Ridge Runner Chronicles – June 28, 2023
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Are you a prime target for skin cancer
By Bill Hoagland
The June 15, 2023 edition of the New England Journal of Medicine (NEJM) contains an article entitled “Squamous-Cell Carcinoma of the Skin”. It is an update regarding a particular form of skin cancer caused by cumulative exposures to ultraviolet radiation from the sun and, to a lesser extent, from tanning beds. I am writing this column because this issue potentially involves so many people I know personally, as you will see in a minute.
According to the article, one in every five Americans will have skin cancer at some point in their lifetime. The most common form is keratinocyte carcinoma, but that form is relatively harmless, does not normally require treatment and is not reported on national cancer registries; it is the next most common form—cutaneous squamous-cell carcinoma—that is potentially more serious and is a form of skin cancer that is currently being diagnosed at a rate of one million new cases each year. This form of skin cancer, if allowed to metastasize, is resulting in death rates that equal or exceed those death rates for melanoma or leukemia. The most important point in the article is that this form of skin cancer is increasing because the population is aging.
The persons most likely to develop squamous-cell carcinoma are white males over the age of 75, with the male ratio being three times that of women of the same age. In fact, the incidence of this cancer developing in persons over 75 is 5 to 10 times greater than in persons younger than 55. There are a number of factors that impact who among senior citizens will develop this form of skin cancer but the most significant factors are cumulative exposures to ultraviolet rays, age and whether you have a weakened immune system. There are also genetic factors, including “inherited phenotypic characteristics—such as light skin, red or blonde hair, and light-colored eyes—[that] are associated with an increased risk of cutaneous squamous-cell carcinoma.” Finally, inflammatory skin conditions, smoking, hypothyroidism, the use of certain drugs and human papilloma virus are all factors increasing the risks for senior citizens.
Most squamous-cell carcinomas that are low risk are removed with destructive or surgical techniques on an outpatient basis. Radiation treatment is utilized in more complicated situations. There are advanced systemic therapies if the condition is recurrent or it has metastasized, including immune checkpoint inhibitors, details of which are beyond the scope of this column.
As I was reading this article, it occurred to me that most of my friends (and me) fall into these high risk populations most prone to develop cutaneous squamous-cell carcinoma. And many of my friends complicate matters further by spending a significant portion of their lives in Florida or some other sun-belt environment. So a word to the wise—it is the cumulative effect of those ultraviolet rays that nail us old-timers. Most of us know what to do; we are just too lazy to take the precautions. So lather up with the sun screen, get the hat on if you can’t resist the pull of the golf course or fishing boat and don’t forget to make that annual trip to the dermatologist.
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■ Bill Hoagland has practiced law in Alton for more than 50 years, but he has spent more than 70 years hunting, fishing and generally being in the great outdoors. His wife, Annie, shares his love of the outdoor life. Much of their spare time is spent on their farm in Calhoun County. Bill can be reached at [email protected].
