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Keep on the shady side

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Early detection of skin cancer is critical

Published:

Story by Sara Rae Lancaster

Marlene Giordano and Rosann Fuhrer may share grandchildren (Giordano’s daughter is married to Fuhrer’s son), but the Kenosha women also share another bond. Both are skin cancer survivors.

The American Academy of Dermatology defines skin cancer as an abnormal growth of skin cells. It’s classified into three groups — melanoma, basal cell carcinoma and squamous cell carcinoma. Most skin cancers develop on areas exposed to the sun, and can affect people of all skin colors and races. However, certain factors, such as a family history of skin cancer, having red or blond hair, and fair skin, can increase a person’s risk.

Fuhrer, 71, had a family history of skin cancer. Her father, sister and brother were all diagnosed with basal cell carcinoma. Even so, when a spot in the middle of her cheek started to change color in 2006, she wasn’t overly concerned.

“I just thought, ‘Oh, that’s what it’s going to do,’” Fuhrer said.

It wasn’t until Fuhrer saw her doctor about some skin tags on her neck that she realized there was cause for concern.

“I wasn’t told right away that they suspected it was skin cancer, but you could tell with how quickly they had me up on the table to do the biopsy they thought it was serious enough,” she recalled.

The diagnosis was melanoma, the most serious — and potentially life threatening — form of skin cancer. After doctors removed a 2-inch section from Fuhrer’s cheek that required 35 stitches, Fuhrer was told all signs of the cancer were gone.

“If I got skin cancer, I always thought it would be the ‘normal’ type, basal cell. When they told me it was melanoma I was surprised,” she admitted. “Even after it was gone, it bothered me for a while.”

Giordano was much younger when she first encountered skin cancer.

“I was 43 years old the first time I had skin cancer,” said Giordano, now 74.

It was just a tiny imperfection, she described. Occasionally her collar or a piece of jewelry would catch on the piece of skin, causing it to bleed. When she finally had the area examined, the doctor was surprised she hadn’t seen him sooner.

The experience taught her a valuable lesson: awareness.

“If you have something that stays there and doesn’t heal up, if part of it scrapes off but never fully goes away, have it checked out,” she said.

That sage advice came to her rescue 20 years later when the cancer returned. Today, Giordano’s collarbone, nose, neck, throat, cheek and forehead all bear the scars of her eight encounters with skin cancer.

Each case was diagnosed as basal cell carcinoma, a slow-growing and the most common form of skin cancer. Although basal cell carcinoma rarely metastasizes or kills, it can be extremely disfiguring, leaving behind permanent scars each time a cancerous lesion is removed.

Both Fuhrer’s melanoma and most of Giordano’s basal cell occurrences were treated with a procedure known as Mohs surgery, a microscopically controlled surgery developed in 1938 by general surgeon Dr. Frederic E. Mohs. During the process, a trained Mohs surgeon removes a conservative layer of skin and then examines the specimen for cancer cells, which then determines where and how much tissue the surgeon will remove next. The procedure is praised for its high cure rate while preserving as much healthy tissue as possible.

Such state-of-the-art treatment offers comfort to those who receive a diagnosis like Fuhrer’s and Giordano’s, but preventing skin cancer is even better. For seniors, the chance of developing either basal cell carcinoma or squamous cell carcinoma at least once is between 40 and 50 percent, according to a 2010 Cancer Trends Progress Report from the National Cancer Institute.

“Once a person is over the age of 55, the risk of developing skin cancer gets much higher because of prior damage and damage that occurs over time,” said Dr. Malik T. Bandealy, an oncologist with Aurora Cancer Care.

That’s not to say there aren’t precautions seniors can take now to prevent future sun damage and their skin cancer risk.

Avoiding the sun during peak hours (generally 10 a.m. to 4 p.m.) and wearing a broad spectrum sunscreen continue to be a person’s best first lines of defense.

“Underline proper use of sunscreen,” added Dr. John Louis Ratz, a dermatologist and fellowship-trained Mohs surgeon with Great Lakes Dermatology. “These are the most common items we can buy and use, but they only offer protection for a couple hours.”

Proper use of sunscreen, Ratz explained, means applying it year round, in sunny and cloudy weather, and repeating the application every two to three hours or after being in the water.

If people followed this advice, Ratz said, “what would happen is people’s skin would not be exposed to ultraviolet light. By getting that type of extra protection, the skin’s repair mechanism would go into effect and prevent the formation of skin cancer and pre-cancer.”

Bandealy and Ratz also recommend people do a self exam every three months and have a physician or dermatologist perform a skin exam annually, twice a year if there is a family history of skin cancer or the person has been diagnosed previously with skin cancer.

“The important thing is to look for spots on the skin that change in size or color, bleed or look like they’re turning into an ulcer,” Bandealy said.

He added, “The key to early detection is looking for it.”

Remember ABCDE

The American Academy of Dermatology suggests using the acronym ABCDE as a guide for gauging questionable moles or lesions:

A= Asymmetry (one half is unlike the other half),

B= Borders (an irregular or poorly defined border),

C= Color (varied from one area to another; has shades of tan, brown or black, or sometimes white, red, or blue),

D= Diameter (usually greater than 6mm or the size of a pencil eraser),

E= Evolving (looks different from the rest or is changing in size, shape or color)

Showing changes in three of the five criteria should be a red flag to have the area examined.