Overexposure to the sun and UV rays is rarely obvious at the time, -- and on many occasions, probably quite unintentional. However repeated exposure has rather more adverse long-term implications for our bodies and our health.

We’re all well aware of the more obvious and painful symptoms of sunburn including hot, red, tender skin – which in the case of a more heavy burn can also include blistering, peeling and dehydration.

The damage that occurs beneath the skin as a result of sunburn is considerably ‘less obvious’ at the time of exposure, and may in fact take years to produce symptoms visible to the naked eye.

The fact that damage caused to skin cells during sunburn can not only accelerate the aging process, but also increase the risk of cataracts and skin cancer, should certainly demand our attention.

When faced with the potential risk of having to treat more than just the temporary symptoms and pain of sunburn, doesn’t it make more sense to avoid the risk in the first place?

Seek prevention rather than cure!

So before you venture out into the sun again, remember these important tips to protect yourself from overexposure of UV rays and sunburn, and its associated risks:

1. Wear protective clothing, including a long-sleeve shirt and a hat. Consider the ‘additional’ protection of an umbrella or shade where appropriate.

2. Avoid sun exposure between 10 am and 3 pm if at all possible.

3. Remember that UV rays are present even on cloudy days.

4. Remember that sunlight is strongly reflected from sand, snow, ice, water and concrete, which can intensify your direct sunlight exposure.

5. Apply sunscreen containing a sun protection factor (SPF) of at least 15, at least 15 minutes before going out into the sun.

6. Reapply sunscreen at regular intervals while out in the sun, especially if you are perspiring heavily or swimming.

7. Remember that UV overexposure is not limited to ‘sun exposure’. Sunburn can also occur as a result of UV exposure from other sources including tanning beds/lamps, welding arcs etc.

Prevention is a far better treatment than cure. In the event however, that you discover any unusual moles or growths on your skin – (particularly if they’re irregular in shape, bleed, itch, or appear to be changing) - consult your healthcare provider as soon as possible.

When it comes to overexposure of UV rays and sunburn that result in skin cancer, early detection will certainly assist in providing you with more effective treatment. But considering your options beforehand – what will provide the best outcome for your health? Prevention or Cure? I know which one I’d choose...!



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The human body benefits from sun exposure. And a little bit of tan protects you from the sun. Right? Wrong!

The body does indeed benefit from sun exposure. But a little bit of tan does not necessarily protect you from the sun. Let’s see why.

The sun’s rays are a major source of vitamin D and help the body’s systems acquire much needed calcium for building healthy bones. However, most people don’t need to spend large amounts of time exposed to the sun in order to get their required amount of vitamin D.

In fact, the body’s health can actually suffer negative effects when it’s exposed too long to the sun’s rays, especially if it’s unprotected. Results can vary from skin and eye damage to immune system suppression and ultimately cancer, even for the young.

So let’s look at the basic facts about sun exposure.

There are three kinds of invisible ultraviolet (UV) rays in the sun that reaches earth: UVA, UVB, and UVC. When these rays come in contact with our skin, affects of UVA and UVB can be - tans, burns and other reactions (e.g. like acne and cancer).

It’s also notable that the effects of all UV rays are not the same. Depending upon the season, time of day and place on the planet in relation to the sun - (i.e. your altitude and latitude), the rays’ intensities vary. For example, during summertime, UV rays are at their strongest. Between 10 a.m. and 4 p.m., the rays are strongest. And close to the equator and at high altitudes (where air and cloud cover are less, resulting in increased harmful penetration of UV rays into the environment), the rays are also strongest.

In order to protect ourselves from the harmful UV rays, let’s look at the skin’s first defense - melanin.

Melanin is a chemical present in a variety of colors and concentrations in most people's skin that helps with defense from the sun. Melanin reacts with UV rays and absorbs them. Or rather, to be more specific, the rays act upon melanin, causing the melanin to spread out or grow, increasing its presence in response to the sun’s exposure. The result? A ‘sun tan’. The darker the skin color, the more melanin the skin has for protection. And ‘tanning’ for darker color is included here; ‘color’ does not have to refer to just the original skin color.

