While Ilan was seated in the dermatologist’s office, he fought the urge to scratch the dermatitis that had been plaguing him the entire week. Whatever it was that had bitten him, none of the creams he was using worked. He had recently bought one of those wide brim No Fly Zone hats that guaranteed protection against any insect bites on his face or neck, but the insect had settled for second best, the palm of his right hand. As a much sought-after tour guide, Ilan found it difficult to shake hands with his clients without involuntarily rubbing the client’s palm against his to relieve the itching. Not an ideal way to greet someone.
When his turn came, he eagerly opened his hand to show the doctor what was bothering him, but the doctor barely looked at his red palm. Instead, he was staring intently at the red bump on Ilan’s nose.
“It’s been there forever, doc,” Ilan said. “Sometimes it gets bigger, sometimes a little smaller, sometimes darker, sometimes lighter. Right now it’s in its spreading stage, but don’t worry about it. Just give me something for the palm. It’s driving me crazy.”
“Of course, Ilan,” said the doctor. “But do you think I could look at that red bump a little closer, maybe take a biopsy? It seems to be spreading out in an irregular pattern, and there’s a scab on the surface.”
“Will it take long?” Ilan asked.
“Ten minutes or so. Then off you go with a prescription that will definitely stop the itching. I’ll call you if anything shows up.”
When Ilan left, the doctor took the biopsy for testing, but it was clear to him that this was a case of basal cell carcinoma. The only question was how deep it went, and how much of the tissue on his nose would have to be removed.
For Dr. Michael Goldenhersh, a leading dermatologist in Israel, basal cell carcinomas are an everyday occurrence.
“Every day I see a patient with basal cell carcinoma,” Dr. Goldenhersh says, “and probably more than once a day. It’s extraordinarily common.”
Dr. Goldenhersh spent years studying special cells of the skin and skin pathology, first at Sloan Kettering Cancer Center in New York, and then at Yale University in New Haven, where eventually he was on the faculty of the dermatology program. He and his family made aliyah in 1985.
“It’s not unusual for a person to come in for some rash or other discomfort of the skin and then I’ll ask the patient if he’s had a complete body checkup recently. Nine times out of ten they’ll say no. Then, when I’m looking over their skin, I’ll find something suspicious, usually squamous cell carcinoma or basal cell carcinoma.”
While both these forms of skin cancer nearly never spread beyond the skin, if left unchecked for long periods of time they can do damage that can lead to deformity of the nose, ear, and other parts of the head.
What is the most prominent cancer in the world? Non-melanoma skin cancer, and basal cell carcinoma is four times as prevalent as squamous cell carcinoma.
“Fortunately, if it’s surgically removed that’s the end of it,” Dr. Goldenhersh reminds us.
According to the Israel Cancer Association, melanoma rates are dropping in Israel, while the men most at risk for both melanoma and non-melanoma skin cancer are those of European and American descent. The majority of those diagnosed with the disease are 55 years old or more. According to the ICA (Israel Cancer Association), Israel now ranks 13th in the world for men and 20th for women in cases of melanoma. Yet, in a recent interview with 600 interviewees, about 90 percent did not think they were at risk of developing skin cancer.
But things are changing. People are becoming more aware of the dangers of ultraviolet light. It’s no longer “cool” to bake in the sun until you’re brown all over. And there seems to be a begrudging awareness, even from the older sacra population, that wearing a
kova tembel to block out the sun is just not enough.
For those of us interested in learning how to protect ourselves from the dangers of melanoma, here are some face-saving suggestions.
The age-old adage “Timing is everything” works for sun protection, too.
“A rule of thumb is that at 12 noon, the amount of ultraviolet exposure is four times the amount that you would get at 8 a.m. or 4 p.m.,” says Dr. Goldenhersh. “That means by choosing your hours to go to the beach you can reduce your exposure to UV rays more effectively than any sunscreen on the market.
“In addition, the best form of sun protection for your face and neck – the most prominent places for basal cell carcinoma – is to wear a hat. Ideally, the brim should be at least 10 centimeters (approximately 4 inches) around the complete circumference of your head in order to get protection for the back of your neck, as well as your nose and forehead.”
Most people believe that sunscreen with a relatively high SPF (Sun Protection Factor) can keep not only sunburn but also ultraviolet rays from their bodies. However, what the SPF measures is how much longer it would take you to get a specific degree of redness using sunscreen, compared to subjecting your body to the sun’s rays without the sun protection factor. So, if you put on a cream with SPF 15 it means that it will take 15 times longer for you to develop redness on your skin from the sun than it would have had you not used the SPF 15 cream. Of course, that holds true as long as you put on a lot of sunscreen at least every two hours. In short, sunscreen works to keep you from burning. But how effective is it in thwarting the sun’s ultraviolet rays?
“There is no conclusive proof that sunscreen use prevents basal cell carcinoma,” insists Dr. Goldenhersh. “What I’m saying is that I don’t believe people should rely on sunscreen as the best method of preventing skin cancer. Instead, I believe the main way to prevent skin cancer is first of all avoidance. Actually, it may be detrimental for people to believe they are getting adequate UV protection by using sunscreen. That’s been demonstrated experimentally. A group of young people were given sunscreen with a high SPF. Naturally, the higher the number they received, the longer they stayed out in the sun because the natural feeling of getting burned was taken away. In the end, the young people spent hours longer without UV protection, creating a false sense of security.”
So, it’s important to realize that exposure to the sun, with or without sunscreen can lead to melanoma. Our best defense should be to dress appropriately against the sun, wear a broad-brimmed hat, and stay away from the sun’s rays when they are at their peak.
A recent study showed that most melanomas are actually not discovered by doctors but rather by the patient or by friends of the family. Below is information that will help you understand what you’re looking for before going to a dermatologist.
1. Pay attention to your body. If a beauty mark or mole changes color, or exhibits multiple colors, see a doctor.
2. Check to see if the borders of the mole on your body have become irregular, asymmetrical.
3. Has the topography of your mole changed? Where once it was pretty smooth across the mole’s surface, is it now elevated on one side and flat on the other.
Israel is a sunny country, with the sun’s rays beating down on us for a large part of the year. We might do well to remember that while the sun will come out tomorrow – we need to be prepared.
Yaacov Peterseil is the proprietor of SherlockS Hats For Men And Women, located in Jerusalem at both 31 King George St. and 9 Diskin St. He opened his first store soon after having basal cell carcinoma growths removed from his forehead, and decided to expand the business to help people prevent cancer of the skin and neck, while earning a living from it, as well
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