Skin Cancer and the Aeromodeler - 201209

When I started aeromodeling nine years ago, I had just fi nished
my dermatology residency and had successfully started a
thriving practice. Since I was a kid, I had always wanted to fl y remotecontrol
airplanes, but I never had the money or the time, being
either a poor high school/college student or an overworked medical
student/resident.
I fi nally reached a point in my life where I had both the time and
the money to participate in a hobby in which I had always had an
interest. Little did I know that my professional life and hobby would
soon collide.
It wasn’t long after I had joined the Jayhawk Model Masters in
Lawrence, Kansas, that I developed some true friendships. Through
these interactions I soon became not only their friend, but also their
physician.
After diagnosing two members of the club with melanomas, and
three members with both basal cell and squamous cell carcinomas of
the skin, it was clear to me that our hobby puts our members at risk
of developing skin cancer.
I wrote this article to give aeromodelers the knowledge and
information they need to protect themselves from the harmful rays
of the sun and hopefully to encourage members who have suspicious
spots on their skin to see a dermatologist before it’s too late.
It provides the light and the warmth
that we need to survive. However, it
also gives off two types of radiation that
penetrate the atmosphere, the clouds,
and even the layers of our skin. That
radiation is in the form of ultraviolet A
and B (UVA and UVB) rays. These nonvisible
forms of light interact with the
DNA of our skin cells, causing damage
to the genes that control how often a
cell divides and multiplies.
When these cells are irrevocably
damaged, the cell loses the ability to
control itself and it repeatedly divides
while ravaging nutrients and space from
the nearby normal cells. If the damaged
cell also starts losing its anchors to the
skin, it can start migrating to other areas
of the body in the form of metastasis.
Depending on the type of skin cancer,
this can rapidly be fatal because the
cancer kills off the normal cells in other
organs and stops their proper function.
More than 3.7 million skin cancers
were diagnosed in 2008 and the
incidence is increasing drastically. There
are many different types of skin cancer
that I will not delve into in this article
for the sake of brevity, but all of these
cancers are different based on the type
of cell from which the cancer is derived.
The three most common types of
skin cancer are: 1) basal cell carcinoma
(BCC), 2) squamous cell carcinoma
(SCC), and 3) melanoma. BCCs are
derived from cells in the hair follicles.
SCCs are derived from the squamous
cells. These are the cells that you see
with your eyes and feel with your
fi ngers when you rub your skin. Finally,
melanomas are derived from the
melanocytes which are the cells that give
your skin its pigment or color.
The damage done by the sun however,
doesn’t always lead directly to cancer.
Sometimes there can be an early form
of damage that we term precancerous
lesions or medically termed as actinic
keratosis (actinic means sun or light, and
keratosis refers to a scaly spot on the
skin).
These lesions sometimes are almost
better felt than seen, and they present
as rough “sandpaperish” spots on
the skin (Figure 1). They also can be
noticeable as thick, red, scaly spots on
the skin (Figure 2). These early types
of precancers can be readily treated by
your physician without surgery.
There are various methods to
remove these and reduce the chance of
progression to cancer. Such modalities
as freezing the lesions with liquid
nitrogen, application of chemotherapy
creams, and treatment with phototoxic
chemicals are the most common
methods used and can usually be done
with minimal downtime.
Failure to treat actinic keratosis
increases the risk that these lesions will
progress to SCC. Roughly 5% to 10%
of all actinic keratosis left untreated will
progress to this type of cancer; however,
it is possible to develop a SCC without
having an actinic keratosis. SCC is the
second most-common type of skin
cancer.
Fortunately, if caught early, it is easily
removed and cured; however, it does
have the potential to metastasize to
other organs. Left untreated, SSC can
rapidly spread to the lymph nodes, lungs,
and other organs which can result in
death.
Sometimes these cancers grow very
rapidly, even within a matter of weeks.
The treatment for these types of cancers
is usually surgery. On the body, these
cancers are usually removed with a
standard surgical margin and sent to
a pathologist who takes several slices
of the specimen and looks to see if it
involves the margin. This usually results
in a 90% cure rate.
Particularly on the face, these types
of cancers can spread beneath the skin,
along the different planes of the skin
and muscle, and be invisible to the
patient and the physician (Figure 3). A
special type of surgery is usually used to
treat these cancers called Mohs surgery
(named after its inventor, Frederick
Mohs).
This surgery involves cutting around
the cancer with thin surgical margins
and then processing it immediately
within the doctor’s offi ce in such a
way that 99% of the margins can be
visualized at one time. This special
type of surgery allows for high cure
rates (98% or greater) and still permits
the surgeon to spare tissue in delicate
areas of the face for the best cosmetic
outcome.
BCC’s are the most common type
of skin cancer (in fact, they are the
most common type of any cancer).
Fortunately, these cancers rarely
metastasize or spread to other organs,
even if left untreated for years, although
it is possible. However, these cancers
can be extremely aggressive locally, and
they can grow quite large and deep
without any evidence to the patient or
the physician until the time of surgery
(Figure 4).
Again, surgical excision is the
treatment of choice, although radiation
and chemotherapy creams may be
utilized by the physician to remove
these cancers. Mohs surgery is the
treatment of choice for basal cell
carcinomas on the face because of its
high cure rate, and tissue-sparing ability.
Finally, I come to melanoma skin
cancer. This is the Tyrannosaurus Rex of
skin cancers, because if not caught early,
it rapidly spreads throughout the body,
particularly the lymph nodes, liver, and
brain.
It is the most ruthless of the skin
cancers—and of
almost any cancer,
for that matter—
because once
it is out of the
skin it is almost
impossible to stop.
It responds poorly
to radiation and
chemotherapy.
Because these
cancers need to be
diagnosed early, it
is important that
an aeromodeler
know what to
look for.
Dermatologists often talk of the
ABCDs of melanoma. Does a mole have
Asymmetry (does one side look different
if you draw a line down the middle)?
Does a mole have irregular Borders?
Does a mole have different Colors?
Does the mole have a Diameter greater
than 6mm (bigger than an eraser head)?
If the answer to any of these questions
is “yes,” then you should have it looked
at by a dermatologist (Figure 5). This
doesn’t necessarily mean its cancer, but
it should be examined to rule it out.
I want to add an E to this list, referring
to Everything else. Is the mole changing,
growing, bleeding, or hurting? These are
also warning signs that a spot needs to be
checked. Remember these rules apply to
melanoma, but any new growth on your
skin that is not going away after several
weeks, should be checked to make sure
it is not cancer, because there are many
types of skin cancer and they can all look
different.
What can an aeromodeler do to
protect himself or herself from these
awful cancers? Short of becoming a
full-time indoor modeler, we need to
protect ourselves from the sun. As I
stated previously, the radiation that
causes skin cancer is invisible to our eyes,
and it penetrates even the clouds, so it
is damaging us even when it is cloudy
outside.
Sunscreen and protective clothing
is our best defense. Most people do
not apply enough sunscreen. If you
were going to the beach, you would
need to apply 1 ounce of sunscreen to
adequately protect your body (roughly
a quarter of an average-size bottle). Also
sunscreen lasts approximately two hours
at best, so it needs to be applied every
two hours. Choose a sunscreen with at
least a sun protection factor (SPF) of 45,
and make sure it covers both UVA and
UVB radiation.
A study determined that for every
inch of brim the hat you wear has, you
decrease your chance of getting skin
cancer on your face by 10%. I will give
you this warning: enjoy fl ying your
aircraft, but make sure you can still see it
under the brim of your sombrero!