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Skin Cancer
What is Cancer?
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Changes to the DNA of a cell
(mutations) lead to cellular damage
Mutations enable cancer cells to
divide continuously, without the
need for normal signals
In some cancers the unchecked
growth results in a mass, called a
tumor
Cancerous cells may invade other
parts of the body interfering with
normal body functions
What is Cancer?
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Although cancer is often referred to
as if it were a single disease, it is
really a diverse group of diseases that
affects many different organs and cell
types
The likelihood of developing any
particular cancer depends on an
individual’s genetics, environment,
and lifestyle.
The occurrence of some cancers may
be prevented/reduced by wise
lifestyle choices.
Introduction to Skin
Introduction to Skin
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The skin is the body’s largest organ
Roles of the skin:
• Prevents water loss (dehydration)
• Shields the internal organs in the event of injury
• Regulates body temperature
• Senses outside stimulus such as touch as well as heat
and cold
• Serves as a barrier to infection
Skin Cancer
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Basics
• An abnormal change in the skin resulting from uncontrolled
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cellular growth
There are three main types of skin cancer:
» Basal Cell Carcinoma (BCC)
» Squamous Cell Carcinoma (SCC)
» Melanoma
Skin Cancer Statistics
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Statistics (7)
• According to the American Cancer Society skin cancer is the
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most common cancer in the United States, with over 1 million
cases diagnosed per year.
Over 10,000 deaths estimated yearly in the U.S.
Survival rates are very good when skin cancer is detected early
» 5 year survival rates:
Localized melanoma – 99%
Regional melanoma – 65%
Distant melanoma – 15%
Skin Cancer Statistics
U.S. Estimated Skin Cancer Cases (2007)
Melanoma
60,000
Basal Cell Carcinoma
250,000
Squamous Cell Carcinoma
850,000
From ACS Facts and Figures 2007
Skin Cancer Statistics
U.S. Estimated Skin Cancer Deaths (2007)
Basal and Squamous
Cell Carcinoma
2,000
Melanoma
8,110
From ACS Facts and Figures 2007
Basal Cell Carcinoma (BCC)
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Basal Cells
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Form the deepest layer (basal layer) of the epidermis
Function as the precursors of all the skin cells above them
Basal Cell Carcinoma (BCC)
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About BCC
• Least dangerous of the skin cancers, grows slowly, and rarely
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spreads beyond original location
Easily detected and treated
Though seldom life-threatening, if untreated it can grow
beneath the skin into underlying tissue and bone causing
serious damage
Statistics
• Most common skin cancer
• Estimated 800,000 to 900,000 people diagnosed yearly
• One out of every three cancers diagnosed is BCC (7)
Basal Cell Carcinoma (BCC)
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Appearance
• Open sores, reddish patches, shiny bump, pink growth, scar
like area
► NOTE: Many non-cancerous skin blemishes will have some of these
traits. It is important to have any suspicious areas evaluated by a doctor.
Basal Cell Carcinoma
Images Courtesy of: The Skin Cancer Foundation, www.skincancer.org
Basal Cell Carcinoma (BCC)
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Major Risk Factors
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Exposure to sunlight/sunburns
 Especially - face, neck, bald scalp, hands,
shoulders, arms, back, rim of ear, and lower lip
Fair skin
• Blonde or red hair
• Blue, green or gray eyes
• Frequent or long exposure to sun (2)
Treatment
•
Reprinted with permission from the
American Academy of Dermatology.
All rights reserved.
Can usually be removed by:
- Surgical excision
- Destroying tumor with electrical current (electrodessication)
- Freezing tumor (cryosurgery)
- Radiation is used in some cases
Squamous Cell Carcinoma (SCC)
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Squamous Cell
• Most abundant cells in the skin
• Located primarily in the epidermis (2)
Squamous Cell Carcinoma (SCC)
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About SCC
• Abnormal growth of squamous cells
• Can spread to other areas (metastasize)
and cause death, but this is rare
• Most cases are not dangerous if detected
and treated early
• Considered “more aggressive” than basal
cell carcinoma, although they are both
highly treatable
Reprinted with permission from the American
Academy of Dermatology. All rights reserved.
