Idaho is known for its breathtaking landscapes. From the rugged peaks of the Sawtooth Mountains to the tranquil waters of Lake Coeur d'Alene. We embrace the outdoors, spending countless hours hiking, biking, fishing, and simply soaking in the stunning scenery. But amidst this natural beauty lies a hidden danger that every Idahoan needs to be aware of. Skin cancer.
While we might not have the intense, year-round sun of some southern states, Idaho's high elevation and clear mountain air mean that the sun's ultraviolet (UV) radiation can be surprisingly potent. Couple this with our love for outdoor activities, and you have a recipe for increased skin cancer risk if precautions aren't taken seriously.
The Stark Reality: Melanoma Rates in Idaho
It's crucial for Idahoans to understand that our state consistently ranks among those with the highest rates of melanoma in the United States. This isn't just a statistic; it's a call to action. Recent data indicates that Idaho has a significantly higher incidence of new melanoma diagnoses compared to the national average. In fact, Idaho ranks 1st among US states for deaths due to melanoma. While mortality rates are thankfully showing a downward trend, the initial diagnosis numbers highlight the importance of awareness and prevention.
Why is Idaho at Higher Risk?
Several factors contribute to this elevated risk:
- High Elevation: At higher altitudes, the atmosphere is thinner, filtering less UV radiation. This means you're exposed to more harmful rays, even on seemingly mild days.
- Outdoor Lifestyle: Our love for outdoor recreation means we often spend extended periods under the sun, sometimes without adequate protection. Think about those long days on the lake, the hours spent gardening, or even just a leisurely hike.
- Fair Skin Population: While skin cancer can affect anyone, individuals with fair skin, light hair, and blue or green eyes are at a higher risk, and this demographic is prevalent in Idaho.
- Clear Air: The pristine air we enjoy in Idaho, while wonderful for visibility, also means less atmospheric haze to diffuse UV radiation.
Understanding the Different Types of Skin Cancer
It's important to know that "skin cancer" isn't a single entity. There are multiple different types, each differing in how they look and potentially how they are treated. The three most common types are:
- Basal Cell Carcinoma (BCC): The most common type, usually slow-growing and rarely spreading to other parts of the body if treated early. It often appears as a pearly or waxy bump, a flat, flesh-colored or brown scar-like lesion, or a sore that bleeds and doesn't heal.
- Squamous Cell Carcinoma (SCC): The second most common type, also highly treatable when caught early. It can appear as a firm red nodule, a scaly or crusty patch, or a sore that doesn't heal. SCC has a slightly higher risk of spreading than BCC.
- Melanoma: While less common than BCC and SCC, melanoma is the most serious type of skin cancer. It develops in melanocytes, the cells that produce melanin (pigment). Melanoma can spread quickly to other parts of the body if not detected and treated early, making it potentially life-threatening. It often presents as a change in an existing mole or the appearance of a new, unusual-looking spot on the skin. Remember the ABCDEs of melanoma:
- Asymmetry: One half of the mole doesn't match the other half.
- Border irregularity: The edges are ragged, notched, or blurred.
- Color irregularity: The mole has different shades of brown, black, red, white, or blue.
- Diameter: The mole is larger than 6 millimeters (about the size of a pencil eraser), although melanomas can sometimes be smaller.
- Evolving: The mole is changing in size, shape, color, or elevation, or if new symptoms like bleeding, itching, or crusting appear.
Protecting Your Gem State Skin: Prevention is Key
The good news is that skin cancer is largely preventable. By adopting sun-safe habits, you can significantly reduce your risk:
- Slop on Sunscreen: Use a broad-spectrum sunscreen with an SPF of 30 or higher. Apply it generously to all exposed skin 15-30 minutes before going outdoors and reapply every two hours, or immediately after swimming or sweating. Don't forget often-missed areas like the tops of your feet, the backs of your hands, and your ears.
- Slip on Protective Clothing: Wear long-sleeved shirts, long pants, tightly woven fabrics, and wide-brimmed hats to shield your skin from the sun.
- Slide on Sunglasses: Protect your eyes and the delicate skin around them with sunglasses that block both UVA and UVB rays.
- Seek Shade: Especially during peak sun hours (typically 10 a.m. to 4 p.m.). Find shade under trees, umbrellas, or other shelters.
- Avoid Tanning Beds: Indoor tanning exposes you to intense UV radiation, significantly increasing your risk of skin cancer, including melanoma. There is no such thing as a "safe" tan from a tanning bed.
- Be Extra Careful at Higher Elevations: The sun's rays are more intense at higher altitudes, so take extra precautions when you're enjoying Idaho's mountains.
- Watch for the Reflection: Remember that snow, water, and even sand can reflect sunlight, increasing your UV exposure.
Early Detection Saves Lives: Know Your Skin
Regular self-skin exams are crucial for detecting skin cancer in its early, more treatable stages. Get to know your moles, freckles, and other skin markings. Look for any new spots, changes in existing spots, or sores that don't heal. If you notice anything suspicious, don't hesitate to see a dermatologist.
