Walter Reed National Military Medical Center, BETHESDA, Md.  –   The Murtha Cancer Center (MCC) at Walter Reed, the only Department of Defense (DOD) Cancer Center of Excellence, hosted its annual Skin Cancer Summit virtually on May 30.

The MCC operates jointly between Walter Reed and the Uniformed Services University (USU), supporting the clinical, educational, and research aspects of cancer throughout the DOD community. Retired Army Col. (Dr.) Craig D. Shriver, director of the MCC and MCC Research Programs, shared that the MCC has hosted the skin cancer summit for about a decade. "It's very important [because] non-melanoma skin cancer is the number two incident of cancer in active-duty service members, [and] melanoma is also one of the most common cancers in active-duty service members."

Shriver added that a Pentagon directive has tasked the MCC with tackling cancer as a readiness issue, explaining that a diagnosis of cancer can take a service member away from their unit and out of the fight for treatment for possibly months or longer. In addition, approximately 1,200 active-duty service members are diagnosed with cancer each year, he continued. "With approximately 15,000 service members currently serving with a diagnosis of cancer, this is clearly an issue that demands attention."

The military risk factors

Sun exposure for many military personnel, especially those serving in outdoor occupations or deployed to regions around the globe with intense sun and hot temperatures, can increase the risk of developing melanoma. According to the Melanoma Research Alliance, roughly nine out of 10 skin cancers are caused by ultraviolet (UV) exposure. In addition to the sun, UV rays can come from tanning beds and sunlamps, damaging skin cells.

While May is annually observed as National Skin Cancer and Melanoma Awareness Month to highlight the most common cancer in the United States, Walter Reed providers encourage people to protect their skin against the sun's harmful rays daily. This includes using sunscreen and wearing clothing to cover skin exposed to the sun for prolonged periods.

It's estimated that every day, about 9,500 people in the United States are diagnosed with this cancer, according to the American Academy of Dermatology. Shriver thanked Walter Reed's dermatology staff for providing skin cancer screenings as part of the summit and their efforts in helping fight the battle against skin cancer.

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 (thin, flat cells that form the top layer of the epidermis); basal (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 skin its color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to 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.

Preventing skin cancer

U.S. Navy Lt. Cmdr. (Dr.) John Linabury, a Walter Reed staff dermatologist and one of the MCC's co-directors, explained skin cancer prevention tips. "Early detection and prevention can save lives," he stated.

Everyone is at risk for skin cancer, but people with specific characteristics are at greater risk, Linabury explained. 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

Linabury said seeking shade is one measure to help prevent overexposure to the sun. "Avoid sun exposure between 10 a.m. to 4 p.m. Use umbrellas and tents during outdoor activities, as well as use the natural shade of trees and other structures," he added.

He also recommends protective clothing, including wide-brimmed hats, sunglasses offering 100 percent UVA and UVB protection, long-sleeved shirts and long pants made with UV-blocking fabrics, and footwear covering all feet (not flip-flops).

The doctor stresses the importance of using sunscreen with an SPF of 30 or higher, preferably SPF 50, and reapplying it every two hours or after swimming and sweating. "Apply generously," he stated.

Keep an eye on moles

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?

Linabury encourages monthly self-exams for new or changing moles and spots and annual professional skin exams by a dermatologist. He also encourages people to maintain healthy lifestyle choices (antioxidant-rich foods, including fruits and vegetables), hydration (drinking plenty of water to keep skin healthy), and avoiding smoking (to reduce skin damage and cancer risk).

Wear sunscreen

U.S. Navy Capt. (Dr.) Melissa Austin, a pathologist, also stressed the importance of wearing sunscreen and being aware of the risk factors and prevention measures for skin cancer, especially for service members whose work often requires prolonged exposure to the sun.

"Melanoma and other skin cancers are increasing within the young active-duty population, and melanoma is by far the most aggressive," Austin added. She explained that as a pathologist, she's had the unfortunate duty of diagnosing young service members with malignant skin cancers.

"The good news is that I've also seen so much advancement in treatment over the past 15 years," said Austin. She credits the MCC and other cancer teams throughout the country for developing effective therapies that are neither incapacitating nor disfiguring.

There are various types of treatment for skin cancer, including radiation therapy, chemotherapy, drug therapy, photodynamic therapy, and others.

Also, during this year's skin cancer summit at Walter Reed, Dr. J. Charles Lacson, MCC molecular epidemiologist, discussed precision prevention trials against skin cancer and melanoma, delving into why melanoma in adolescents and young adults, including those in the U.S. military, is increasing.

"[Melanoma] can be challenging to diagnose," said Austin, but investigators such as Lacson are researching if there are biomarkers in the blood and tissues that would allow for identifying abnormalities while they are still pre-cancerous or even earlier.

Dr. Jennifer Stein, professor of dermatology at the NYU Grossman School of Medicine, discussed melanoma gene expression. Austin explained that this has the potential to "tell us why melanoma develops, who's going to develop it, the risk factors for it, and how they might be modified."

"Melanomas more likely to metastasize, may express different genes from less aggressive ones," Stein added.

Jennifer Strong, a National Institutes of Health research fellow, discussed notable cases from the cutaneous oncology clinic. "It's important to put a face, put a story behind why we are doing what we are doing [in cancer care and research]," Austin stated. "It's important to understand that there is a patient at the end of this, and the reason we are doing this is to make their lives better, longer, and of a higher quality."