Skin cancer is the leading cancer diagnosed in the United States, with more than 1 million cases reported annually, according to the Skin Cancer Foundation Web site, skincancer.org. The Web site also says one in five Americans will be diagnosed at some point in his or her lifetime.
And Arizona leads the nation in diagnosed cases, says Karla Horton, a physician's assistant at Arizona Dermatology in Paradise Valley.
"The only [part of the world] that beats us as far as skin cancer is Australia," Horton says.
For many ASU students, the damage may already be done. Horton says 80 percent of skin damage occurs before people reach age 20 — meaning that for most of the student body, the time for preventative skin care is now.
But for ASU students Leigh White and Stephanie Azevedo, skin cancer is a threat that's all too real. They've both encountered the most dangerous skin cancer, melanoma, before college graduation.
"My skin was looking different than before"
One and a half years ago, Leigh White, a tourism management and development junior, was diagnosed with melanoma on the left side of her stomach.
White says she went to see a doctor when the skin there looked different.
"The doctors took some of my skin and did a few tests on it," White says. "They found out it was cancerous from the results."
White's surgery to remove the cancer was planned shortly after the diagnosis, she says.
Horton says there are three different types of skin cancer: melanoma, squamous cell and basal cell. Squamous and basal cell skin cancers are purely sun-induced, Horton says, while melanoma is a mixture of sun damage and genetics.
Depending on the type of skin cancer and the severity of each case, different courses of action to remove the cancer may be taken, except with melanoma.
"Melanoma or an abnormal mole has to be cut out by surgical incision," Horton says.
White says she took the diagnosis in stride.
"I asked the doctors what the steps were and dealt with it from there," White says. "I tried to not overreact and kept cool the whole time."
The surgery to remove White's melanoma took more than four hours, she says. The doctors numbed the left side of her body with a local anesthetic and performed the surgery, leaving White with a nearly 4-inch scar as a parting gift.
White says her skincare routines have not changed much since the surgery. She says she feels it is hard for her to change her habits, since she is from Orange County, Calif, and loves going to the beach to "lay out" in the sun.
"I have been a little smarter on how long I lay out and how often," White says.
Because of her mostly unchanged habits, White says she doesn't push good skincare on others.
"I'm not one to preach to others when I myself don't follow the rules," she says. "If people ask me what happened, I explain to them what happened and how it has changed me, but I try to never preach to others about it."
"My mom used to tan, like everyone does here"
Biochemistry junior Stephanie Azevedo was first impacted by skin cancer when her mother was diagnosed.
"I was sort of in shock, like everyone else in my family," Azevedo says. "It's not something that you anticipate happening to you. It really makes you sort of contemplate the value of your life and everything that's going on."
Azevedo says she and her mother went to a dermatologist seven years ago to have a darkened mole on her mother's calf inspected.
"My mom used to tan, like everyone does here," Azevedo says. "The doctor said, 'Oh, it just got tan like the rest of you.' Then a few months later, she went to a different dermatologist and the dermatologist said, 'Let's go ahead and take that off [to biopsy it].'"
Azevedo says a few days later, at her own dermatologist appointment, the nurse told them the dermatologist wanted to talk to her mother.
"We thought that she [the dermatologist] was going to talk about something, you know, about my appointment," Azevedo says.
However, when the dermatologist re-entered the examination room, the news was not for Stephanie, Azevedo says. The mole that Stephanie's mother had biopsied turned out to be cancerous and required surgery.
The surgeons removed a large area of flesh from the back of her mother's calf: all the way through the skin, past the fat and down to the first layer of muscle to ensure the cancer was gone, Azevedo says.
"It looked just like you took an ice cream scoop straight out of the back of her leg," she says. "Just about that size."
The experience was nerve-wracking for the entire family, Azevedo says. But her mother's cancer also made the family become closer and realize what was important to each of the members, she adds.
Unlike White, Azevedo says her family did become preachers of good sun habits.
"We are definitely a sun-aware family. I wear sunscreen every day, no matter what I'm doing — even just to walk to the mailbox and back," Azevedo says.
She says she often tells her friends to avoid prolonged sun exposure when the sun is highest in the sky, between 10 a.m. and 4 p.m. Azevedo and her mother always tell people to wear sunscreen.
"When my mom first was diagnosed, she would tell everyone she saw that if they had anything on their skin, they needed to go have it checked out at the doctor," Azevedo says.