What to Do If You Suspect Skin Cancer
If you find a suspicious spot on your skin, make an appointment with your primary care physician or a board-certified dermatologist as soon as possible. They are the experts in diagnosing and treating skin cancer. Early detection and treatment offer the best chance for a positive outcome.
When is Surgery Necessary for Skin Cancer?
Surgery is the most common and often the first-line treatment for many types of skin cancer, especially when the cancer is localized and hasn't spread to other parts of the body. The primary goal of surgical removal is to completely excise the cancerous tissue along with a small margin of surrounding healthy skin to ensure all malignant cells are gone.
Here's a breakdown of when surgery is typically recommended for the different types of skin cancer:
Basal Cell Carcinoma (BCC):
Most BCCs are treated with surgery. Due to their slow-growing nature and low risk of metastasis, surgical removal is often highly effective.
Different surgical techniques may be used depending on the size, location, and characteristics of the BCC:
- Excisional Surgery: The cancerous lesion and a small margin of healthy tissue are cut out with a scalpel and the wound is stitched closed. This is a common and effective method for many BCCs.
- Curettage and Electrodesiccation (ED&C): After scraping away the cancerous cells (curettage), an electric needle is used to destroy any remaining cancer cells and control bleeding. This is often used for smaller, superficial BCCs.
- Mohs Surgery: This specialized technique is often used for BCCs that are large, recurring, in cosmetically sensitive areas (like the face, ears, or nose), or have aggressive growth patterns. It involves removing thin layers of skin and examining them under a microscope until no cancer cells are found. Mohs surgery has the highest cure rates for high-risk BCCs while preserving as much healthy tissue as possible. This procedure is typically performed by dermatologists who have undergone extensive extra training to perform it successfully.
Squamous Cell Carcinoma (SCC):
Surgery is also a primary treatment for many SCCs. Similar to BCC, surgical removal aims to completely excise the tumor and a margin of healthy tissue. Surgical options for SCC include:
- Excisional Surgery: Often used for smaller, well-defined SCCs.
- Mohs Surgery: Frequently recommended for SCCs that are large, recurring, in high-risk locations (like the lips, ears), rapidly growing, or have poorly defined borders. Mohs offers precise removal and high cure rates for these types of SCCs.
- Curettage and Electrodesiccation (ED&C): May be used for small, superficial SCCs in low-risk areas.
Melanoma:
Surgery is the primary treatment for all stages of melanoma. The extent of surgery depends on the thickness (Breslow depth) and stage of the melanoma.
Surgical procedures for melanoma include:
- Wide Local Excision: The melanoma is removed along with a wider margin of surrounding healthy skin. The size of this margin depends on the melanoma's thickness.
- Sentinel Lymph Node Biopsy (SLNB): For melanomas of a certain thickness, a sentinel lymph node biopsy may be performed to determine if the cancer has spread to the nearby lymph nodes. This helps with staging and treatment planning.
- Lymph Node Dissection: If melanoma cells are found in the sentinel lymph node(s), a more extensive removal of lymph nodes in the area (lymph node dissection) may be necessary.
- Surgery for Metastatic Melanoma: In cases where melanoma has spread to distant organs, surgery may be used to remove isolated metastases to help control the disease and improve symptoms. However, it's often part of a broader treatment plan involving other therapies like immunotherapy or targeted therapy.
Factors Determining the Need for Surgery:
Several factors influence whether surgery is the recommended treatment for skin cancer:
- Type of Skin Cancer: As outlined above, surgery is a cornerstone of treatment for all three common types.
- Size and Thickness of the Tumor: Larger or thicker tumors may require more extensive surgery.
- Location of the Tumor: Tumors in cosmetically sensitive areas or near vital structures may necessitate specialized techniques like Mohs surgery to maximize tissue preservation.
- Stage of the Cancer: Localized skin cancers are typically treated with surgery. If the cancer has spread, surgery may be combined with other therapies.
- Patient's Overall Health: The patient's general health and other medical conditions will be considered when determining the suitability and type of surgery.
- Recurrence: Surgery is often used to treat recurrent skin cancers.
Important Note: While surgery is often the primary treatment, other options like radiation therapy, topical medications, photodynamic therapy, or systemic therapies such as immunotherapy may be used in certain situations, either alone or in combination with surgery. If more extensive surgery or a sentinel lymph node biopsy is recommended, then you will be referred to a surgeon for management. From there, you may be referred to other specialized providers such as a medical oncologist or radiation oncologist. Your care team (which may include your dermatologist, surgical oncologist, and medical oncologist), will discuss the most appropriate treatment plan based on your individual diagnosis and circumstances.
Let's Protect Our Idaho Community
Living in Idaho offers an incredible quality of life, largely thanks to our access to the great outdoors. By understanding the risks of skin cancer and taking proactive steps to protect ourselves and our families, we can continue to enjoy the beauty of our state for years to come. Let's make sun safety a priority so we can all continue to explore and appreciate the Gem State, safely.
If you suspect any signs of skin cancer, see your primary care provider right away or schedule an appointment with a dermatologist to be seen quickly.
