Even if you've never spent time on a tanning bed or skipped a day of sunscreen, you could be at risk. Learn how five women saved their own lives.
By Jeannette Moninger
"Every month I see women who say a tan made them feel more attractive," says Vernon Sondak. But he doesn't work at a salon. Sondak, an M.D., is chair of the department of cutaneous oncology at Moffitt Cancer Center in Tampa. "These women now have scars on their legs, arms and faces from having malignant cells cut out," he says. There's another important reality to skin cancer too: the fact that the disease—which affects one in five Americans—is highly preventable. Read the incredible stories these survivors share. They'll help you better safeguard your skin and your family's.
Shannon Hays-Gruss, 41, Binghamton, New York
When Shannon Hays-Gruss first saw a dermatologist five years ago, vanity, not cancer, was on her mind. "I wanted an unattractive mole removed," she says. It wasn't cancerous, but because Shannon has lots of moles (which ups her melanoma risk), her doctor suggested doing monthly skin checks at home. During one of these self-exams last summer she felt a bump on the back of her upper left leg. "I had to use a mirror to see it," says Shannon, who thought the black spot was an ingrown hair. When it didn't disappear in a month, she made an appointment with a doctor. A biopsy revealed it was melanoma. Because the cancer had already spread, surgeons cut out the spot on Shannon's leg, as well as 25 lymph nodes in her groin.
"Melanoma is almost 100% curable—when caught early," says Sancy Leachman, M.D., director of the melanoma and cutaneous oncology program at the University of Utah's Huntsman Cancer Institute in Salt Lake City. That's why the Skin Cancer Foundation recommends annual visits to the dermatologist (more often if you're high risk) and monthly skin checks at home. "The better you know your body, the better you'll be at identifying changes," says Shannon, who discovered another melanoma on her left leg this past January. Think ABCDE when performing a self-exam: Be on the lookout for moles that are asymmetrical (one side's different from the other); have notched, uneven or blurry-looking borders; are a mix of brown, tan, black or other colors; have a diameter wider than a pencil eraser; or evolve in size, shape, color or texture. Also watch for moles, pimples or dry patches that appear suddenly or that itch or bleed. To help monitor changes, download a self-exam mole-mapping guide at skincancer.org.
Kristi Blue, 39, Bardstown, Kentucky
Fear of blistering sunburns wasn't the only reason fair-skinned and strawberry blond Kristi Blue was a sunscreen fanatic during her younger days: Both her father and uncle had experienced skin cancer. "My mom stressed sun protection," Kristi says. Nonetheless, in 2005, Kristi's brother, then 26, was diagnosed with melanoma, the most lethal form of skin cancer. "I'll never forget that family gathering when my brother, a bricklayer, took off his shirt revealing a black, jagged mole on his back," Kristi says. "Our mom burst into tears. She knew his life was in danger."
That same year, a mole removed from Kristi's arm was deemed precancerous. When her brother's melanoma returned last year, this time spreading to his brain, doctors suggested testing for a genetic mutation linked to skin cancer. "The CDKN2A gene typically suppresses tumors," explains Dr. Leachman. "But when it's altered, cancer cells can grow uncontrollably."
Both Kristi and her brother (but not their sister) have the mutation, which means they have a 76% chance of getting melanoma in their lifetime. There's a 50% chance each of Kristi's five children, ages 4 to 12, have it too; however, experts don't advise testing everyone. "Only about 2% of melanoma is caused by this mutation, and a positive test still requires the same recommendations as those with strong family histories: monthly self-skin checks, biannual dermatologist visits, regular sunscreen use and reduced sun exposure," says Dr. Leachman. Although any physician can request the genetic test, Dr. Leachman suggests first consulting with a counselor (find one at nsgc.org) to determine whether testing is necessary and right for you.
"I worry about our health, but I can't let fear keep us inside," Kristi says. "So we always wear sunscreen, hats and UV-blocking clothes; sit under beach umbrellas; and head out before 10 a.m. or after 4 p.m., when the sun's rays aren't as intense."
Tiffany Blackwell, 44, Bloomington, Minnesota
While Tiffany Blackwell was applying body lotion one day in 2001, her hand grazed a bump on her left hip. "It was about the size of a pencil eraser, brown, and looked like a cross between a pimple and a mole," she says. Two years passed before Tiffany mentioned the growth to her family doctor during a checkup. It turned out to be basal-cell carcinoma (BCC), the most common form of skin cancer, which affects up to 2 million Americans every year. Though slow growing, BCC can be highly disfiguring if not caught early because it can become invasive.
"I'm an African American living in the overcast state of Minnesota," Tiffany says. "To say that my diagnosis came as a shock is an understatement." Although skin cancer makes up only 1% to 2% of all cancers in African Americans, it's deadlier because it's often diagnosed late. "People with dark skin falsely believe their melanin or pigmentation provides ample sun protection. But anyone can burn, tan and get cancer," says Kavita Mariwalla, M.D., director of Mohs and dermatologic surgery at Beth Israel Medical Center in New York City. What's more, in dark skin, cancer often lurks in unusual areas like the palms, the soles of the feet and under the nails.
