What is the most common form of cancer in the United States? 

If you guessed skin cancer, you’re correct. 

With over five million cases diagnosed each year, skin cancer impacts more Americans than all other forms of cancer combined. A whopping one out of every five of us — that’s more than 5,000 Scott Countians — will be diagnosed with skin cancer by the age of 70. Yet, it remains one of the least-discussed forms of cancer — perhaps because many of the cases are relatively minor, perhaps because most Americans feel it can’t happen to them. But it’s not always minor — it can be deadly, in fact. The Skin Cancer Foundation estimates that someone dies of melanoma every hour. And the two most common types of non-melanoma skin cancer — basal cell carcinoma and squamous cell carcinoma — will kill more than 18,000 Americans this year alone.

With spring quickly turning into summer and millions of Americans exposing themselves to the sun and tanning beds, May is designated as Skin Cancer Awareness Month in an effort to educate Americans on the risks of skin cancer.

Almost Always Preventable

Skin cancer may be common, but it’s also preventable in almost every instance. The single biggest risk factor? The sun.

A whopping 90 percent of non-melanoma skin cancers are caused by exposure to UV radiation, and even 65 to 85 percent of melanomas are caused by UV radiation. 

Yet, many Americans continue to head outside without considering the risks of exposure to the sun. That’s why more than 58 million Americans have actinic keratosis — the most common precancer of the skin. It’s perhaps also why skin cancer cases continue to increase. Between 1994 and 2014, in fact, the number of non-melanoma skin cancers in the U.S. increased by 77 percent. Since 2008 alone, the number of melanoma cases has increased by 53 percent. And more than 175,000 cases will be diagnosed this year, with more than half of them invasive — meaning they’ve already penetrated into the skin’s second layer.

Nearly 10,000 Americans will die of melanoma in 2019, about two thirds of which will be men. While the five-year survival rate for melanoma — which is the deadliest form of skin cancer because of its propensity for spreading — is about 99 percent when the disease is detected early, it falls rapidly once the cancer begins to spread. Once it reaches the lymph nodes, melanoma’s five-year survival rate drops to 63 percent. And once it metastasizes to distant organs, the survival rate is a dismal 20 percent.

Just how dangerous is the sun? Consider this: While tanned skin may be considered attractive in Western culture, tanned skin is actually damaged skin. Experts say that skin tans as UV radiation causes damage to cell structure, which can lead to premature aging such as wrinkles and skin cancer. Sunburns are even more dangerous than tans. In fact, it is estimated that a person’s risk for melanoma doubles if he or she has had more than five sunburns. And it isn’t just older people who have to worry. If someone sustains five or more sunburns in their youth, their lifetime risk for melanoma increases by 80 percent.

So what can you do to protect yourself from the sun? Always use a sunscreen product if you’re going to be outside for more than a few minutes. The ingredients within the sunscreen help prevent the sun’s UV radiation from reaching the skin, preventing the damage that would otherwise be caused.

Experts say that sunscreens with a Sun Protection Factor, or SPF, of 15 or greater are best for protecting against UV rays, and anyone over the age of six months should use a sunscreen daily. (Children under the age of six months should not be exposed to the sun, since their skin is highly sensitive to the chemical ingredients of sunscreen.) An SPF 15 sunscreen means that if you ordinarily see your unprotected skin start to turn red in 20 minutes of exposure to the sun, you should be safe for 15 times longer — five hours.

Dangers of Sunless Tanning

Would you smoke a cigarette, knowing what nicotine can do to your body? Increasingly, Americans are saying “no way!” They’re finding ways to break their tobacco habits, or never smoking in the first place.

But experts say that tanning beds are even more closely linked to skin cancer than cigarettes are to lung cancer — yet they continue to increase in popularity.

According to the Skin Cancer Foundation, people who first use a tanning bed before the age of 35 increase their risk of melanoma by 75 percent. That’s why dermatologists are increasingly concerned about the growing trend of teen tanning. Skin cancer can occur early in life, they warn. Women who use tanning beds are six times more likely to be diagnosed with melanoma in their 20s than those who don’t. Even occasional tanning indoors is dangerous, the experts say. That 75 percent increased risk of melanoma among those who tan indoors before the age of 35 applies even to those who have used a tanning bed only once.

There are alternatives, doctors say — like sunless tanning lotions. 

Sunless tanners don’t rely on harmful UV rays to darken the skin; instead, they achieve the same look through a coloring agent — usually DHA, or dihydroxyacetone. It combines with the amino acids in the skin to cause browning, involving only the outermost cell layer of the skin, which is already dead.

Professional spray tans are generally preferred for big events, like weddings and proms, but experts say it’s possible to get a natural-looking tan at home with self-tanners that can be purchased over the shelf in pharmacies and discount stores.

Self Check at Home

According to the Skin Cancer Foundation, it’s important to check your body often for skin cancers, so that they can be diagnosed and treated early. The SCF recommends checking your face — especially your nose, lips, mouth and ears — from front to back, using one or two mirrors for a clear view. Thoroughly inspect your scalp, using a blow-dryer and mirror or the help of a family member or friend. Check your hands carefully — both palms and backs, as well as between your fingers and under your fingernails — before moving on to your upper arms with the use of a full-length mirror. Focus on your neck, chest and torso before using a hand mirror in combination with a full-length mirror to check the back of your neck, shoulders and upper back. Finally, move on to the lower part of your body. 

While inspecting yourself for skin cancer, the SCF recommends knowing the ABCDEs of melanoma:

A — Asymmetry. A warning sign of melanoma are moles that are not symmetrical, meaning if you draw a line through the middle of it, the two sides won’t match.

B — Border. A benign mole typically has smooth, even borders, while melanomas tend to be uneven, or even scalloped or notched, especially early on.

C — Color. Most benign moles are all one color. If a mole has a variety of colors, or if it becomes black, red, white or blue, it could be melanoma.

D — Diameter. Benign moles are usually smaller than malignant moles. Melanomas are generally larger than the eraser on a pencil, but can be smaller in the early stages.

E — Evolving. Benign moles tend to look the same over time. But if they start to change, it’s a warning sign of melanoma. They can take on a different size, shape, color or elevation, or a new symptom, such as bleeding, itching or crusting.

This article is the May 2019 installment of Focus On: Health, presented by Brennan's Foot & Ankle Care, Big South Fork Medical Center, Roark's Pharmacy and Danny's Drugs on the second week of each month as part of the Independent Herald's Focus On series. A print version of this article can be found on Page A3 of the May 9, 2019 edition of the Independent Herald.