Enright Skin Cancer Program

• Skin cancer is the most common cancer in the United States and worldwide.
• More people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.
• 1 in 5 Americans will develop skin cancer by the age of 70.
• More than 2 people die of skin cancer in the U.S. every hour.
• The main types of skin cancer are squamous cell carcinoma, basal cell carcinoma and melanoma.
• About 86% of melanoma and 90% of nonmelanoma skin cancers are associated with ultraviolet (UV) radiation exposure from the sun.
• Risk for melanoma doubles on average having had 5 or more sunburns, but just one blistering sunburn in childhood or adolescence more than doubles your risk.
• Regular daily use of an SPF 15 or higher reduces the risk of developing squamous cell by about 40% as well as the risk of developing melanoma by 50%.
• More than 400,000 cases of skin cancer are estimated to be related to indoor tanning in the U.S. each year.
• Treatment for skin cancer costs $8.1 BILLION each year in the United States.
• Anyone can get skin cancer. Although persons with light skin and eyes are at higher risk of getting skin cancer, people with darker skin may not seek care or be diagnosed with skin cancer until a later stage, making it more difficult to treat.
• Melanoma is less common than the other types of skin cancer, but more likely to invade nearby tissue and spread to other parts of the body.

(Source: American Cancer Society)

Skin cancers are named for the type of cells that become malignant (cancer). There are three common types:

Basal Cell Skin Cancer

Basal cell skin cancer grows slowly. It usually occurs on areas of the skin that have been in the sun. It is most common on the face, upper trunk and shoulders. Basal cell cancer rarely spreads to other parts of the body.

Squamous Cell Skin Cancer

Squamous cell skin cancer also occurs on parts of the skin that have been in the sun. But it also may be in places that are not in the sun. Squamous cell cancer sometimes spreads to lymph nodes and organs inside the body.

Melanoma

Melanoma begins in melanocytes (pigment cells). Most melanocytes are in the skin. Melanoma can occur on any skin surface. In men, it is often found on the skin on the head, on the neck, or between the shoulders and the hips. In women, it is often found on the skin on the lower legs or arms or between the shoulders and the hips. Melanoma is rare in people with dark skin. When it does develop in people with dark skin, it’s usually found under the fingernails, under the toenails, on the palms of the hands, or on the soles of the feet.

Click here to learn more about these types of skin cancer.

Learn About Sun Safety Now. Get educated and certified in sun safety with the online Enright Sun Safety Certification™ programs for ages 5 and over.

Get educated and certified in sun safety with the Enright Sun Safety Certification Program

The Enright Sun Safety Certification Programs are FREE online learning courses, designed by our skin cancer professionals, to educate children and young adults on sun safety by answering two simple questions:

• How do you stay safe in the sun?
• Why is staying safe in the sun so important?

How Do We Teach Them?

Through an advanced e-learning platform with engaging visuals, a healthy dose of creativity, proven instructional methods and a highly interactive user experience. All of which makes learning about sun safety FUN and EASY for all ages.

There Are Three Courses. One for Each Age Group:

• 5 to 8
• 9 to 12
• 13 and over

Make a difference! Spread awareness and provide education about sun safety. It’s vital to help prevent skin cancer.

Take the program!

Melanoma is the most serious form of skin cancer. It begins in cells in the skin called melanocytes (cells that produce pigment and cause your skin to tan). It is the leading cause of death from skin disease.

Some Key Facts and Figures About This Widespread, Potentially Deadly Disease

• If melanoma is recognized and treated early, it is almost always curable. When diagnosed at later stages, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal.
• An estimated 100,000 new cases of invasive melanoma will be diagnosed in the U.S. in 2016, resulting in an estimated 9,000 deaths.
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
• Skin cancer is the most commonly diagnosed cancer in the United States, with 5 MILLION PEOPLE treated each year.
• Most skin cancers can be prevented—but we can do much more.
• Sunburn is a clear sign of overexposure to UV (ultraviolet) rays, a major cause of skin cancer.
• Tanned skin is damaged skin, yet nearly 1 out of every 3 young white women engages in indoor tanning each year.

Choose sun protection strategies that work:

1. Wear a hat, sunglasses, and other protective clothing, seek shade, especially during midday hours.
2. Use broad spectrum sunscreen with SPF 30-50 to protect any exposed skin.
3. Remember that sunscreen is most effective when used in combination with other methods, and when reapplied as directed. Learn to Apply, Cover and Enjoy

People from every sector of society have a role to play to reverse the rising tide of skin cancer. Government, business, health, education, community, nonprofit, and faith-based sectors are all essential partners in this effort.

