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See a spot, check a spot

Protecting your skin in the Pacific Northwest

The Rose City’s reputation for cloudy skies and gray days, coupled with our passion for outdoor activities, is a recipe for a serious health risk.

Skin cancer is the most common form of cancer — and the deadliest — in the United States and, despite the rain and clouds, Oregon has one of the highest rates of melanoma (one of three types of skin cancer) in the country. Portlanders average 25.1 cases of skin cancer per 100,000 people while the national average is 17.1.

The good news is that skin cancer, in many cases, can be treated or prevented entirely. While proper skin care is a year-round endeavor, as part of National Melanoma Awareness Month this May, the doctors and nurses at The Portland Clinic are joining colleagues across the country to raise awareness of the risks.

Why is melanoma so common in Oregon?

You might ask, “How is it possible that the states with the highest rates of skin cancer are places like Oregon, where we get so little sun?” While experts are currently not able to pinpoint a definitive answer, research suggests that several factors may be in play. Notably, Portlanders enjoy outdoor activities and spend a lot of time outside whether the forecast calls for clouds or full sun. Often, residents may not think to take the necessary steps to protect themselves from Mother Nature if it’s a cloudy day, even though damaging rays are still present. Other factors could include a higher usage of tanning beds, exposure to the sun during childhood and vacations to sunny climates – without proper protection.

Who is at risk?

While nearly anyone can get skin cancer based on their lifestyle, some groups are at a higher risk for the disease, including individuals who:

  • Have lightly pigmented skin
  • Have fair, red or blond hair
  • Have blue or green eyes
  • Burn easily
  • Have experienced five or more blistering sunburns (especially between the ages of 15 and 20)
  • Use tanning beds
  • Have had a high level of exposure to the sun
  • Live near the equator (higher level of sun exposure)
  • Are older than 65 years (due to UV exposure they’ve received over the course of their lives)
  • Have a family history of the disease
  • Have immune deficiencies
  • Have more than 50 moles, large moles or atypical (unusual) moles

Your chances increase significantly if you’ve had a previous melanoma or if you have had either basal cell carcinoma or squamous cell carcinoma, the two other varieties of skin cancer. Your risk for melanoma may also be higher if you have had other cancers, such as breast or thyroid cancer.

For people of color, melanoma is often diagnosed at later stages, when the disease is more advanced. This may be because many individuals are under the mistaken impression that people of color cannot get skin cancer, or have much less risk.

Even if you haven’t spent a lot of time in the sun, it is still possible to develop melanoma and other skin cancers.

Warning signs

One of the critical steps to successfully treating melanoma and other skin cancers is early detection.

To help increase awareness and make the melanoma warning signs memorable use this mnemonic: ABCDE.

A — Asymmetry: Is the mole asymmetrical? Imagine a line drawn across the center of the mole — if the two halves do not match then they are considered asymmetrical.

B — Border: Does the border or edge of the mole look uneven or irregular?

C — Color: Does the mole have several colors or shades of color within the mole?

D — Diameter: Does the mole have a diameter of one-quarter inch or more (diameter is the width across the mole).

E — Evolving: Has the mole changed in shape, size or color? Have you noticed any other changes such as bleeding, itching or puss coming from the mole?

If you answered yes to any of these questions, it could be an indication of skin cancer and the doctors and nurses at The Portland Clinic ask that you please seek medical attention as soon as possible.

Early detection crucial

Despite the rapid growth of skin cancer cases across the country, most skin cancer patients can expect an optimistic prognosis if the cancer is caught and treated early. The average five-year survival rate for individuals whose melanoma is detected and treated before it spreads to the lymph nodes is 98 percent. That figure drops dramatically if the cancer has spread to the lymph nodes or other organs, 62 and 18 percent, respectively.

That’s why the providers at The Portland Clinic say it’s a good idea to get screened by your dermatologist every year, even if you check your own skin regularly. Not all cancers are easy to spot on your own — in men, the most common site for melanoma is on the back; for women, it’s the back of the calves. Melanoma can also develop in the eye, underneath nails and inside the nose and mouth.

Dermatologists know what to look for, and use tools that make it easier to examine suspicious areas up close. If you have multiple moles, they can take photos to track them over time.

Can melanoma be prevented?

While some cases of melanoma are purely based on genetics, the vast majority have external factors. Preventive steps can go a long way toward helping prevent the disease from developing.

  • Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.
  • Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses.
  • Generously apply a broad-spectrum, water-resistant sunscreen with a sun protection factor (SPF) of at least 30 to all exposed skin. Broad-spectrum sunscreen provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating.
  • Use extra caution near water, snow and sand, as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
  • Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you’ve been in the sun, you may wish to use a sunless self-tanning product — but make sure to continue to use sunscreen as well.
  • Keep babies out of the sun. The skin of a newborn is incredibly vulnerable, so they should be kept out of the sun entirely. Babies over the age of six months need regular applications of sunscreen.

To be safe, our providers recommend that everyone perform a monthly self-examination of their skin to detect any changes in its appearance. This means looking over your entire body, including your back, scalp, palms, soles and between your toes. If you notice a mole different from others, or one that changes, itches or bleeds, even if it is smaller than a quarter-inch, you should make an appointment to see a doctor as soon as possible. The Skin Cancer Foundation has details on how to conduct a self-exam.

If you see a suspicious spot on your skin, or it’s time for a baseline exam, schedule an appointment with one of our dermatologists online.