Skin Cancer Explodes
Posted Tue, Dec 21, 2010

3,5000,000! That is 3,500,000 new cases of skin cancer in the US in 2011.While the numbers are discouraging, the population, especially young people, continue to ignore warnings of unhealthy sun exposure and more importantly dangerous exposure to UVA and UVB radiation in tanning salons. This number also belies 40,000 new cases of malignant melanoma and more than 8,000 deaths from skin cancer in 2011.
There are many consequences of the escalation in incidence of skin cancer. Most obvious is the injury to the skin and subsequent necessity for surgery. Another is the huge cost incurred for diagnosing and treating skin cancer. Lastly there are the cottage industries which have arisen from inappropriate fears of the public. Many physicians have found a lucrative income in performing biopsies and removal of lesions that are not and have little chance of being malignant. Another, or the same? set of physicians make a handsome living removing lesions they “suspect” may become malignant in patients who have already had skin cancer. Many patients return to their physicians month after month and year after year for needless procedures and the track records of these physicians is somewhere between elected officials and the prognostic accuracy of weathermen. The cosmeceutical industry has reaped huge rewards for promoting herbs, vitamins, and proteins for the prevention of skin cancer. None of them, except for vitamin A, have demonstrated conclusive evidence of efficacy.
It is easy for me to become discouraged when I review the indifference of the public to this dynamic problem and the readiness for the medical and cosmeceutical industry to exploit it for profit. I remember the parable of the cave in Plato’s Republic. Plato tells us of a civilization of men and women living in a cave and chained to its walls. Each day light entered the cave from the outside and was reflected down the cave by a series of mirrors so that the perception of reality that the people experienced was a literal reflection of time and light, and not the real thing. Ultimately one of the inhabitants broke free and wandered through the cave to the outside where he saw the sun actually rise and set and observed the subterfuge that had been foisted upon the cave’s inhabitants. Breathlessly he hurried back through the cave to tell his people of the reality that awaited them in the outside world. As he told his story the inhabitants overwhelmed him; chained him again to the wall; and, ignoring his advice continued on with their labors as if nothing had happened.
And then I remembered the campaign against smoking which we have waged over the past 50 years. I remember when people argued over whether cigarette smoke could cause lung cancer. I remember the Marlboro man with his version of macho and his appeal to my generation. And I remember the cost to individuals and to society as we battled what was then the number one cancer and cancer killer. Yet today, smoking in the United States is less frequent; many cities and states ban smoking in public places and restaurants; and no one debates the health hazards of smoking.
Therefore I will once again reiterate that the World Health Organizaiton has found sun tan parlors to be the single biggest cause for the increase in malignant melanoma and skin cancer death. Also, people who have had skin cancer can prevent new cancers with judicious use of topical vitamin A and systemic administration of vitamin A analogues. Lasers combined with photosensitizing chemicals can treat some skin cancers and prevent many others; and neoadjuvant therapy in the form of application of topical chemotherapeutic agents can prevent others. Lastly, there is no proven benefit to constantly destroying lesions that might become cancerous. At the very least patients can request a second opinion before undergoing repeated procedures. And at a bare minimum, all patients should obtain a copy of their records and even more important, read and retain a copy of all pathology reports from removal of lesions of their skin.
Your physician is not the repository of responsibility of your skin health. Like it or not, the buck stops with each of us. 

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Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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