(Source: U.S. Surgeon General’s Call to Action to Prevent Skin Cancer, 2014.)

Skin cancers can be caused by overexposure to the sun and ultraviolet (UV) rays. The sun’s rays damage your skin and frequent sun exposure, even if you don’t burn, can lead to skin cancer. Just one blistering sunburn in childhood or adolescence more than doubles your chances of developing melanoma later in life.

Indoor tanning is not a safe alternative. This exposes the skin to ultraviolet rays in amounts 10-15 times higher than the sun at its peak intensity.

Know How to Protect Your Skin

• Minimize exposure to the midday sun (10 am – 4 pm) by seeking shade
• Wear clothing, hats, and sunglasses that protect the skin
• Use a broad-spectrum sunscreen (UV-A and UV-B protection) with a sun-protection factor (SPF) between 30-50 year round
• Examine your skin regularly and report changes or concerns to your doctor
• Do not use sunlamps or any type of indoor tanning.
• UV radiation from artificial sources is identified as a known cancer-causing source
• Many states in our nation and at least 2 other countries have enacted legislation to restrict the use of tanning beds by minors

What are the Warning Signs of Melanoma?

During an inspection of the skin, specific attention should be given to the size, shape, edges and color of each mole.

A handy tool in remembering these features is to think of the A-B-C-D-E’s.

The A-B-C-D-E’s of Melanoma

(Source: The American Academy of Dermatology)

Early detection and recognition of melanoma is key to improving the chances for successful treatment and overall survival. Recognizing early warning signs of melanoma and doing regular self-examinations of the skin will help find melanoma early when the disease is highly curable.

Melanoma can occur anywhere on the body, not just on areas exposed to the sun.

Self-Examination of Skin

Self-examinations should be performed monthly in front of a full-length mirror in a brightly lit room. It helps to have another person check the scalp, back and back of the neck.

Include the following steps in a self-examination:

• Examine the front and back of the entire body in a mirror, then the right and left sides, with arms raised.
• Bend the elbows and look carefully at the outer and inner forearms, upper arms (especially the hard-to-see back portion), and hands.
• Look at the front, sides, and back of the legs and feet, including the soles and the spaces between the toes.
• Part the hair to lift it and examine the back of the neck and scalp with a hand mirror.
• Check the back, genital area, and buttocks with a hand mirror.

Talk with your doctor if you find any of the following:

• A growth on the skin that matches any feature on the ABCDE rule list (See ‘What Causes Melanoma?’)
• New growth on the skin
• A suspicious change in an existing mole or spot
• An unusual sensation in a mole, such as itching or tingling
• Any mole that looks significantly different from all the other moles (ugly duckling)

Screening for Melanoma

Routine annual check-ups should include an examination by a dermatologist or other health care professional qualified to diagnose skin cancer.

Risk factors including family history of melanoma, light hair and eye color, fair skin, history of at least one severe sunburn, history of extensive sun exposure, presence of many moles on the body, a weakened immune system and exposure to certain chemicals, may warrant more frequent screenings.

Watch How It’s Done

If skin cancer is suspected, a skin biopsy is conducted. A biopsy is the only way to confirm the presence of skin cancer. The doctor takes a skin sample from the suspicious area for examination by a lab.

There are 4 ways the doctor can determine which kind of skin cancer you have. Click here for details.

The Doctor Found a Suspicious-Looking Lesion. Now What?

If skin cancer is suspected, a skin biopsy is conducted.  A biopsy is the only way to confirm the presence of skin cancer.  The doctor takes a skin sample from the suspicious area for examination by a lab. The type of biopsy depends on the size and location of the suspicious area:

• Shave Biopsy: a thin layer of the lesion is shaved off
• Punch Biopsy: a special tool rotates and cuts through layers of the skin to take a skin sample
• Incisional Biopsy: takes a deeper skin sample using a surgical knife to cut through the full thickness of the skin, removing only a portion of the tumor
• Excisional Biopsy: removes the entire tumor and is the recommended method when a melanoma is suspected.

