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published July 2011

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Herald Journal Publishing
PO Box 129
Winsted, MN 55395
(320) 485-2535

Skin surprises: Some people may have skin cancer and not even know it

By Starrla Cray, Staff Writer

They were just tiny red spots that never went away.

Jennifer Gallus of Howard Lake never dreamed it was skin cancer.

“To me, it looked like a really, really small cluster of acne – like the size of a pencil eraser top,” Gallus said.

About five years ago, she offhandedly mentioned it to a dermatologist.

“I said, ‘by the way, I have this spot on the side of my face,’” Gallus recalled. “I’d had it for at least 10 years.”

When the test results came back, it was basal-cell carcinoma.

Thankfully, that’s the “best” kind of skin cancer to have, as it rarely spreads to other areas of the body.

According to the Mayo Clinic website, basal-cell carcinoma occurs when one of the skin’s basal cells develops a mutation in its DNA. Much of the damage to these cells is thought to result from sun exposure and the use of tanning beds.

People at higher risk are those who’ve had exposure to radiation, those with fair skin, men, a personal or family history of skin cancer, those taking immune-suppression drugs, exposure to arsenic, and inherited syndromes, according to the Mayo Clinic.

The other two major types of skin cancer are squamous cell carcinoma and melanoma.

The Mayo Clinic states that squamous cell carcinoma typically appears as a firm, red nodule, or as a flat lesion with a scaly, crusted surface.

“A lot of people who come in say they’ve had what looks like a pimple,” said dermatology RN Kim Kane, who works for Park Nicollet Health Services.

Hidden melanoma

In contrast, melanoma often looks like a large brownish spot with darker speckles. It can also appear as a small lesion with an irregular border, and portions that appear red, white, blue, or blue-black.

“Melanomas are from moles that are changing,” Kane said. “It’s caused by both sun exposure and genetics.”

Winsted resident Marnie Ebensperger was diagnosed with melanoma a few years ago. She had been going in for knee surgery, when the nurse noticed a tiny spot on her lower leg.

“I had never noticed it,” Ebensperger said. Since it wasn’t raised, and didn’t look like anything serious, Ebensperger said she didn’t bother getting it tested at that time.

Several months later, when she was getting a mole removed from her neck, Ebensperger mentioned the spot to the dermatologist.

A biopsy showed that it was melanoma, the deadliest form of skin cancer. Fortunately, Ebensperger’s could be removed with in-office surgery and local anesthetic.

“Mine was stage zero. It was very early,” she said.

Sunburns and tanning

Growing up, Ebensperger said she only remembers one “very bad sunburn,” in which she fell asleep outside in the Bahamas.

“I think I was pretty burnt everywhere,” she said.

However, Ebensperger isn’t typically one to lie out in the sun.

Gallus said she doesn’t lie in the sun either, but she has used tanning beds occasionally in the past. She also remembers being sunburned as a child.

“I spent summers at the lake,” she said. “I didn’t even know about using sunscreen as a kid.”

The only product she remembers her family buying was a cream to soothe the burns.

Now, Gallus has been instructed by her dermatologist to wear sunscreen on her face every day, even in the winter.

The way to removal

Gallus’ first cancerous area was deep enough that it had to be removed by a plastic surgeon.

“They’re very slow-growing,” Gallus said. “They just go deeper and deeper the longer you have it.”

Since then, she’s had a few more bouts of basal-cell carcinoma – under her eye, above her lip, and on her forehead.

“They all looked different,” she said. “I didn’t think they were skin cancer at all.”

The one under her eye was a red spot that itched, and the one on her lip was a skin-colored bump that kept increasing in size.

Pre-cancerous cells on her forehead were discovered with the use of a special cream that targets abnormal cells and kills them.

Before Gallus started applying the cream, there was just one small spot visible. As the cream took effect, several other troublesome areas also appeared.

Some of Gallus’ cancer was treated with Mohs surgery, which involves the removal of skin growth layer by layer, until no abnormal cells remain. She’s also had freezing treatment, which destroys early cancers with liquid nitrogen.

Young and old

As a young mother with no family history of skin cancer, Gallus said she’s surprised to have so much sun damage on her face.

“I just keep wondering how many I’m going to get in the next 30 years,” she said.

According to Kane, people seem to be getting skin cancer at increasingly young ages.

“I’ve seen melanoma in 16-year-olds, and we had a 10-year-old with basal cell,” she said.

According to the National Council on Skin Care Prevention, it’s estimated that more than two million cases of basal cell or squamous skin cancer (non-melanoma) and 68,720 cases of malignant melanoma were diagnosed in 2009 in the US.

Best sunscreens

Although other factors are involved, wearing sunscreen is an easy way to lessen the risk of skin cancer.

“It’s the most preventable type of cancer,” Kane said.

The best types of sunscreen have ingredients that act as a physical barrier, such as titanium dioxide and zinc oxide. Of the chemical barriers, Kane said that avobenzone is a good choice.

People who protect their skin from the sun are less likely to obtain enough Vitamin D, however. Kane said many dermatologists recommend taking a supplement as a healthy way to maintain an adequate level.

“A lot of midwesterners, just because of where we live, don’t get enough Vitamin D,” Kane said.

As with most things, the key to healthy skin care is moderation.

“It’s about being smart, but still enjoying life,” Kane said.

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