COMMENTARY
Prevention, detection key skin-cancer issues

By Dr. John D. Boyer
Special to The Advertiser

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Skin cancer facts Skin cancer will affect one in four Americans. 1.3 million cases will be diagnosed this year. Skin cancers outnumber all other major cancers combined. 85 percent of skin cancers occur on the head and neck. Melanoma rates in Caucasian males in Hawai'i are three times the national average. Check yourself Get free skin cancer screenings at Kailua, Manoa, Mililani, Mo'ili'ili, Pali and Pearlridge and Longs Drugs stores on O'ahu Wednesday from 10 a.m. to noon. Call the American Cancer Society for details: 595-7544.

Minimize sun exposure

Prevention of skin cancer focuses on minimizing sun exposure. While past sun damage to the skin may not be easily correctable, evidence exists that sun avoidance and protection with sunscreens can minimize further damage and new mutations.

Sunscreens also have been shown in studies to preserve the skin's immune surveillance system that could eliminate skin cancers before they ever become apparent.

The American Academy of Dermatology recommends avoiding sun exposure from 10 a.m. to 4 p.m., wearing a broad-spectrum sunscreen (SPF 30 UVA & UVB), applying sunscreen frequently and generously, wearing protective clothing, including hats with brims four inches wide, and protecting children.

Early detection

Early detection is essential. If skin cancers are detected early and when they are small, cure can be maximized and disfigurement minimized. For example, if treated early, the majority of melanomas, the most deadly skin cancers, can be cured with a simple outpatient surgery.

Melanomas detected in advanced stages may have survivals below 50 percent. It is therefore recommended that people examine their skins every month and see a dermatologist for any new or changing growth. Seventy percent of patients with melanoma reported a new or changing lesion.

There are effective treatments for skin cancer. Mohs micrographic surgery, an outpatient surgical procedure, is the most effective and innovative treatment for skin cancer. Cure rates of up to 99 percent are achieved because lesions are excised, processed and precisely mapped using the Mohs technique.

The Mohs surgeon then analyzes the specimen under the microscope to verify that all the cancer has been removed. Mohs surgery maximizes cure rate and spares healthy tissue. Mohs surgeons and dermatologists are listed by the American College of Mohs Micrographic Surgery at www.mohscollege.org or American Academy of Dermatology at www.aad.org.

Other routine surgical treatments have excellent reported cure rates of up to 90 percent.

A new treatment

In addition, Aldara, a new FDA-approved topical cream chemotherapy, has reported clearance rates of 80 percent for select cancers. Skin- cancer treatment will vary depending on the cancer type, size, location and prior recurrence.

Dr. John D. Boyer is board-certified by the American Academy of Dermatology and is a fellow of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. He is an associate professor at the University of Hawai'i School of Medicine and is in private practice at The Queen's Medical Center.