Neil Box, PhD, is an assistant professor in the Department of Dermatology. In this interview we discuss the risk of skin cancer in Colorado and how people can prevent it from occurring in the future.
Q: What are the top three things people need to know about skin cancer?
Box: Skin cancer is extremely frequent in the white population and can be deadly. It is often associated with a history of sun exposure, including sunburns during childhood. Non-melanoma skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are very frequent in the general population, although they are less deadly than melanoma, another less common form of skin cancer. More than 2 million people are diagnosed with skin cancer each year nationally, including 700,000 cases of SCC and 76,000 new cases of melanoma. Melanoma is the most likely to kill, with around 9,500 estimated to have died from it in 2013. Nevertheless, around 2 percent of SCC cases are fatal, accounting for a large number of deaths.
Skin cancer is highly preventable. Sun exposure plays a major role in promoting formation of all skin cancers, and sun exposure behavior can be readily modified in a manner that can prevent cancer formation. This is perhaps of greatest importance in younger people, since it is the early life exposures that are critical for later melanoma formation.
Skin cancer is easily detectable. Because the skin’s surface is visible, very early stage cancers, even deadly melanomas, can be detected readily. Many cancer types, such as pancreatic, ovarian or brain cancers require special screening procedures and population-wide early detection efforts can only come at great effort and expense. For skin cancers, detection is easy and may be performed by any qualified dermatologist or skin specialist. If you have any concerns about any lesions on your skin, make an appointment with a dermatologist. To improve your awareness of what to look for, it may also help to review the ABCDs of melanoma.
Q: Who is at the greatest risk for skin cancer?
B: Epidemiologists have known for many years that both sun exposure history and inherent skin type and pigmentation are important in determining who is at greatest risk for skin cancer. Those who have had multiple sunburns and blistering sunburns in childhood and adolescence are at elevated risk of melanoma, whereas cumulative lifetime sun exposure is key for risk of basal and squamous cell carcinomas. Regarding phenotypic risk factors for melanoma, people who have more than 100 moles are at greatest risk, as are those with red or fair hair color, pale skin color or many freckles. People who report a skin type that never tans and always burns with sun exposure are also at risk. Poor tanning ability and fair pigmentation are likewise risk factors for non-melanoma skin cancers. It is important to consider family history too, since those with two or more first degree relatives with skin cancer are at elevated risk.
Q: What can people do to prevent skin cancer, especially in our high-altitude state?
B: Everyone should be vigilant at all times of the year in Colorado. Colorado enjoys great weather, and there are so many outdoor activities to engage in year round. Due to the altitude, we also have a higher ambient ultraviolet (UV) light level than other states that are at sea level. Everyone can benefit from wearing a hat and sun protective clothing as well as sunscreen while enjoying outdoors activities. Also, try to take the benefit of any shade that is available while outdoors. It is particularly important to engage in sun protection between 11 a.m. and 3 p.m., when the sun is directly overhead and UV levels are greatest.
Q: Tanning bed legislation has been a big controversy in Colorado, why is this an important topic and what are you doing to educate the public?
B: Professional organizations such as the Society for Behavioral medicine that focus on prevention as a means to improve health recommend an outright ban on tanning bed use. This is based on data showing that indoor tanning increases risk for all types of skin cancer, and these risks are even higher when sun bed use begins in adolescence or early adulthood. In fact, in one study, the increase in risk for melanoma associated with 10 or more indoor tanning visits was fourfold for melanoma diagnosed between 18 and 29 years of age. The International Agency for Research on Cancer has even listed artificial UV sources alongside tobacco and asbestos in the highest category of human carcinogens.
In an effort to combat this increased cancer risk, states including California, Vermont, Texas, Nevada and Oregon have banned indoor tanning for all minors, and many other states have imposed varying age limits on minors in efforts to combat this increased cancer risk. In Colorado, the Skin Cancer Task Force, Colorado Dermatologic Society, and a number of other important organizations banded together and pushed for House Bill 14-1054 which includes an outright ban on tanning beds for minors. Unfortunately, the bill was not passed. Tanning bed regulation is, however, a rapidly growing movement nationally, so it is inevitable that we will see a form of this bill passed in Colorado in the near future. In this next period, we will be working with other interested organizations, including the Skin Cancer Task Force and the Colorado Melanoma Foundation to raise public awareness on the dangers of sunbed use, and we will continue to lobby our elected state officials prior to a new legislative initiative next year.