As ultraviolet radiation nears peak intensity this summer, it's a good idea to reflect on skin cancer. It's the most common cancer, it can be deadly, and it's on the rise.
"Skin cancer is an epidemic," said Dr. Robert Skaggs, dermatologist and founder of the Kentucky Skin Cancer Center in Bowling Green, which opened in October.
About 90 percent of non-melanoma skin cancers and 86 percent of melanomas are associated with exposure to ultraviolet radiation from the sun, according to the Skin Care Foundation, which estimates that one in five Americans will develop skin cancer by age 70.
Kentucky residents who work outside or spend recreational time outdoors fishing or swimming might face a greater risk for skin cancer. Kentucky has one of the highest rates of melanoma in the U.S., with 28.7 per 100,000 new melanoma cases in 2016, according to the Centers for Disease Control and Prevention.
"Kentucky has some of the worst outcomes of skin cancer," Skaggs said. "That's one of the reasons I opened this skin cancer center."
Dr. John Cowan, a dermatologist at Bowling Green Dermatology and Skin Cancer Specialists, agrees that the region has some of the highest skin cancer rates.
"We just see a ton of skin cancer," Cowan said.
Basal cell, squamous cell carcinoma and melanoma are the three most common types of skin cancer that Cowan and Skaggs treat in their practices.
But there are other types of skin cancer. This week, Cowan examined a sty (infected hair follicle) on an eyelid that might actually be a sebaceous carcinoma, a rare form of skin cancer.
Patients with skin cancer tend to be 50-plus, but the dermatologists will occasionally see patients with troublesome spots much younger. Skaggs recently diagnosed a 10-year-old with a precancerous mole.
"Skin cancer affects people of all ages," Skaggs said.
Both dermatologists recommend annual skin checks. While it's especially important to examine itching, burning, bleeding and growing spots, many skin cancers are asymptomatic - and might remain asymptomatic and unchanged for years, according to Cowan.
"Most times, skin cancer is not symptomatic," Cowan said. "A lot of times people don't know what to look for. The best thing you can do is have a routine skin exam. Let people look at you head to toe."
Skaggs also recommends routine self-checks.
"Check your birthday suit on your birthday," Skaggs said.
For people at higher risk, he suggested that they check their skin and existing moles at least once a month to make note if they change or if new spots develop.
To prevent skin cancer, both dermatologists recommend that people prioritize physical protection, utilizing UV-protective clothing, sunglasses and hats - which Skaggs clarified should be wide-brimmed hats, not baseball caps.
"The head and neck is the most common place to have skin cancer," Skaggs said.
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Body areas not physically protected should be covered with sunscreen of at least 30 SPF. Cowan suggests ensuring that the sunscreen is broad spectrum and offers both UVA and UVB protection. If chemical, Cowan said the benefits outweigh the risks associated with the sunscreen ingredients. (Recently, researchers discovered that certain sunscreen chemicals can absorb into the bloodstream. The U.S. Food and Drug Administration is investigating.)
Skaggs said physical sunscreen works better, but it's "not as elegant" as the skin-absorbing chemical sunscreens. That's because physical sunscreens, zinc oxide and titanium dioxide, leave a white cast on top of the skin.
Avoiding sun during peak UV radiation, usually between 10 a.m. and 2 p.m., is just as important as lathering up with sunscreen or wearing hats each day, according to Cowan.
"Sun avoidance is the most critical component of sun protection," he said.
UV radiation in Kentucky is expected to remain at dangerously high levels of 10 and 11 through July, according to the National Oceanic and Atmospheric Administration's UV Index Forecast.
UV levels above three indicate a need for thorough sun protection, and levels eight or more indicate that you minimize sun exposure while utilizing protective garments, sunglasses and sunscreen. If you can't check the UV index, then check your shadow: Shorter shadows mean higher UV radiation, according to the Environmental Protection Agency.