More Than Skin Deep

By staff July 1, 2008

Let’s make this very clear. Skin cancer isn’t just for seniors. Think because you’re young, the sun can’t hurt you? Think again. Melanoma, the deadliest form of this disease, is the third-most-common form of cancer in women aged 20 to 39.

Kristi Michael knows that all too well. This Tampa Bay resident was a beautiful and enterprising film and video make-up artist and the mother of a young daughter. One day, in 1997, Michael noticed a new mole on her ear. When she touched it, it stung. On a hunch, she got it checked by a dermatologist, even though she had no family history of skin cancer. The dermatologist told her she had nothing to worry about. Yet something nagged her about the pain and she decided to seek a second opinion. That doctor ordered an immediate biopsy. A few days later, the diagnosis came back: stage four melanoma. Michael was 31 years old.

Michael spent the next four years in a painful fight for her life. She endured more than a dozen surgeries and radiation and chemotherapy treatments. She fought it every step of the way, undergoing experimental procedures; even so, the cancer spread rapidly through her body. After a valiant struggle, she died in 2001.

“So many of us were deeply affected by Kristi’s experience,” says Stan Kozma, Michael’s fiancé. “It opened our eyes to this insidious disease, which, by the way, is almost 100 percent curable if caught early.”

Kozma can’t forget Michael or her battle. Empowered by her memory, he’s spent the last seven years getting the word out about skin cancer—especially to the parents of young children.

“The treacherous reality is that melanoma is like a time bomb placed in our bodies between the age of five and 15,” says Kozma. “We have this false sense of security that skin cancer only affects Grandpa, and even then, the doctor just cuts it out or freezes it and all is well. But it’s in our youth and adolescence when most of us experience 80 percent of the sun exposure we’ll ever receive. We need to be more vigilant with our children during infancy and childhood. Two to three blistering sunburns in youth can lead to a deadly situation later in life.”

One of the ways Kozma, a filmmaker and proprietor of the Tampa-based Z Film, gets the word out about skin cancer is through a series of televised public service announcements directed at kids and parents that he and a team of volunteers wrote and produced. These 30-second segments are child-friendly, funny—and extremely effective.

Recently, Kozma also had the opportunity to work with H. Lee Moffitt Cancer Center & Research Institute and WUSF Public Broadcasting to make More Than Skin Deep: Skin Cancer in America, a one-hour documentary narrated by Sam Donaldson, a legendary news anchor and a skin cancer survivor. The documentary is slated for distribution on public television stations across the country during the next few months.

According to Kozma, the documentary provides facts about skin cancer from both the hard and soft sciences. “We look at the latest research and medical advances,” he says. “We also look at the disease on a historical, social and cultural level, weaving the personal stories of skin cancer patients through the film. We aim to inspire a grassroots effort to understand skin cancer—to take it seriously from a young age.”

The documentary also addresses the baby-boomer generation. “Baby boomers have enjoyed more leisure time than most generations,” says Kozma. “And they’ve spent more time outside—with fewer clothes on than any other generation in history. Health experts are predicting skin cancer cases to skyrocket as baby boomers age—and the medical community isn’t set up to handle it.”

Time for some statistics. Each year, there are more than one million cases of skin cancer diagnosed in the United States—and most are sun-related. Melanoma accounted for nearly 60,000 cases of skin cancer last year and most (about 8,110) of the nearly 11,000 deaths.

A few simple precautions would have saved most of these people from pain, suffering—and death.

“We’re losing the battle with skin cancer, it’s sad to say,” says Dr. Brad Abrams, a board-certified dermatologist in Sarasota. “Statistics show an alarming increase of skin cancers, especially in younger people.”

Why younger people? “One big issue is tanning salons,” says Abrams. “Americans think we look healthier and younger when we’re tan. Although the tanning salon industry promotes their product as being safe, it is not.”

Indeed, it’s reported that 28 million Americans use tanning beds regularly, with an alarming spike in use by teenage girls. Although the $2-billion-a-year tanning industry claims that no-burn tans are safe, the medical community refutes their claim. Studies show that tanning causes damage to skin cells, increases the risk for melanoma and squamous cell carcinoma, and accelerates skin aging. Remember Kristi Michael? She used tanning booths, believing they were safer than direct sun exposure. They weren’t.

Ultraviolet radiation, whether from the sun or artificial light, is almost always the source of skin cancer, which comes in an assortment of types. Here are the top three:

Basal cell carcinoma (BCC) is the most common form of skin cancer found in Caucasians—especially those with lighter skin. Overexposure to the sun is usually the cause. Signs for concern include a persistent, non-healing sore, an irritation on the chest, legs or arms, a bump or nodule that’s pink, red or white, or a scar-like area that’s white or waxy in appearance. BCC is usually diagnosed with a simple biopsy and is fairly easy to treat when detected early, although it can leave scars and disfigurement. 