A word of caution…

Tanning may look great on the surface, - but the amount and length of time a person is exposed to the sun, determines the amount of possible damage. It also determines the future risk of damage that’s likely.

For example, people who are exposed to the sun in huge doses like ship crews, field workers and beach surfers, are at higher risks for skin damage than indoor workers. What happens is that when the amount of UV exposure is greater than what the skin's melanin can handle, sunburn can result. And those with lighter, fairer skin, who have less melanin, absorb less UV, suffering less protection.

Since research has shown that UV damage from the sun is the main cause of skin cancer, (with as high as 20% of some populations developing skin cancer during their lifetime), we need to take a proactive approach in relation to sun exposure to avoid harmful skin damage.

As we say colloquially here in Australia - “Slip, Slop, Slap”. (I.e. ‘Slip’ on a shirt, ‘Slop’ on a hat, ‘Slap’ on a sunscreen). Look after the skin you’ve got, because you’re the one who will be living with it!



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The process of detecting skin cancer, the most common form of cancer in the United States, can be practiced with a monthly self examination combined with a yearly visit to your doctor. Early detection is key because, if diagnosed soon enough, skin cancer is almost always curable.

There are three main types of skin cancer, all of which are visible if you know what to look for. Melanoma, one of the main forms of skin cancer, is the deadliest. This disease is the most difficult to stop after it has spread throughout the body, which is why early detection and treatment are crucial. Skin cancer, of any kind, can usually be treated with success in it’s early stages.


As individuals, everyone has freckles, birthmarks and moles. These are a part of you and you are used to seeing them, but you may not notice slight changes right away and that’s what you need to be watching for. Any change in a mole’s shape, edges, size or color should be checked by a physician. If a mole becomes larger than that of a pencil eraser or if it’s color is multiple shades of brown rather than a solid color, these are both potential warning signs of skin cancer. A mole’s border should be well defined and, if that is no longer the case, notify your doctor. In addition, any sore that will not heal or a mole that grows larger at a rapid speed should be tested immediately.

Deciding to seek medical attention is difficult. For this reason, it’s best to choose a physician that you are comfortable with, such as a family doctor. He/she can examine your skin and refer you to a dermatologist if needed. The presence of skin cancer is determined by removing all, or part, of the questionable area and testing it with a microscope. Surgery is often utilized in the removal of ski cancer and, if done in the early stages, can be a very quick process. There will likely be a scar, but the physician may be able to completely remove all cancerous cells with only a very small incision.

If the cancer has spread, or is very large in the defined area, additional surgery may be required. In that case, chemotherapy or radiation treatments may be ordered to ensure the cancer is completely removed. Your physician will be able to answer all questions that you may have and should do so without reserve. When meeting with a doctor, ask for an explanation of all treatment options, including their likelihood for success in your particular case. Deciding to seek medical attention is a big step and one that a patient must be mentally prepared for.

This article should not be construed as professional medical advice. If you, or someone that you know, is concerned about the possibility of cancer, you should seek medical attention immediately. A medical doctor can discuss various options, prevention and treatment possibilities should the presence of cancer be detected. A series of tests may be conducted in order to confirm, or rule out, any such diagnosis and can only be done by a medical doctor.



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Water, sunlight, and warmth are essential to life. People require frequent exposure to natural sunlight in order to produce Vitamin D, an essential vitamin needed for growth, and to develop healthy bones and teeth. In recent decades, however, sunlight has also been implicated as a cause of some types of skin cancer.

While both types of ultraviolet rays are associated with skin cancer, some skin cancers are caused by genetic factors. In fact, recent research has indicated that cell mutation and abnormal genes probably play a much more significant role in the development of skin cancer than was originally believed.

Although anyone may develop skin cancer, some persons are at higher risk than others are. Those persons who should be concerned most about sunlight exposure include individuals with fair skin, those who live in areas that are close to the equator, and those who spend a significant amount of time outside.

Three primary kinds of skin cancer have been identified. Each of these is associated with a particular skin cell. The first of these is called basal cell carcinoma, and begins in the skin's basal cells. Nine-tenths of all individuals diagnosed with skin cancer in the United States have this kind. Since it grows slowly and usually does not spread, it is considered to be the least serious variety with which a person can be diagnosed.

