In the past, I freely admitted to fear of three things: snarling canines (Yes, I’ve been bitten), fast-moving water (a near drowning) and snarling dogs in fast water.
I’ve never really thought about a “fear” list, and, subsequently comfortable in whitewater, I’ve removed that item from the list. Maybe life experiences add and delete items as the years pass.
Skin cancer is not on my fear list, but it is on my “concern” list, especially considering Durango’s southern latitude, 6,512-foot elevation and sunny climate. Skin cancer is the most common cancer, hitting almost half of us in our lifetimes.
Basically, there are three categories of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. All three types, at least partially, result from sun exposure – ultraviolet (non-ionizing) radiation, specifically UV-B and, to some extent, UV-A.
Of the three, BCC is usually slow growing, almost indolent. It may initially be perceived as a sore or a cut that refuses to heal. Growing in place and rarely spreading (metastasizing), it can eventually form a crater-like depression with raised edges about the periphery.
This type of skin cancer has been treated with radiation, as in X-rays, with 5-fluorouracil cream and with excision. My choice would usually be the scalpel. The BCC’s location is a huge consideration as it was in the case of a friend who had a BCC between his nose and his lower eyelid – very touchy, indeed. Another friend had a BCC on his right nasolabial fold (the crease between nose and cheek) that also happened to be aggressive. His second surgery, successful, required a large excision and a replacement flap on his face and nose.
SCCs are more of a concern because some may spread to other areas, that is, metastasize. SCCs, like BCCs, often occur on the face, ears, neck, hands and arms, common areas of sun exposure and may appear as firm, rough spots with scaly surfaces and flat reddish patches.
Some SCCs originate from actinic keratoses, which begin as flat, scaly areas often topped with white or yellow crusty scale. AKs are easily “burned” off with liquid nitrogen, although the results remind one of the sores characteristic of meth users.
If these sound bad, melanoma is worse. The incidence of melanoma has nearly doubled from the 1950s to the 1990s. There are 44,000 new cases of melanoma and 7,000 deaths in the U.S. annually.
Melanoma predominates in white, Caucasian males, and, again, sun exposure is an important factor, especially intermittent exposure versus constant exposure. Sunburns earlier in life also add risk, and the use of tanning parlors and sun lights about double the risk.
In the U. S., melanoma is latitudinal, more frequent in the south than the north. Unpredictably, it also occurs on covered areas of skin and on folks with little sun exposure, suggesting genetic or other causal factors. The jury is still out on whether sunscreens are at all effective.
Shouldn’t skin cancer be on your “concern” list?
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.
