If you see something abnormal, don't delay taking action. Even patients who contact a dermatologist and say they urgently need to be checked face an average wait time of 38 days for an appointment. Yet a suspicious lesion should be assessed much sooner—in a matter of days. "A delay in treatment can mean more extensive surgery and lower odds for survival if you have melanoma," says Dr. Dover.
What You Should Do: "Ask your primary care doctor to intervene and speed things up if you can't get in to see a dermatologist quickly," says Dr. Dover. To ensure you get the best treatment, request a second opinion on your biopsy slides. In a recent study, surgery was canceled in 55% of patients, in most cases because the tumor—initially diagnosed as malignant—turned out to be benign.
Zoom in on suspicious moles with help from these ABCDEs.
A is for Asymmetry. Check for irregularly shaped moles, where one half is unlike the other.
B is for Border. Moles that are ragged or scalloped around the edge are worrisome.
C is for Color. Be alert to variations from one area to another and differences in shading.
D is for Diameter. Moles bigger than a pencil eraser deserve special attention.
E is for Evolving. Changes in the size, shape, or thickness can signal trouble.
In an extensive American Cancer Society study of kids between the ages of 11 and 18, 69% reported having one or more sunburns the previous summer. When a parent isn't around to nag about putting on the sunscreen, kids often won't bother. Plus, more than 10% of kids visit tanning booths each year—which increases the risk of melanoma by as much as 75%. Explain to your teen that being tan isn't healthy, and be a good role model: Let your teen see you routinely applying sunscreen and never use a tanning booth. In addition, buy your teen some fashionable protective clothing, hats, and sunglasses. You can also encourage a safe sunless tan by giving her bronzer or gift certificates for spray tans.
Originally published in the June 2010 issue of Family Circle magazine.
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