The second type is more serious than basal cell carcinoma, but is also a nonmelanoma. Squamous cell cancer affects keratinocyte, cells in the outer layer, or epidermis, of the skin. This type does spread in approximately three percent of all sufferers, but usually spreads slowly. Therefore, it can often be diagnosed and surgically removed before it affects other body organs.

A few other types of nonmelanoma skin cancer do exist, but they are extremely rare. Less than one person in 100 who develops a nonmelanoma cancer will develop one of these kinds. These cancers include Kaposi's sarcoma, Merkel cell carcinoma, and T cell lymphoma of the skin.

The final type is most serious. Melanoma is a cancer that originates in melanocytes, the cells responsible for producing melanin. The amount of melanin present in skin tissue determines the lightness or darkness of the skin's color. Malignant melanoma can spread rapidly and invade vital organs and other body tissues. Prompt diagnosis and treatment is crucial to a successful cure.

At the corporation where I provide healthcare (massage) services to the employees, they have wellness weeks several times a year. One of the things they offer is free skin cancer screenings. However, they are not thorough enough to be confident you are in the clear.

A proper body check done by a dermatologist in the privacy of the office should include EVERYWHERE. This includes the scalp, the bottoms of the feet and between the toes and also your private areas.

What I want to bring to your attention in this article is your feet. More specifically, the bottoms of your feet.

What would normally look like an ordinary mole (smaller than 6mm, even color and shape, flat) on another part of the body like your arm, face, or torso, can be something like melanoma if on the soul of your foot.

I've recently had three clients in the last week have possible melanomas on their feet. One client did have them. In fact, she was the one who brought this to my attention. Here I am, a healthcare professional and in 11 years, this is something I just learned. And believe me, I've seen a lot of feet in those 11 years. Needless to say, I went and checked the bottoms of my feet that day.

Remember, I am not saying that a mole or freckle on the bottom of your foot is cancer, but it's not normal for them to be there (verified by my dermatologist) so if you have any, I would HIGHLY recommend getting it checked out very soon by a dermatologist. Melanomas are the fast growing kind of skin cancer you DON'T want to get as they spread quickly and can be fatal.

One of the most common places for occurrences of skin cancer is on the nose. Because the nose is often exposed to the sun, it is constantly experiencing the bulk of the atmosphere's ultraviolet rays, making it a prime target for skin cancer. This is an issue for many, not only for health reason, but as the nose's prominent placement on the face makes it a rather unsightly place for the sores associated with skin cancer. And, with other cancers it is always important to seek treatment for nose skin cancer, as it may spread throughout the body.

Like any other cancer, the sooner you catch and treat nose skin cancer, the better off you will be. Early detection, as always, is the key. With nose skin cancer, it is best to seek surgery quickly, in order to remove the cancer before it increases in size, becoming larger and more noticeable. If you think you may be developing the warning signs of this, it is important to go see a doctor immediately -- either your general physician, or a dermatologist. Your doctor will be able to answer any questions, address any fears and walk you through the available treatment options. So, do not let fear keep you from seeking immediate help.

Often, it is treated either by blasting with liquid nitrogen or cutting with a hot knife. Only in the case of the most extreme or persistent nose skin cancers, including malignant melanoma or cancers of a larger size, will surgery be necessary. But even those procedures are relatively quick and easy. Just remember, if you have this, no matter which type of cancer it is, whether serious or not, it is most likely that your doctor will opt for the least invasive method possible to treat it and treat it correctly, in order to lessen the chance of the cancer's reemergence.

Skin cancers, including melanoma, basal cell cancer, and squamous cell cancer, are the most common of all cancers. New research suggests that diet may play a role in the development of at least one kind of skin cancer, squamous cell cancer. Each year, between 200,000 and 300,000 people in the United States are diagnosed with this cancer, and the incidence rate is rising. Researchers in Australia studied more than 1,000 adults over an 11-year period to see which factors were associated with skin cancer. Even when factors like sun exposure and skin color were taken into account, people who ate a lot of red or processed meat and high-fat dairy products had a greater risk of developing squamous cell cancer. This was especially true for people who had already had skin cancer. Those eating more fruits, vegetables, and whole grains and having a lower fat diet had a 54 percent lower risk of developing squamous cell cancer. Of course, the most important way to reduce risk of skin cancer is to avoid excess sun exposure and to use sunscreen. Eating generous amounts of fruits, vegetables, and whole grains can also reduce your risk.

