Who is at Risk for Skin Cancer?
Anyone can get skin cancer. People with fair hair, light eyes and those who burn easily are at greatest risk. Skin cancer develops more commonly in people who spend a lot of time in the sun, had blistering sunburns and multiple moles (50 plus). Family history of skin cancer and multiple moles are important because they may indicate that a person has a predisposition to develop skin cancer. Atypical moles or moles present at birth (congenital) may become cancerous more often than acquired (typical) moles. An atypical mole may be larger in size with an irregular shape or uneven pigmentation. Both congenital and atypical moles should be evaluated.

Why Should We Protect Our Skin and Do Self-Exams?
Ultraviolet light from the sun damages skin cells causing visible (sunburn/tanning) or invisible injury (genetic damage). There are more than a million skin cancers diagnosed each year in the United States. One American dies every hour from this disease. Skin cancer may be easily detected with a thorough skin examination.

What to Look for When Doing An Examination
Normally, people have between 10 and 40 moles (nevi). They develop during childhood and adolescence. Moles are regularly shaped, small, brownish bumps or flat brown marks. They are usually found in sun-exposed areas but they may develop elsewhere. An actinic keratosis is a premalignant growth. It presents as a reddish, scaly patch on sun exposed skin. There are three common forms of skin cancer: basal cell, squamous cell and malignant melanoma. Basal cell and squamous cell skin cancers are slow growing. They usually develop on the head, forearms and hands. They may appear as a shiny bump, reddish patch or warty growth on the skin. They may bleed easily and crust over but do not heal. Melanoma is less common but more serious. It may begin within or near a mole anywhere on the body. Look for a change in color, shape, texture or size of the mole. A new mole in a person over 40 should always be evaluated. Because melanoma arises from the cells that give skin color, they are usually pigmented. Melanomas may be multicolored with shades of brown, black, red or blue. Look for the four warning signs of melanoma: asymmetry, border irregularities, color changes or diameter larger than an eraser head (6 mm). See a doctor if you have atypical or congenital moles, a wound that does not heal, a changing mole or a new mole if you are over 40.

How to do a Self Exam for Skin Cancer
Examine your body from head to toe. Use a full-length mirror in a well-lit room. Use a consistent approach examining from head to toe in a clockwise fashion. Use your fingers to feel for bumps or scaly patches on the scalp, ears, face, forearms and hands. A magnifying mirror may be helpful for examining the face. Use a hand mirror to examine the neck, buttocks and genitals. Check palms and soles. Look between the toes.

When to Protect Yourself from Ultraviolet Light
Limit exposure to the sun between 10 a.m. and 4 p.m. Wear protective clothing and eyewear. Sun protective clothing is commercially available for adults and children. Laundry additives that boost the sun protection factor (SPF) are now available. Wear a broad-spectrum sunscreen with a high SPF daily (in all seasons). Broad spectrum denotes protection from both ultraviolet A (tanning) and B (burning) rays. Sunscreens that contain avobenzone (Parsol® 1789, L'Oreal), micronized zinc oxide or titanium dioxide provide excellent protection against UVA damage.

For daily protection wear an SPF of 15. An SPF of 30 is best for prolonged sun exposures. Apply one ounce of sunscreen 20 minutes before sun exposure and reapply every 2 hours or after swimming. Indoor tanning causes pre.mature aging and sun damage. It does not protect against sunburn. Re.member that medications, oral contraceptives and cos.metics may cause photosensitivity (increased risk of sunburn). Consult with your health care professional before sun exposure to de.ter.mine if you are at increased risk for sunburn. Remember that an ounce of prevention (sunscreen) is worth a pound of cure.

For more information, see the Memorial Sloan Ketter.ing Cancer Center Web site at www.mskcc.org

Compiled by Maryellen Maguire-Eisen, MSN, RN, CS, OCN, a nurse practitioner with the South Shore Skin Cancer Foundation, Plymouth, MA; chairperson, Skin Cancer Workshop-Dermatology Nurses Association; and liaison to the Environmental Council of the American Academy of Dermatology.