When the Azevedo family goes to the pool in the summer now, Stephanie says they wear and reapply sunscreen and wear "rashguard" shirts with sun protection in them. She says when they were younger, the family would go to the pool and apply sunscreen, but they often neglected to reapply throughout the course of the day.
"To this day, I always, always tell people not to go tanning and to wear sunscreen, because the choices that you make now are going to have much larger consequences later on in your life," Azevedo says.
"But melanoma can go anywhere"
Horton says the process for checking for cancer is simple: a dermatologist or physician's assistant asks patients to strip down to their underwear and then does a head-to-toe check of the body for moles and signs of cancer.
The face, arms, neck, chest and back are the most likely places for sun-induced-only types of cancer, Horton says.
"But melanoma can go anywhere," Horton says. "So we usually have them undress down to their underwear and then we take a really good look everywhere to make sure that nothing's going on that we're concerned about."
If there is a spot that the doctor or physician's assistant wishes to look further into, they will perform a biopsy, Horton says. The spot is numbed with a local anesthetic similar to what a dentist uses during oral surgery and a piece of the mole in question is removed.
"We take a fancy little razorblade and cut the top part off," Horton says. "Then we use either medicine or electricity to stop the bleeding, and you'll have a scab for about a week or so. And then we send [the biopsied skin] in and they take a look at it under a microscope to tell us what's going on."
If a spot is determined to be cancerous, removal depends on the type and severity of the cancer. Horton says for some cases of squamous and basal cell skin cancers, removal can be as easy as a topical medication, whereas the only known cure for melanoma is surgical removal.
A 2006 study by the New York Presbyterian Hospital concluded that melanoma is the most common type of cancer in women ages 25 to 29. Horton says there are many factors that play into that study, including the knowledge that squamous and basal cell cancers often take many years to develop and surface, that women tend to tan for vanity more often than men do, and that there is a genetic link involved with melanoma.
"If you have a first-degree relative, meaning a parent, a sibling or a child that has abnormal moles or melanoma, then you're at a 50 percent increased risk for developing it yourself," Horton says. "From our standpoint in the medical community, they haven't really been able to completely understand what that link [between women and melanoma] is and why that's the case."
"When people come in to tan, they feel happy"
Heather Bailey, 25-year-old manager of Sunchain Tanning on Baseline and Rural roads, is an advocate of using tanning beds.
Bailey says some of the benefits of tanning include vitamin D production — the tanning beds use Ultraviolet A (UVA) light like the sun, which is proven to spur Vitamin D production. The light also helps release beta-endorphins, which produce "happy feelings," she says.
"So when people come in to tan, they feel happy with themselves, they feel good about themselves," Bailey says.
Bailey also says tanning indoors provides a more controlled environment and allows for less chance of getting burned, which she says helps prevent skin cancer development.
Horton says the UVA rays used in tanning beds are actually more dangerous.
"UVA is actually what's going to increase your risk of skin cancer. That actually causes malformations or abnormalities within the skin cells themselves," Horton says. "And then those abnormalities reproduce and that becomes a cancer."
The other type of ultraviolet ray, UVB, is linked to sunburns, Horton says. However, they are not known to increase risk for causing skin cells to become cancerous.
UVA rays are also detrimental to skin because they age skin prematurely, Horton says.
"So wrinkles and all that stuff that females obviously don't want get worse with sun exposure as well," Horton says.
Bailey says that's why her tanning salon encourages customers to purchase and use a lotion.
"A lot of the lotions we carry are anti-aging and firming lotions," Bailey says. "Basically, when you're not using a tanning lotion in the beds, it's starting the premature aging factor. So with the lotions that we carry, it's helping prevent that."
However, the lotions do not contain sunscreen, Bailey says.
"We do have a lot of customers ask if they want to take their lotions and use them outside, but we just recommend wearing an SPF with the lotions," Bailey says. "But no, the lotions specifically do not carry an SPF."
Horton says the medical community believes tanning increases a person's chances of developing skin cancer by 200 times the normal risk.
"You have to take into consideration, too, that people that go tanning are doing it for the intention of becoming tan," Horton says. "So they're not wearing sunscreen and they're not protecting themselves against the more serious rays."
Horton says college students need to become aware of good skincare habits and start taking care of themselves now, while they're young and healthy.
"Protect yourselves because 20, 30, 40 years from now, we're going to start seeing you guys in here for skin cancer," she says.