Squamous Cell Carcinoma (SCC)
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Statistics for U.S.
• Estimated 200,000 to 300,000 people diagnosed yearly
• Second most common cancer diagnosed
• 1,000 – 2,000 deaths yearly
• Most cases are easily cured when caught early (7)
Squamous Cell Carcinoma (SCC)
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Appearance
• Wart-like growth, scaly red patch(es), open sore(s)
• Often appear as elevated growths with a central depression
Images Courtesy of: The Skin Cancer Foundation, www.skincancer.org
NOTE: Many non-cancerous skin blemishes will have some of these traits.
It is important to have any suspicious areas evaluated by a doctor.
Squamous Cell Carcinoma (SCC)
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Major Risk Factors
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Exposure to sunlight/sunburns
 Especially - face, neck, bald scalp, hands, shoulders, arms,
back, rim of ear, and the lower lip
Fair skin
• Blonde or red hair
• Blue, green or gray eyes
• Frequent or long exposure to sun (2)
Treatment
•
Can usually be removed by:
- Surgical excision
- Destroying tumor with electrical current (electrodessication)
- Freezing tumor (cryosurgery)
- Radiation is used in some cases
Melanoma
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Cells involved: Melanocytes
• Found in the basal layer of the epidermis
• Responsible for the production of skin pigment (melanin)
Basal Layer
Melanocytes in
Basal Layer
Melanoma
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Statistics in the U.S.
• Responsible for 75% of deaths due to skin cancer
• Estimated over 60,000 people diagnosed in 2007
• Highest death rate of all skin cancers
• One American dies of melanoma almost every hour
• Melanoma is the third most common cancer in
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women aged 20 - 39
Estimated 8,110 deaths in 2007 (7)
Melanoma
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About Melanoma
• More likely to metastasize than
other types of skin cancer
• Increased ability to spread makes
melanoma more dangerous
• When melanoma spreads to other
parts of the body, it becomes very
difficult to treat (3)
Reprinted with permission from the
American Academy of Dermatology.
All rights reserved.
Melanoma
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Appearance
• Tumors generally brown or black due to increased
melanin production
• Frequently appear on the trunk and lower legs but can
occur anywhere on the body including the soles of the
feet and between fingers/toes.
Melanoma
Images Courtesy of: The Skin Cancer Foundation, www.skincancer.org
Melanoma
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Treatment
• Surgical removal of the primary tumor
• Removal of surrounding tissue for staging purposes
• Removal and examination of any additional suspicious growths
• Chemotherapy and radiation may be used in advanced cases
• Biological treatments including interleukin 2 (IL-2)
• Investigational treatments
Melanoma
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Major Risk Factors
• Exposure to ultraviolet radiation
» Sun
» Tanning Lamps
• No ethnic group is immune to skin cancer
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Other Risk Factors
• Blonde or red hair – blue, green, or gray eyes
• People with more moles are at a higher risk
• Family and personal history of melanoma
• Fair complexion
Image courtesy of NASA
Detection of Skin Cancer
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ABCDE’s of Skin Cancer (3)
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These are the general characteristics used to identify skin growths of
possible concern
 A – asymmetry – one half doesn’t look like the other
 B – border – irregular, ragged or blurred edges
 C – color – a mixture of colors or marks that change color
 D – diameter – a growth more than 6 millimeters across
 E – evolution – changes in shape, size or color
Note that not every skin cancer will have all of the following
characteristics. Medical advice should be sought for any suspicious
area or when an existing mark has a change in appearance
Detection of Skin Cancer
Images Courtesy of: The Skin Cancer Foundation, www.skincancer.org
Know the Flow: Melanoma
The Big Risk: Ultraviolet (UV) Radiation
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Understanding UV Radiation
• The nuclear reactions that fuel the sun and other stars release
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an enormous amount of energy
This energy is emitted as radiation of several kinds, including
visible light and the heat that warms the earth
