WRNMMC, Bethesda, Md.   –   The Murtha Cancer Center at Walter Reed, the only Department of Defense Cancer Center of Excellence in the Military Health System, hosted its annual Skin Cancer Summit virtually on May 25. May is National Skin Cancer and Melanoma Awareness Month.

This year’s summit featured Dr. David Brodland, a board-certified dermatologist and Mohs surgeon in Pittsburgh, Pennsylvania with the Zitelli & Brodland Skin Cancer Center.

According to the Centers for Disease Control and Prevention (CDC), skin cancer is the most common cancer in the United States. The American Academy of Dermatology reports that approximately 9,500 people in the U.S. are diagnosed with skin cancer every day. In addition, “research estimates that nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), affects more than 3 million Americans a year,” the AAD states.

The skin is the body’s largest organ with several layers, including the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, made up of three kinds of cells: squamous cells (thin, flat cells that form the top layer of the epidermis); basal cells (round cells under the squamous cells); and melanocytes (cells that make melanin and are found in the lower part of the epidermis).

Melanin is the pigment that gives to skin its color. When skin is exposed to the sun melanocytes make more pigment and cause the skin the darken. Basal and squamous cell carcinomas are the two most common types of skin cancer. Melanoma, the third most common type of skin cancer, begins in the melanocytes.

Everyone is at risk for skin cancer, but people with certain characteristics are at greater risk, the CDC states. These characteristics include:
• A lighter natural skin color.
• Skin that burns, freckles, reddens easily, or becomes painful in the sun.
• Blue or green eyes.
• Blond or red hair.
• Certain types and a large number of moles.
• A family history of skin cancer.
• A personal history of skin cancer.
• Older age.

Dermatologists at Walter Reed explain that a change in the skin is the most common sign of skin cancer, including a new growth, a sore that doesn’t heal, or a change in a mole. They urge people to remember the A-B-C-D-Es for warning signs. These include:
• A: Asymmetrical: Does the mole or spot have an irregular shape with two parts that look very different?
• B: Border: Is the border irregular or jagged?
• C: Color: Is the color uneven?
• D: Diameter: Is the mole or spot larger than the size of a pea?
• E: Evolving: Has the mole or spot changed during the past few weeks or months?

Most skin cancers are caused by too much exposure to ultraviolet (UV) rays, according to dermatologists. UV rays come from the sun, tanning beds and sunlamps and they damage skin cells.

To reduce your risk for skin cancer, the CDC recommends practicing sun safety, which includes if the UV Index is 3 or higher in your area, protecting your skin from too much exposure to the sun. The CDC recommends:
• Stay in the shade.
• Wear clothing that covers your arms and legs.
• Wear a hat with a wide brim to shade your face, head, ears, and neck.
• Wear sunglasses that wrap around and block both UVA and UVB rays.
• Use a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 or higher.

Dr. Craig D. Shriver, director of the Murtha Cancer Center and its Research Programs has stated cancer can impact military readiness, explaining that a diagnosis of cancer can take a service member away from his or her unit for treatment for a number of months. Approximately 1,000 active-duty service members are diagnosed with cancer each year, and there are about 8,000 active-duty service members living with a cancer diagnosis, according to Shriver.

While there are various types of treatment for skin cancer including radiation therapy, chemotherapy, drug therapy, photodynamic therapy and more, Brodland discussed using Mohs micrographic surgery for melanoma treatment during his presentation at Walter Reed. “Mohs has the highest cure rate for primary melanoma, 99.5 percent,” he stated.

The standard of care for melanoma, wide local excision (WLE), is used to remove the melanoma and some of the normal tissue around it. “If excision is incomplete, recurrence has 25 to 33 percent risk of increased invasion, and increased risk of metastasis,” Brodland explained. He added there is a 4 to 14 times higher rate of cancer recurrence with WLE.

Brodland explained that with Mohs, removal of the cancer involves the least amount of healthy tissue to ensure the smallest possible wound, which heal better than large wounds.

With Mohs micrographic surgery, the procedure is done in stages, including lab work, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows where they are and removes another layer of tissue from that location, while attempting to spare as much healthy tissue as possible. This process is repeated until no cancer cells remain.

“Mohs surgery is the gold standard for treating many basal cell carcinomas and squamous cell carcinomas,” according to the Skin Cancer Foundation.

“Mohs surgery is likely to keep increasing as the number of skin cancers continues to rise and as more people become aware of the advantages,” Brodland stated.

The summit concluded with Army Capt. (Dr.) Scott Whitecar presenting a metastatic melanoma case review.