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Action Plan logo
Executive Summary
Background Paper
  I. Incidence, mortality, and impact on society
  II. Skin cancer
  III. Contributing and causative factors
  IV. Prevention
  V. Cancer prevention and information services that impact the skin cancer problem
  VI. Barriers to early detection and treatment of skin cancer in Texas
  VII. Policy initiatives that would affect skin cancer awareness and prevention
  VIII. Professional practice regarding skin cancer prevention, detection, and treatment
  IX. Prevention and information models
Action Plan
  Goal I Initiate data collection and analysis
Goal II Develop prevention information and services to increase public awareness
Goal III Enhance professional education and practice
Goal IV Improve access to prevention, detection, and treatment
  i. Melanoma of the Skin Incidence and Mortality Rates, 1988-1992
ii. Five-Year Relative Survival Rates, by Site 1986-1992
iii. Average Years of Live Lost per Person Dying of Cancer, 1993
iv. Demographic Characteristics of Patients Diagnosed with Malignant Melanoma of the Skin
v. Counties Reporting Health Care Availability as an Issue
vi. Federally Designated Medically Underserved Areas
vii. Additional Texas Cancer Council Initiatives

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  Background Paper title

Skin cancer [ 12 ]

The skin is the largest organ in the body, playing a vital role in regulation of the body's temperature and fluid balance, as well as protecting the structures beneath it from injury or invasion by microorganisms.

BCC, SCC, and MM develop from cells that are part of the uppermost level of the skin, the epidermis. The epidermis has three layers: a protective top layer; a middle layer containing squamous cells; and a bottom layer containing basal cells. Melanocytes, usually found just above the basal cells, produce melanin, which is responsible for skin pigmentation. In response to UV exposure, melanocytes release additional melanin granules in an attempt to reduce radiation damage to skin cells.

A . Basal cell carcinoma (BCC)
A . Basal cell carcinoma (BCC) BCC is the most common type of skin cancer. It originates in the basal cells occurring at the lowest layer of the epidermis, and is the result of chronic UV radiation exposure over time. BCC develops slowly, usually appearing on parts of the skin that are exposed to the sun, such as the top of the head, the tops of ears, the face, and the neck. Although it rarely spreads to other parts of the body, it can invade the surrounding skin, bone, or other structures, causing severe disfigurement. Removal of BCC at this advanced stage can mean the loss of a nose, eye, or ear. BCC often recurs in the same area, and predisposes 35% to 50% of people to develop a second BCC within five years. Usually, BCC develops in middle-aged or elderly adults, but is now increasingly being seen in younger people.

B . Squamous cell carcinoma (SCC)
SCC is less common than BCC. It originates in the squamous cells of the epidermis, and is also the result of chronic UV radiation exposure over time. It is usually found on sun-exposed parts of the head, face (including the lip), and the hands. SCC can invade tissues beneath the skin, and may eventually metastasize (spread) to the lymph nodes and on to other organs.

C . Malignant melanoma (MM) [ 4 ]
In normal skin, melanocytes manufacture melanin, which is responsible for skin pigmentation. When exposed to UV radiation, melanocytes release melanin to protect skin cells against the destructive effects of UV radiation. The visible result of this activity is a tan. The exact mechanism by which melanocytes become cancerous is still under study, although there is growing evidence linking this process to severe, intermittent, exposure to UV radiation. When experienced before the age of 15, this type of UV radiation damage, leading to blistering sunburn, is thought to double the risk of developing MM. [ 13 ] MM most often develops on the torso of men and the lower legs of women, but may occur on any part of the body. In darker-skinned people, MM is commonly found under nails, between toes, on the soles of feet, and on the palms of hands. Because MM frequently occurs in places not exposed to UV radiation, it is imperative that skin cancer prevention initiatives not only include visual re p resentations of melanoma lesions, but also instructions for full skin self-exams.

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