Ibiebele TI, van der Pols JC, Hughes MC, et al. 2007. Dietary pattern in association with squamous cell carcinoma of the skin: a prospective study. Am J Clin Nutr 85:1401-1408.

Angiogenesis is the formation of new capillary blood vessels from existing vasculature. Cancers are dependent upon angiogenesis for their growth. Inhibition of angiogenesis can slow, halt, or regress tumors. Angiogenesis inhibition is now validated for the treatment of cancer using a variety of approved biologic, small molecule, multitargeting, and immunomodulatory agents. In the skin, strategies to inhibit angiogenesis-signaling pathways include blockade of COX-2, m-TOR, sonic hedgehog, growth factor receptor activation, and activation of Toll-like receptors (TLR). The agent with the most clinical experience as a topical antiangiogenic therapy is imiquimod. Imiquimod is a TLR agonist, with immune response modifying properties that also stimulates antiangiogenic cytokines, downregulates the expression of proangiogenic factors, upregulates the expression of endogenous inhibitors, and induces endothelial cell apoptosis. By titrating its dosing for angiogenesis inhibitory activity and not for gross inflammation, imiquimod can be applied in an efficacious and well-tolerated fashion to treat skin cancer.

Judah Folkman's pioneering work in tumor angiogenesis beginning in the 1970s established the field of angiogenesis research. (1) Since then, an enormous body of angiogenesis research has elucidated the growth control mechanisms of the microcirculation, yielding new insights into the critical role of new blood vessel growth in both physiological and pathological conditions.

All solid tumors are dependent upon angiogenesis to grow beyond a few millimeters in diameter. (3) Antiangiogenic therapy for cancer stems from a large body of experimental evidence showing that inhibition of angiogenesis can slow, halt, or regress tumors. Unlike cytotoxic chemotherapy and ionizing radiation, antiangiogenic therapy does not directly kill tumor cells but instead targets the vasculature supporting tumor growth, resulting in a cytostatic effect. This approach represents a paradigm shift for cancer treatment. Clinical benefits of antiangiogenic therapy include prolonged survival, disease stabilization, and improved quality of life, and can often be achieved with less debilitating toxicities than conventional therapies.

Angiogenesis in the Skin

Angiogenesis, the formation of new capillary blood vessels from the existing vasculature, is a tightly regulated physiological process. Under normal circumstances, vascular endothelial cells comprising blood vessels are quiescent and have one of the lowest mitotic rates in the body. (3) This non-proliferating state is governed by the balancing effects of endogenous stimulators and inhibitors of angiogenesis present in healthy tissue. Positive regulators of angiogenesis (proangiogenenic) include fibroblast growth factors (FGFs), vascular endothelial growth factor (VEGF; sometimes called vascular permeability factor), platelet-derived growth factor (PDGF), interleukin-8 (IL-8), and more than 30 other proteins. Endogenous angiogenesis inhibitors include endostatin, tumstatin, tissue inhibitors of matrix metalloproteinases (TIMPs), interferons (IFN-[alpha], -[beta], -[gamma]), interleukins (IL-10, IL-12, IL-18), and thrombospondins (TSP-1, TSP-2), among other factors.

Pathological angiogenesis, typically defined as aberrant or uncontrolled angiogenesis underlying a disease, occurs in a number of skin conditions. The epidermis is an avascular tissue layer separated from underlying dermal capillaries by the basement membrane. Viable epidermal cells are located within 100 to 150 [micro]m from vessels, the diffusion distance of oxygen. Beyond this zone, epidermal cells undergo keratinization and ultimately die and slough. Tumor cells in benign and malignant skin conditions are also subject to growth restriction defined by limits of oxygen diffusion. Unlike normal tissues, however, growing tumors release high concentrations of proangiogenic growth factors that induce capillary growth and override this control mechanism. Tumors can also upregulate growth factor production from host stroma, furthering the angiogenic process.