UV light is a type of high energy (short wavelength) radiation
that is produced by the sun
There are three types of UV radiation: UVA, UVB, UVC
UV RADIATION IS THE MAIN CAUSE OF SKIN CANCER
Ultraviolet Radiation
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UVA: Longest UV wavelength (400 - 315) nm
• Can be harmful to humans
• Very little absorbed by the atmosphere
• Not absorbed by the ozone layer
• Responsible for most sunburns
• Penetrates deeper into the skin than other UV
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wavelengths
Long term exposure can cause significant damage
to skin including blemishes, wrinkles and possibly
cancer
Ultraviolet Radiation
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UVB: Middle UV wavelength (315 - 280 nm)
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May be harmful to humans
Approximately 90% absorbed by the atmosphere
Mostly absorbed by the ozone layer
Responsible for most sunburns
Penetrates skin and is absorbed by DNA
Causes DNA damage leading to cancer
UVC: shortest UV wavelength (280 - 100 nm)
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Not harmful to humans
Completely absorbed by the atmosphere
Ultraviolet Radiation
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Other bad things from UV radiation
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Immune System Suppression (17)
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Impairs the body’s ability to fight disease
May activate viruses already in skin
Can promote cancers and worsen infectious diseases caused by bacteria
Research is ongoing to discover more
Eye Disorders (20)
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Cataracts
Cancer of skin surrounding the eyes
Burns caused by overexposure to UV light
Macular degeneration: damage to the central part of the retina
Pterygium: non-cancerous growth on the corner of the eye that can
partially block vision
Electromagnetic Spectrum
Solar Radiation and the Earth’s Atmosphere
The Sun and You
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Benefits of the SUN
• The sun triggers Vitamin D synthesis, which is good for the body
• Only SMALL amounts of sunlight are needed (10-15 minutes;
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NOT a suntan)
Vitamin D is found in foods such as eggs, fish, and cheese
Prevention
American Cancer Society Recommendation
“Slip! Slop! Slap! Wrap!”
Slip on a shirt,
Slop on 15 SPF (or higher) sunscreen,
Slap on a hat, Wrap on sunglasses
before any exposure to the sun.
* From ACS Skin Cancer Fact Sheet 2006
Prevention
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Limiting Exposure
• The sun’s UV rays are the strongest between 10 a.m. and 4 p.m.,
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limit exposure to the sun during these hours if possible
Exposure varies with times of the year and areas of the world
Sunny seasons provide the most UV exposure
Prevention: Sunscreen
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Reducing Risk While Being Exposed
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SUNSCREEN!  Your personal ozone layer!
Blocks most UV radiation, although not all of it
Different SPF numbers (Sun Protection Factors)
SPF 15, 30, 45, etc.
The higher SPF equals a longer period of protection
Sunscreen wears off, so it must be reapplied every few hours…especially
when sweating, swimming, or toweling off
Prevention
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“Most people benefit from sunscreens with sun protection factor
(SPF) numbers of 15 or more. The SPF number gives you some idea
of how long you can stay in the sun without burning. For example,
if you burn in 10 minutes without sunscreen and you apply a
liberal dose with a SPF number of 15, you should be protected
from sunburn for 150 minutes. Although sunscreens with identical
SPF numbers give you equivalent sunburn protection from UVB
rays, no sunscreen product screens out all UVA rays. Some may
advertise UVA protection, but there is no system to rate UVA
protection yet.” (4)
Prevention: SPF by the Numbers
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SPF = number of minutes required
to get the equivalent of 1 minute of
unprotected exposure
Example: SPF 30
30 minutes in the sun = 1 minute of
unprotected exposure (8)
Prevention
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SUNSCREEN…USE IT!
• “In 2003, only 14% of high school students
reported routine sunscreen or sunblock use
with an SPF of 15 or higher when outside for
more than 1 hour on a sunny day, and this
rate has remained unchanged since 1999.”