Squamous cell carcinoma (SCC) forms on the upper layer of the skin. Most cases of SCC are caused by longtime overexposure to the sun, with tumors appearing on such sun-exposed areas as the neck, face, scalp, back and arms. People with fair skin, light hair and blue, green, or gray eyes are at highest risk. That said, darker-skinned individuals aren’t invulnerable; SCC can occur on sites of preexisting inflammatory skin conditions or burn injuries. Signs of SCC include wart-like growths, persistent, scaly red patches with irregular borders that occasionally bleed, open sores that bleed and crust, and any kind of growth that bleeds and/or grows rapidly in size. Usually, SCCs aren’t serious if detected and treated early, but not always. In some cases, SCC resists treatment, grows quickly and attacks the healthy skin surrounding the area and, sometimes, the bone and cartilage below. If treatment isn’t immediate, it’s hard to fight. Even if the fight is won, it often leaves disfiguring scars.

There’s no magic bullet to treat these two forms of skin cancer—only a range of countermeasures. Finding what’s best depends on the patient’s health, the size, type and site of the tumor, whether it is primary or recurring, and even the physician’s skills and surgical strategy.

Melanoma is another thing entirely. It’s the most serious form of skin cancer, quickly spreading to other parts of the body. Blistering sunburns in childhood and adolescence increase the risk, but constant sun exposure over time does, too. If you live in a sunny state like ours, you’re more susceptible to this and other types of skin cancers. Heredity also stacks the deck. If you have a first-degree relative who’s been diagnosed with melanoma, your risk is 50 percent greater. Count the moles on your body. If there are more than 100, see your doctor.

The first signs? A melanoma first pops up as a flat or slightly raised blotchy patch, a vaguely geometric shape with wiggly borders. A previously benign mole can go rogue. A melanoma can appear on any part of the body. In men, it’s usually the trunk and upper back; women usually get it on the legs and upper back.

After detecting a melanoma, the physician classifies its severity. Melanomas have three stages, depending on thickness, depth and proliferation. The treatment depends on the stage. Early melanomas (stages I and II) are local; the more advanced cases (stages III, IV, and V) have metastasized and carried the attack to the rest of the body. The good news? New research is shedding light on treatments that are beginning to work.

“The remarkable and horrifying thing about melanoma,” says Kozma, “is it presents a sort of a perverse challenge to researchers. It’s inscrutable; one of the hallmarks and mysteries of melanoma is that it’s one of the few cancers that can spontaneously regress, which means totally disappear, and be consumed by the body. This has led researchers to observe what activity in the body is responsible for this—and whether it can be stimulated. How can the body’s own immune system be used to treat melanoma?”

The result, Kozma says, is immunotherapy, a new brand of cancer treatment. Researchers are trying to stimulate the body’s own immune system to attack the cancer and eradicate it. In our region, he says, the Donald A. Adam Comprehensive Research Center in Melanoma at the Moffitt Cancer Center & Research Institute is “taking huge strides” in melanoma research. 

Other innovations in skin cancer treatment include photodynamic therapy, or PDT, says Abrams. Both non-melanoma and melanoma skin cancers respond to PDT, which combines a light source and a photosensitizing agent to destroy cancer cells. “This is very exciting technology,” says Abrams. “We’re treating pre-cancer spots and finding that PDT can even prevent new skin cancers from forming if we treat patients once or twice a year.” Abrams also hails the use of such topical applications as Aldara Cream, which, by activating the immune system, can fight certain skin diseases. “With these new treatments, we’re able to bypass surgery in some cases. I believe the next few years will bring even more options. It’s phenomenal!”

But if you want to avoid skin cancer in the first place, Abrams has some simple advice.

“Wear protective clothing when you go outside; it’s better than sunscreen.” That means long-sleeved, lightweight shirts that protect from both UVA and UVB rays. Wear a hat with a wide brim. When you use sunscreen, use ones with zinc oxide and titanium dioxide. Abrams recommends Neutrogena’s Ultra Sheer Dry Touch Sunblock (SPF 55). And he advises adults to have a yearly skin exam by their primary care doctor. Those at higher risk should have annual skin cancer screenings performed by a dermatologist.

Kozma hopes that stories like Kristi Michael’s will save others from her fate.

“Subjecting oneself to the possibility of skin cancer is an aesthetic decision that people make based on what people think will make them look better,” he says. “But it’s not worth it. Be happy in your own skin—whatever shade you are.”

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