Skin Cancers

Like all solid malignancies, cancers occurring in skin are highly angiogenic. Vascular tumors of the skin, such as Kaposi's sarcoma, hemangioma of infancy, pyogenic granuloma, and angiosarcoma, are composed of proliferating cells of endothelial origin and are also angiogenesis-dependent. (4,5) Hemangiomas were the first human tumors to be successfully treated with antiangiogenic therapy using interferon-[beta]-2a, based on the recognition that they overexpress angiogenesis stimulators (FGF-2, VEGF) during the proliferative phase. (6,7) Conversely, during their involutional phase, endogenous angiogenesis inhibitors (tissue inhibitor of metalloproteinase-1 [TIMP-1], interferon-[beta] [IFN-[beta]]) are upregulated. (8)

Benign growths, such as warts, are also angiogenic in nature. (9-12) Increasing vascularity is observed between HPV-negative and HPV-positive warts; pinpoint hemorrhagic capillaries are a gross manifestation of the neovascularization that accompany wart growth and persistence. (9) Further, it has been shown that other HPV-associated lesions exhibit increased microvessel density during the transformation of intraepithelial neoplasia to anal carcinoma and from cervical dysplasia to cervical carcinoma.

In recent years medical healthcare professionals have made strides to raise awareness about skin cancer. Despite these efforts, the false notion that non-Caucasian individuals are exempt from this disease is still espoused by many physicians and patients. Primarily as a direct result of delayed diagnosis, these populations often have a poor prognosis when afflicted with skin cancer. Nearly 1 in every 10 of the 3141 counties in the US has a minority population greater than 5:0 percent.(1) This demographic and coupled with the fact that skin cancer is generally a curable disease make it impossible to ignore the higher mortality rates seen in people of color who have a cutaneous malignancy. Dermatologists should become acquainted with the epidemiology of skin cancer in skins of color, so these patients receive the educational information which promotes understanding and prevention of this disease.

Along with their respective colleagues, Drs. Rebat Haider and Hugh Gloster have published extensively on this topic. Below is largely a condensed review of their findings.

Not All Skin is Created Equal

Literature dating back to 1957 provides evidence that, as it pertains to the histological makeup of the integument, not all skin is created equal.(2) Differences in both the size and distribution of epidermal melanosomes determine an individual's vulnerability towards ultraviolet (UV) light.(2-5) Smaller, less dense, grouped melanosomes, which are more prevalent in the keratinocytes of Caucasians, are less effective at blocking UV light, In contrast, larger, denser, and less aggregated melanosomes found in the epidermis of darker skinned people afford more protection against the deleterious and carcinogenic effects of sunlight. It follows that when people of color do get squamous cell carcinomas (SCCs) or malignant melanomas (MMs), incidents usually occur in sun-protected areas, suggesting an etiology other than UV radiation. The exception to this rule is in the case of basal cell carcinoma (BCC), which arises primarily on sun-exposed skin in all ethnic groups.(6), (7)

Nonmelanoma Skin Cancer

The Americas

Basal cell carcinoma is the most common skin cancer amongst Caucasian and Hispanic populations. It is the second most frequently occurring cutaneous malignancy in African Americans.(2), (7), (8) The incidence of BCC per 100 000 people amongst various North American ethnic groups is as follows: Caucasians in Kauai, Hawaii (262); Caucasian men (250); Caucasian women (212); New Mexican Hispanic men (171); New Mexican Hispanic women (113); Southeastern Arizona Hispanic men (91); Southeastern Arizona Hispanic women (50); African American men (1); African American women (2)(7) (Figure I).