(18)
Sunscreen CAN Reduce SunBURN
Prevention
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Protective Accessories (8)
• Clothing
» Provides UV radiation protection
» Loose fitting, long-sleeved shirts and long pants made
from tightly woven fabric offer the best protection
» Typical lightweight t-shirts worn in the summer
provide less protection than a sunscreen with an
SPF of 15 or higher
Prevention
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Protective Accessories (8)
• Hats
» Hats can help shield your skin from
the sun’s UV rays
» Wear hats with a brim that shades
the face, ears, and the back of the
neck
• Umbrellas
» Must be opaque, not transparent
Tanning
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Dangers of Tanning (5)
• Causes skin cancer!
• Cosmetic issues
• Leathery skin, wrinkled skin
• Can suppress the immune system
• Premature aging of the skin
Tanning Truths
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Some Tanning Truths
• “Tanning not only increases the risk for melanoma
and squamous cell carcinoma, but accelerates skin
aging”
James M. Spencer, MD, director of dermatologic surgery at Mount Sinai Medical Center in New York City (12)
• Five or more sunburns doubles your risk of developing
skin cancer (13)
Tanning Myths
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Myth: Tanning is okay (5)
Reality
• NO!
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Tanning provides excessive exposure to harmful UV radiation, which
can cause skin cancer
“A tan is actually the result of skin injury…[w]hen a person's skin
darkens from a tan, it is an indication that damage has occurred to the
skin and the skin is trying to protect itself by producing more pigment
or melanin.”
James Spencer, MD, FAAD, professor of clinical dermatology at Mount Sinai School of Medicine (6)
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Using tanning oil will not prevent sun damage
Tanning Myths
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Myth: Tanning beds are safer than the sun
Reality
• NO!
• Most tanning bed lamps emit both UVA and UVB rays
• A study from Dartmouth in 2002 showed tanning bed
users had 2.5 times the risk of SCC and 1.5 times the
risk for BCC. (19)
• “Indoor tanning…is a dangerous practice leading to a
vast array of adverse effects” (10)
Artificial Tanning
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Tanning Salon Statistics (12)
• $2 billion-a-year industry in the U.S.
• Up to 28 million Americans tan indoors annually
• There are about 25,000 tanning salons across the country
• Adolescent females report the highest usage
» About 36.8% of the white female
adolescents in the US report using a
tanning bed at least once (11)
Ohh yeah that looks healthy!
Artificial Tanning
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Sunlamps and Tanning Beds
• Emit both UVA and UVB rays
• Can cause deep skin damge
• Increases the risk for SCC and melanoma
• May be linked to immune system
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damage
Can cause premature aging of the skin
Currently 25 states have laws prohibiting
the use of tanning beds by minors (9)
NOT GOOD FOR YOUR SKIN!
UV Radiation Myths
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Myth: Clouds block UV radiation (16)
Reality
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Not really
A thin layer of clouds can let up to 80% of UV rays through
A thick layer of cloud cover can block most but not all UV rays
Myth: Clothes block UV radiation (8)
Reality
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Somewhat correct
A white, dry cotton shirt provides less protection than sunscreen
with an SPF of 15
Fabric that allows light through also allows UV ray’s through
Wet clothing allows about 50% transmission of UV radiation
UV Radiation Myths
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Myth: Water doesn’t reflect UV radiation (8)
Reality
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Yes it does!
Sand and concrete reflect 15% of UV radiation
Water reflects less than 10% of UV radiation
Snow reflects 80% of UV radiation
Cancer Myths
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Myth: Darker skinned people don’t get skin cancer
Reality
• False!
• They are at risk for skin cancer and most frequently at risk
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for melanoma
Frequent areas from cancer in darker skinned people are
palms, soles, under nails, in the mouth, or on genitalia
NO ONE is 100% risk free from skin cancer
Check Yourself Before You Wreck Yourself
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Be in tune with your body
• Pay attention to things inside and out
• As always, if you are unsure about something seek
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professional help
A simple exam can be done to check for skin cancer
» Check all areas of the skin
» Focusing on the face, arms, neck and torso
• Also, DON’T SMOKE it’s terrible for you!