"I'm doing all I can to lower my risk: daily moisturizer with SPF, monthly skin checks and yearly visits to the dermatologist," says Tiffany, who has a dime-size scar on her hip where the cancerous mole was removed. "I shudder when I think about how nonchalant I was about a change in my skin, and I'm lucky it wasn't worse."
Timna Understein, 43, Chapel Hill, North Carolina
California native Timna Understein often sported a golden glow. "I felt healthier with a tan," says Timna, who occasionally went to tanning beds when she couldn't hit the beach. Her love affair with a sun-kissed look ended in 2008 when a black melanoma mole appeared on the bottom of her foot. "My first visit to the oncologist was an eye-opener," she says. "I couldn't believe I was in the cancer ward because of a tiny dot on my skin. It was frightening."
Now she's on a mission to keep herself, as well as her 9-year-old daughter and 14- and 17-year-old sons, safe. "The kids see a dermatologist every year for skin exams," Timna says. That's a skin-saving move for people with a first-degree relative (parent or sibling) who has melanoma because they have a 50% greater chance of developing the disease. In fact, the Skin Cancer Foundation recommends that kids with strong family histories of melanoma see a dermatologist starting at age 10 for twice-a-year skin exams. Parents also should check their children's skin regularly starting in infancy. Just one blistering sunburn in childhood doubles melanoma risk later in life. That's particularly troubling since a recent study suggests sunscreen usage drops—while sun exposure increases—as a child gets older.
"Even with my cancer history, it's a constant battle to convince my kids to wear SPF-protected swim shirts and to apply sunscreen every day," says Timna. "They think they're invincible," she adds. As with most topics—safe sex, drinking and drugs, smoking—experts suggest addressing the dangers of sun exposure, as well as the importance of sun protection, early and often. "Stash sunscreens in highly visible, easily accessible locations: in your children's backpacks, purses and sports bags, and by the door," suggests Dr. Sondak. And try different products—lotions, sticks and sprays. "The best sunscreen is the one your child will use," he says.
To protect the entire family, choose a broad-spectrum sunscreen with an SPF of 15 or higher; apply 1 ounce (that's 2 tablespoons of sunscreen) to the entire body at least 30 minutes before heading outside, and reapply after swimming or excessive sweating; don hats and UV-protective sunglasses and clothing; and say no to tanning beds.
Mary Beth Thompson, 49, Simpsonville, South Carolina
Mary Beth Thompson was enjoying some last-minute pampering before the birth of her first child in December 2004 when her hairstylist pointed out a brown spot on Mary Beth's right earlobe. She'd never noticed it before. "I was already seeing my dermatologist about a bump on my chest, and while I was there, she biopsied the growth on my earlobe," she says. One week after her son was born, Mary Beth learned she had melanoma (the chest bump was benign). "I was devastated!" says Mary Beth. "I couldn't imagine not seeing my baby grow up, and yet my doctor was discussing survival rates." Mary Beth traces the trouble back to her youth. She spent her Florida childhood soaking up the rays; she also frequented tanning beds in her 20s and 30s. "On the rare occasions that I used sunscreen, I never thought to apply it to my ears." Yet any body part that gets an excessive amount of sun—especially your face, ears, neck, scalp, shoulders and back—is more susceptible to skin cancer.
Doctors cut out Mary Beth's melanoma, which, thankfully, hadn't spread. Since then, she's had other nonmelanoma skin cancers removed from her face. "Tanning bed users are almost 75% more likely to develop melanoma than nonusers," says Jeanine Downie, M.D., Skin Cancer Foundation spokesperson and director of Image Dermatology in Montclair, New Jersey. They're also twice as likely to develop squamous-cell carcinoma (SCC). "This cancer often looks like a rough, scaly patch or sore that bleeds and crusts. And it can spread to other organs," says Dr. Downie. An estimated 2,500 people die every year from SCC, and over the last 30 years, incidences among women under age 40 have increased an astounding 700%. "I show my many skin cancer scars to everyone, especially young women who go to tanning beds and think it won't happen to them," Mary Beth says. "Future generations need to learn from my faulty ways."
Stop smoking. Female smokers who light up for 20 years or more have triple the risk of squamous-cell carcinoma, according to a February 2012 study in the journal Cancer Causes & Control.
Wear darker colors. Red or blue fabrics provide better UV protection than yellow or lighter colors, says a 2009 study in Industrial & Engineering Chemistry Research.
Eat healthy. A 2007 study in The American Journal of Clinical Nutrition shows you can reduce skin cancer risk by consuming a low-fat diet rich in leafy greens like spinach and lettuce.
Products are sporting new, FDA-approved claims this summer. Look for the following terms:
Broad Spectrum: Protects equally against ultraviolet A (UVA) and B (UVB) rays that cause skin cancer and aging.
Sun Protection Factor (SPF). Indicates the amount of UVA and UVB defense with a new maximum of 50+.
Water Resistant. Replaces the now-defunct "waterproof" claim, since products must be reapplied 40 to 80 minutes after swimming or sweating.
Originally published in the June 2012 issue of Family Circle magazine.
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