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12 EPA J. 7 (1986)
Skin Cancer: The Price for a Depleted Ozone Layer

handle is hein.journals/epajrnl12 and id is 283 raw text is: Skin Cancer: The Price for * a Depleted Ozone Layer - by Medwin M. Mintzis, MD S kin cancer has reached epidemic proportions in the United States. It is the most common of all cancers, 41 affecting one out of seven Americans. One-third of all new cancers affect the skin; upwards of a half million new cases are treated each year. This is a 30 percent increase in just 10 years. The chief culprit in causing this sharp increase seems to be the sun, rather than chemicals and X-rays, and depletion of the stratospheric ozone layer would dramatically exacerbate this disquieting trend in the years ahead. The ozone layer screens out much of the harmful ultraviolet B light (UV-B) from the sun and prevents it from reaching the earth's surface. But when the ozone layer is depleted, even a one percent increase in UV-B would result in a two percent increase in the number of skin cancers. According to a new EPA study, the number of cases of skin cancer in the next 88 years would total 40 million, with as many as 800,000 deaths if the current trends in use of ozone-depleting chemicals continues. Skin cancer types are usually categorized in terms of melanoma and non-melanoma. The most dangerous form of skin cancer is malignant melanoma, which arises in the pigment-forming cells (melanocytes). When a melanoma reaches a certain thickness, it spreads rapidly to the vital organs of the body. In 1986, 23,000 Americans will be diagnosed as having malignant melanoma, and another 6,000 will die of its effects. An individual's lifetime risk (Mintzis is a member of the Medical Council of The Skin Cancer Foundation and Assistant Professor of Dermatology at New York University School of Medicine.) for melanoma has soared by 1,000 percent since the 1930s. Currently, one in 150 Americans is expected to develop the disease. Non-melanoma skin cancers-mainly basal cell and squamous cell carcinomas-affect the skin's surface cells. Though often considered harmless annoyances, such cancers are far from trivial in their advanced forms. They can result in great disfigurement-the loss of an eye, ear, lip, or nose. And close to 2,000 Americans will die this year because of In 1986, 23,000 Americans will be diagnosed as having malignant melanoma, and another 6,000 will die of its effects. non-melanoma cancers that spread-or metastasize-throughout the body. This human devastation need not occur. These cancers are largely preventable. No one should die of skin cancer. The warning signs are there for us to see. When recognized early and treated promptly, skin cancer is 100 percent curable. The connection between skin cancer and excessive exposure to the sun's damaging rays has been clearly established. In the case of non-melanoma skin cancer, the link is direct. With malignant melanoma, exposure to ultraviolet light is a causative factor, although its precise role is not well understood at this time. Other factors such as chemical carcinogens, oncologic viruses, and genetics may also be involved. The incidence of non-melanoma skin cancer among the white population in the United States increases as one travels from North to South (that is, closer to the Equator where the daily hours of sunlight are greatest). Studies in Europe and Australia indicate similar patterns. The number of cases of skin cancer doubles with every eight degrees latitude nearer the Equator. Altitude is also a factor. At greater heights, more UV-B light penetrates the thinner atmosphere. The highest rates of skin cancer incidence in the United States have been found in Albuquerque, New Mexico, which has both a low latitude and a high altitude. Over 90 percent of all skin cancers occur on those parts of the body normally unprotected by clothing-the face, ears, neck, and backs of the hand. Protruding lower lips, lower eyelids, and ear rims are particularly vulnerable sites. In temperate zones, people who spend a great deal of their time outdoors -fishermen, farmers, sailors, construction workers, athletes, for example-are the more likely candidates for skin cancer. Of course, the darker a person's skin, the less likely he or she is to get skin cancer. Blacks and Hispanics are seldom affected; their highly pigmented skin (containing more melanin) is a natural sunblock. Overall, fewer women than men develop basal and squamous cell carcinomas. But among younger people, women develop the disease almost as frequently as men. The sexes differ somewhat in terms of where skin cancer occurs. Men frequently develop skin tumors on the tips of the ears and on the scalp, areas unwittingly exposed to sunlight by the balding process. On the other hand, women get more cancers on the lower legs-exposed when they wear skirts or dresses-then men. (One may wonder DECEMBER 1986

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