Basil cell skin cancer

What's the most important thing to remember before loading the kids into the car for a day at the neighborhood swimming hole? The latest trashy detective novel? A comfy beach chair? A cooler full of yummy snacks and drinks? While any of these poolside accoutrements will certainly make for a more enjoyable summertime experience, none will do a thing to protect from the sun's harmful rays. The four most important things to throw into your beach bag are sunscreen with a sun protection factor of at least 15; tightly woven, loose-fitting clothes; a wide-brimmed hat; and sunglasses.

According to the American Cancer Society, skin cancer has reached epic proportions. When people hear the word cancer, they most commonly think of breast, colon, or lung cancer. But consider the following facts.

* One of every two cancers diagnosed is a skin cancer.

* One out of every six Americans will develop skin cancer at some point in his or her lifetime.

* Skin cancer claims the life of one American every hour.

* Of the 1 million cases of skin cancer diagnosed this year, more than 40,000 will be malignant melanoma.

* Children born today have a 1 percent chance of developing malignant melanoma.

* Malignant melanoma killed 7,300 people in 1998.

Distressing as these figures are, most skin cancers can be prevented. The primary cause of skin cancer is overexposure to the sun's deadly rays, or sunburn. A sunburn is defined as "exposure to ultraviolet radiation." While tanning is the skin's protective response against damage to UV light, it does not prevent skin cancer, a disease in which malignant cells develop in the skin's outer layers.

Skin is made up of two main layers. The epidermis, the top layer, has three kinds of cells: flat, scaly cells called squamous cells; round cells known as basal cells; and melanocytes, the cells that give our skin color.

The most common forms of cancer that start in the skin are basil and squamous cell cancers. Although they are rarely fatal, if left untreated they can spread and cause more serious health problems. In 1994, 1,200 of the 900,000 Americans who developed these forms of cancers died.

Basal cell carcinoma usually appears as small, raised, translucent fleshy bumps or nodules on the head and neck. It is the most common skin cancer found among fair-skinned people. It grows slowly and rarely spreads to other areas of the body; however, it can penetrate below the skin and cause considerable damage.

Squamous cell carcinoma appears as raised red scaly patches. Like basal cell carcinoma, it is common among fair-skinned people. This cancer can develop into large masses and can metastasize to other areas of the body. Squamous cell carcinoma typically develops on the edge of the ears, face, lips, mouth, and hands. Both basal and squamous cell cancers have a 95 percent cure rate if detected and treated early.

Malignant melanoma most often appears as visible changes in existing moles or birthmarks. It is the rarest and deadliest form of skin cancer. It is responsible for three-quarters of all skin cancer deaths. Melanoma begins as an uncontrolled growth of malignant pigment-producing melanocyte cells. These cells may suddenly develop from or near a mole, or may occur as the appearance of a new mole.

You should see a doctor immediately if:

* There is any change in the size, shape, or color of a mole.

* A mole feels itchy, hard, lumpy, swollen, or tender to the touch.

* Pigment from existing moles spreads into surrounding skin.

* You observe any dark or irregularly pigmented growth or spot.

Use the ABCD system for tracking any changes in moles.

-- Asymmetry: One half does not match the other.

-- Border: Ragged, notched edges.

-- Color: Multicolored lesions (tan, brown, blue, or black).

-- Diameter: Anything bigger than a pencil eraser.

Men most commonly get melanoma on the head, neck, chest, and back; it strikes women on the arms and legs. Don't be fooled -- it can occur anywhere. And although it afflicts men and women in equal numbers, men have a higher mortality rate. Fair-skinned blondes and redheads are most susceptible; however, no one is immune. African-Americans may develop melanomas, most often on the palms, soles, or under fingernails. In any case, early detection is critical for successful treatment.

But no matter how careful you are, there are contributing risk factors beyond your control.

Your family history: People with a family history of skin cancer have a much greater risk of developing it themselves. Do you have a family member who has been diagnosed with some form of skin cancer?

Your physical characteristics: Fair-skinned people with light blue or green eyes, those with red or blonde hair, and those who freckle easily have a much greater risk of developing skin cancers.

Your environment: People who work outdoors or live close to the equator or at higher altitudes run a greater risk of developing skin cancer.

Reflection: Sand, concrete, snow, and water are highly reflective surfaces, bouncing back as much as 90 percent of the sun's rays.

Clouds and haze: While clouds do keep out much of the sun's heat, they block as little as 20 percent of UV radiation. Rain may reduce LTV radiation by as much as 50 percent.

Other negative health effects from overexposure to the sun include actinic keratosis, cataracts, pterygium, macula degeneration, immune suppression, and premature wrinkling. But the most alarming statistics relating to the development of skin cancer involve our children. Consider the following facts.

* Eighty percent of all damage to skin occurs before the age of 18.

* Children's exposure to the sun is three times that of adults.

* A newborn in the United States now has a 1 percent chance of developing a malignant melanoma as an adult -- an increase of 1,500 percent since 1935.

The melanocytes in children's skin are not developed. Youngsters also have fewer pigment cells than do adults. Children burn faster, and cumulative skin damage starts with the first sunburn.

A 1994 survey of 25 daycare centers revealed that more than half of kids spent two to three hours outdoors each day. Twenty-four of the centers held outdoor activities during the sun's period of strongest intensity. Additionally, 64 percent of these centers provided little shaded play space; of these, only two provided canopies for additional shade. Remember, one bad sunburn increases a child's risk of developing skin cancer by 50 percent.

The American Academy of Dermatology and the Skin Cancer Foundation have made the following recommendations to reduce the chance of both sunburn and skin cancer.

* Minimize sun exposure between 10 a.m. and 3 p.m.

* Use a sunscreen with an SPF of at least 15. Reapply every two hours, even on cloudy days.

* Wear clothing that covers the body. (Don't forget that wide-brimmed hat.)

* Keep young children out of the midday sun. When exposed to the sun's rays, they should be coated liberally and frequently with sunscreen.

To avoid eye damage from ultraviolet rays, the American Academy of Ophthalmology recommends wearing "UV-absorbent sunglasses and a wide- brimmed hat whenever you're in the sun long enough to get a suntan or a sunburn, especially if you live at a high elevation or anywhere near the equator."

Aquatics and park and recreation professionals should consider developing and instituting a policy for sun safety. Points to examine include:

* Amount of time employees and patrons spend outside each day.

* UV exposure at your location.

* Provision of shade where necessary.

* Education of health hazards.

* Provision of sunscreen for employees and patrons.

Made in the Shade

Finally, providing sufficient bastions of shade for employees and patrons is important. Areas to consider include lifeguard stations, play pools, bleachers, outdoor concession kiosks, and outdoor maintenance and storage areas.

According to the Environmental Protection Agency, one in five Americans will develop skin cancer during his or her lifetime, making it the most common cancer in the United States. Unfortunately, with more than 1 million new cases diagnosed each year, it is also one of the country's fastest rising cancers. Aquatics and park and recreation professionals, often subject to long hours under the midday sun, should take special precautions to protect themselves from this very preventable disease. Author Evan van Koeck, an avid ocean swimmer and river rat, will explain how to do just that (p. 62).