References
1. Basal Cell Carcinoma. The Skin Cancer Foundation. 2006.
http://www.skincancer.org/basal/index.php (accessed 6/12/06)
2. Squamous Cell Carcinoma. The Skin Cancer Foundation. 2006
http://www.skincancer.org/squamous/index.php (accessed 6/12/06)
3. American Cancer Society. Learn About Skin Cancer – Melanoma. 2007.
http://www.cancer.org/docroot/lrn/lrn_0.asp
4. Sunscreens and Sun-Protective Clothing. Federal Trade Commission. May 2001.
www.ftc.gov/bcp/conline/pubs/health/sun.htm (accessed 7/3/2006)
5. The Darker Side of Tanning. American Academy of Dermatology
http://www.fda.gov/cdrh/consumer/tanning.html, (accessed 6/29/2006)
6. Innovative Public Service Advertisement Campaign Sends Strong Message To Teens About Dangers
Of Indoor Tanning American Academy of Dermatology. October 19 2006.
http://www.medicalnewstoday.com/medicalnews.php?newsid=54504 (accessed 11/13/2006)
7. American Cancer Society Cancer Facts and Figures, 2007. American Cancer Society Publication.
Atlanta, GA. 2007.
References
8.
American Cancer Society. Skin Cancer Prevention and Early Detection .
http://www.cancer.org/docroot/PED/content/ped_7_1_Skin_Cancer_Detection_What_You_Can_Do.as
p (accessed11/13/06).
9.
Tanning Restrictions for Minors A State-by-State Comparison. March 2007.
http://www.ncsl.org/programs/health/tanningrestrictions.htm
10. Jody A. Levine MD, Michael Sorace MD, James Spencer MD and Daniel M. Siegel MD. The indoor UV
tanning industry: A review of skin cancer risk, health benefit claims, and regulation. Journal of the
American Academy of Dermatology. Volume 53, Issue 6, December 2005, Pages 1038-1044.
11. Catherine A. Demko, PhD; Elaine A. Borawski, PhD; Sara M. Debanne, PhD; Kevin D. Cooper, MD; Kurt C.
Stange, MD, PhD. Use of Indoor Tanning Facilities by White Adolescents in the United States. Arch
Pediatric Adolescent Medicine. 2003;157:854-860.
12. The Skin Cancer Foundation. The Case Against Indoor Tanning. 2007.
http://www.skincancer.org/artificial/index.php
References
13. Pfahlberg A, Kolmel KF, Gefeller O. Adult vs childhood susceptibility to melanoma: Is there a difference? Arch
Dermatol, Sep 2002; 138: 1234 – 1235.
14. Vander's Human Physiology: The Mechanisms of Body Function, 10/e. Eric P. Widmaier, Hershel Raff, Kevin T.
Strang. 2006. McGraw-Hill Inc: New York, New York.
15. Ries LAG, Harkins D, et al. SEER Cancer Statistics Review, 1975-2003, National Cancer Institute. Bethesda, MD.
http://seer.cancer.gov/csr/1975_2003/, based on November 2005 SEER data submission, posted to the SEER web
site, 2006.
16. Carolyn Strange. Thwarting Skin Cancer with Sun Sense. FDA Consumer Magazine (July-August 1995)
http://www.fda.gov/fdac/features/695_skincanc.html (accessed 7/5/07)
17. Stephen E. Ulrich. Mechanisms underlying UV-induced immune suppression. Mutation Research (571) 185-205.
2005
18. Sherry Everett Jones, Mona Saraiya. Sunscreen Use Among US High School Students, 1999-2003
Journal of School Health, April 2006, Vol. 76, 4, 150-153.
References
19. Margaret R. Karagas; Virginia A. Stannard; et al. Use of Tanning Devices and Risk of Basal Cell and
Squamous Cell Skin Cancers Journal of the National Cancer Institute; Feb 6, 2002; 94, 3; Research Library
pg. 224
20. World Health Organization. Global disease burden from solar ultraviolet radiation.
http://www.who.int/mediacentre/factsheets/fs305/en/index.html