Depending on the thickness of the tumor, most biopsies are simple and quick procedures that can be performed in the doctor’s office. The doctor uses a local anesthetic to numb the affected area and uses sutures for all but the shave biopsy. The samples are examined by a pathologist under a microscope to confirm the presence or absence of skin cancer and its type.

Once a melanoma is diagnosed, the next step is determining the stage of the disease. Staging determines the extent of a person’s cancer. It includes the determination of the following:

• Thickness of the tumor (Breslow depth)
• Presence or absence of ulceration
• Number of mitoses (dividing cells) within the tumor
• Whether the tumor had spread to the lymph nodes and the number of lymph nodes involved
• Whether the tumor had spread or metastasized to distant parts of the body.

Staging may involve laboratory tests and imaging studies.

Staging is very important. Treatment recommendations and prognoses are based on the stage of the cancer. Stages range from stage 0 to stage IV.

STAGE 0

The tumor has not spread and is still limited to the outer layer of the skin (melanoma in situ).

STAGE I

In Stage IA, the tumor is not more than 1 millimeter thick with no ulceration or mitosis.

In Stage IB, the tumor is 1 to 2 millimeters thick with no ulceration.

STAGE II

The tumor has spread to the dermis (deep part of the skin), but has not reached the lymph nodes.

In Stage IIA, the tumor is 1 to 2 millimeters thick with ulceration or 2 to 4 millimeters thick with no ulceration. In Stage IIB, the tumor is 2 to 4 millimeters thick with ulceration or more than 4 millimeters thick with no ulceration. In Stage IIC, the tumor is more than 4 millimeters thick with ulceration.

STAGE III

The tumor has spread to lymph nodes near the affected skin.

In Stage IIIA, the tumor may have spread to as many as three lymph nodes, but the nodes are not enlarged, and the tumor in the lymph nodes can only be seen under a microscope.

In Stage IIIB, the following may happen:

• The tumor is ulcerated and has spread to as many as three lymph nodes but the lymph nodes are not enlarged and the tumor in the lymph nodes can only be see under the microscope OR
• The tumor is not ulcerated and has spread to as many as three lymph nodes but the lymph nodes are enlarged OR
• The tumor has not spread to the lymph nodes, but has produced satellite tumors in the vicinity (within 2 centimeters) of the original melanoma or the tumor cells are in the lymphatic channels nearby.

In Stage IIIC, the tumor has spread to four or more lymph nodes or has clinically evident enlarged lymph nodes.

STAGE IV

The tumor has spread to other organs, such as the lung, liver, brain or to lymph nodes far away from the original site.

Read more about the stages of melanoma here.

Treatment of melanoma depends on the stage of the disease

Depending on the stage, surgery to remove a tumor is usually the first line of treatment.

The standard treatment approaches may include a combination of surgery, chemotherapy, and biologic or immunotherapy.

It is also important to discuss all treatment options with your doctors and to ask about new treatments and clinical trials.

Click here to learn more about the options for treating melanoma.

There are several factors that may increase your risk of melanoma including:

Fair Skin

Having less pigment (melanin) in your skin means you have less protection from damaging UV radiation. If you have blond or red hair, light-colored eyes, and freckle or sunburn easily, you’re more likely to develop melanoma than is someone with a darker complexion. But melanoma can also develop in people with darker skin types.

A History of Sunburn

One or more severe, blistering sunburns can increase your risk of melanoma.

Excessive Ultraviolet (UV) Light Exposure

Exposure to UV radiation, which comes from the sun and from tanning lights and beds, can increase the risk of skin cancer, including melanoma.

Living Closer to The Equator or At A Higher Elevation

People living closer to the earth’s equator, where the sun’s rays are more direct, experience higher amounts of UV radiation than do those living in higher latitudes. In addition, if you live at a high elevation, you’re exposed to more UV radiation.

Having Many Moles or Unusual Moles

Having more than 50 ordinary moles on your body indicates an increased risk of melanoma. Also, having an unusual type of mole increases the risk of melanoma. Known medically as dysplastic nevi, these tend to be larger than normal moles and have irregular borders and a mixture of colors.

A Family History of Melanoma

If a close relative — such as a parent, child or sibling — has had melanoma, you have a greater chance of developing a melanoma, too.

A Weakened Immune System

People with weakened immune systems, such as those who’ve undergone organ transplants, have an increased risk of skin cancer.

(Source: Mayo Clinic and the Skin Cancer Foundation)