In distinct contrast to SCC and MM, UV light seems to be inextricably linked to the development of BCC in all skin types despite pigmentation, and does not result in increased mortality.(6), (7) Subsequently, at presentation, non-Caucasian patients with BCCs share a similar phenotype with their Caucasian counterparts: most are persons 50 years old or greater with a lesion on photo-exposed skin.(6), (7) A study at Howard University revealed that BCCs arising in brown skin occur on the head and neck at a rate of 89%.(9) The correlation between UV light and BCCs in darker skin types also explains the relatively higher incidence of this malignancy amongst darker skinned populations living in warmer climates, such as Hispanics residing in New Mexico and Arizona.(7), (10) Both African Americans and Hispanics present with BCCs of many histological subtypes, although the mor-pheaform variant is particularly uncommon, especially in African Americans(6) Pigmentation is present in greater than 50% of BCCs found in skins of color versus 6% in Caucasian skin.(7) In a study by Bigler et al, 30 BCC biopsy specimens from patients with Hispanic surnames were compared with 30 BCC biopsy specimens from patients with Northern European surnames. Results revealed that pigmented BCCs were twice as common in Hispanic patients.(6), (11) Another review indicated that when Hispanic patients do get BCCs, they have a propensity to have multiple lesions either at the time of presentation or in the ensuing years.(6) These additional tumors occurred as soon as I year, and long as 10 years after the initial diagnosis.(6) In addition to the sun, other preexisting conditions can increase minorities' predisposition for developing BCC: previous radiation therapy, albinism, trauma, chronic scarring processes, arsenic exposure, nevus sebaceous, and genodermatoses such as basal cell nevus syndrome and xeroderma pigmentosum.(6), (7), (9)

Squamous cell carcinoma is the most common skin cancer amongst African Americans.(6), (7), (9), (12) The incidence of SCC per 100 000 population is Caucasian men (195), Caucasian women (84), Caucasians in Kauai, Hawaii (118), New Mexican Hispanics (21), Southeastern Arizona Hispanics (23), and African Americans (3)(7) (Figure 2). Squamous cell carcinoma occurs on the head and neck of darker skinned, non-Caucasian people approximately 35% of the time according to one review.(13) This supports the premise that when it comes to populations with brown skin, UV radiation does not seem to play a formidable role in SCC carcinogenesis. A retrospective chart review performed over a 5-year period in Atlanta, Ga helped to further elucidate the clinical nature of and predisposing factors for these seemingly unique SCCs occurring in African Americans.(14) Squamous cell carcinoma was identified in 35 patients. Although some of the cancers did occur on the photo-exposed sires of the head, neck, and arms; the overwhelming majority were found on the photo-protected skin of the legs and anogenital region. Interestingly, amongst the African American patients, only males were found to have SCC in the anogenital region, and only females (age range: 32-101 years) were found to have SCC on their legs. These cohorts of African American females with SCC of the legs were found to have commonalities as it pertained to the presentation of their disease. More specifically, the SCCs found amongst these women were largely accompanied by perilesional mottled dyspigmentation, halt of the lesions were hyperpigmented, and many were accompanied by smaller hyperkeratotic plaques thought to appear clinically similar to seborrheic keratosis, verruca vulgaris, and actinic keratosis. Clinicians should thus be aware of this constellation of findings in African American patients, as they may herald a cutaneous malignancy.

Skin Cancer, edited by Dr. Keyvan Nouri, is an excellent reference for dermatologists and other specialists. The first 35 chapters include a comprehensive review of cancers and tumors of the skin, hair, and nails. This section begins with a thorough description of normal skin, aging skin, and the epidemiology and etiology of skin cancer. The next 30 chapters present an in depth discussion of various cancers including outstanding clinical and histopathologic corrections. The clinical photographs of the dermatological manifestations of internal malignancies are most impressive. Also included in each chapter is a differential diagnosis and a brief review of treatment options and prognoses.

The second section of the textbook addresses the techniques for evaluation, including biopsies, dermoscopies, and sentinel lymph node biopsies. This is followed by a comprehensive as-sessment of treatment options such as Mohs surgery, cryosurgery, photodynamic therapy, radiation, topical therapy, and vaccines. Skin cancer prevention and sunscreens are also reviewed.

The third and last section includes related issues such as photography, economic and medical legal issues, psychosocial aspects, and public awareness of skin cancer.

Each chapter of the book has a well delineated overview and summary. This contributes to the textbook being user friendly as a reference and easily readable. Each of the 55 chapters is well referenced. The authors are all respected experts in their field of specialty. I would like to compliment Dr. Nouri on the high quality of the photographs. These color illustrations enhance the value of this textbook to all specialties as a comprehensive reference on skin cancer.