Heat treatment: Skin cancers on the rise - May 27, 2016

Courtesy of the Post-Tribune • May 27, 2016, 10:19 AM

By Christin Nance Lazerus • Contact Reporter

My back looks like the craters of the moon,” said the 72-year-old skin cancer survivor.

Years of lifeguarding and boating on Lake Michigan caught up with the Northwest Indiana resident once he turned 40 and was diagnosed with his first basal cell carcinoma. The man didn’t wish to be identified for this article.

Since then, he’s had more than 400 basal cell and squamous cell carcinomas removed from his back and face through liquid nitrogen and cream treatments.

“I’ve been to four dermatologists and retired three of them,” he said with a chuckle.

For many baby boomers, the dangers of skin cancer weren’t on their minds during years of unprotected sun exposure in their teens and 20s. Summer meant working on that perfect tan, baking at the beach or in the back yard during the day then wearing white to look even darker at night.

Hobart resident Tina Romeo said she was an avowed sun-worshipper as a teen and into her 20s.

“Because I was fair skinned, I loved the sun,” she said.

But since a family member was diagnosed with skin cancer, she makes a point to cover up, wear sunblock and get annual skin cancer screenings, like a recent one at Methodist Hospital Southlake.

Lowell resident Sandy French, 71, and her husband Charles French, 76, were getting checked for the first time in May.

“I’ve noticed little spots, but I’ve never been checked,” Sandy French said. “I have a sun allergy — I break out in a rash.So when that started happening I started using sunscreen and wearing a hat when I garden.”

Dr. Ashwin Garlapati, a Merrillville dermatologist, was doing the full-body screenings, paying special attention to areas exposed to the sun that people may not think of — the tops of ears and head, the back, neck and chest, arms — and the face, of course.

Many hospitals are sponsoring skin cancer screenings this month as part of Skin Cancer Awareness Month. Garlapati said older adults, especially those 65 and older, are being treated often in his office.

“There was no such thing as sun protection discussed when they were young,” Garlapati said. “Every severe sunburn you get will increase the risk of melanoma in your lifetime.”

Garlapati and other local doctors say that baby boomers aren’t the only age group at risk for skin cancers, and cases areon the rise.

Skin cancer is the most common form of cancer with more people being diagnosed with than all other cancers combined. Every year, more than 5.4 million cases of basal cell carcinoma and squamous cell carcinoma — the most common types— are treated in more than 3.3 million people, according to the Journal of the American Medical Association.

Melanoma is diagnosed in less than 1 percent of skin cancer cases — about 76,380 cases annually — but it’s responsible for the vast majority of skin cancer deaths, according to the Skin Cancer Foundation.

Skin cancer is also appearing in young people with greater frequency as tanning bed use and lack of sunblock use can have devastating long-term impact.

Dr. Michael O’Donoghue, a Michigan City dermatologist, said that the number of patients he treats has been on the rise.

“The number of skin cancers has been rising steadily nationwide,” O’Donoghue said. “For example, melanoma is most common in young adults between the ages of 25 and 29, and rates are rising in females between 15 and 29.”

“The thought is with women, specifically, is that it’s directly related to tanning beds,” O’Donoghue said. “Patients who require more biopsies are the younger ones and the ones who spend more time in the tanning booth have more biopsies as well.”

In December, the FDA proposed a rule for banning tanning bed use for people under 18, but it is still under consideration. It was in response to a 2013 government report that found 1.6 million minors using tanning beds annually.

O’Donoghue said longer life expectancy is having an impact on the number of cases, too.

“These are cancers that we wouldn’t have seen when people died, for example, at age 65,” O’Donoghue said. “Now it’s not uncommon to see 80-year-olds, 90-year-olds, even a few who are over 100.”

Doctors say there are other risk factors for skin cancers, including a history of multiple sunburns and fair skin that burns easily.

“For every blistering, peeling sunburn, our DNA repair mechanisms have to work overtime to fix our skin,” said Munster plastic surgeon Dr. Jason Petrungaro.

Preventative measures include using a sunblock with an SPF of at least 30, wearing hats and long-sleeved shirts while in the sun and avoiding the sun between the hours of 10 a.m. and 2 p.m. when the rays are strongest.

O’Donoghue said doing a monthly skin check at home is important to see if there are any spots that raise concern.

“Most people come in and we’re looking at either a new or changing lesion,” O’Donoghue said. “The most common visits are when somebody has found spot and it just doesn’t sit right with them.”

O’Donoghue said it’s important for doctors to look at your skin from head to toe, because cancers can occur anywhere on the body.

“We look at bottom of peoples feet and between toes because people can have melanoma there,” O’Donoghue said. “The most famous person who had a melanoma on the foot was Bob Marley. With African-Americans and people of Asian descent, it’s most common.”

Treatments include creams, “freezing” off spots with liquid nitrogen or using the Mohs procedure, which involves cutting of the cancerous spot until there is a perimeter of noncancerous tissue.

Petrungaro said his procedure varies on what part of the body he’s treating.

“If there’s a basal cell carcinoma on a patient’s back for example, it’s not cosmetically sensitive area, as it’s covered most of the time, so skin in those areas is looser and there’s more to play with,” said plastic surgeon Dr. Jason Petrungaro. “I do an elliptical skin incision and it leaves linear scar.”

If the carcinoma is on the face, it’s a different story.

“If the same spot is on the nose, cheek, eyelid, you want to remove the absolute smallest area you can with a margin,” he said. “Sometimes we’ll refer them to a dermatologist who specializes in Mohs surgery. They can cut out a three-dimensional piece of a lesion and the test each quadrant to see if they need to go further. It’s a lot more skin sparing.”