Burned by the Sun
Just a mole, or worse? Find out what you need to know to keep your skin healthy.
By LISA BENDALL

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Lisa fera of Toronto was just in her early 30s when she noticed the small blemish on her face. It appeared on the left side of her face where the nose meets the cheek and looked like an ordinary whitehead. It never occurred to her that it might be anything more serious than a pimple.
Despite having fair skin and freckles, Fera had spent hours in the summer sun without a hat or sunscreen while growing up. She and her sister lounged by the swimming pool and played outdoor sports like soccer and tennis. Like most Canadian parents in the 1970s, their mother encouraged the girls to be out in the sunshine and fresh air.

And notwithstanding the agonizing burns she sometimes suffered, Fera, who had used a tanning bed several times, didn’t consider the sun’s rays to be harmful. “I thought skin cancer was rare,” she says, “and something only older people got.”
The whitish spot on Fera’s face
didn’t go away, but for years she remained unconcerned. It wasn’t until 2003, when she was sitting in a dermatologist’s office to ask about a mole on her chest—which proved harmless—that she casually pointed out the spot.
“The doctor looked at it, touched it and immediately said, ‘That’s not a blemish, that’s skin cancer,’” Fera remembers. At 35, she was diagnosed with basal-cell

Dream Cream? Aldara (imiquimod), a cream originally created to treat genital warts, has been used successfully on some basal-cell skin cancers. But is it a miracle cure? Dr. Jason Rivers of the Skin Care Centre in Vancouver says it works best on precancerous lesions or on superficial types of basal-cell cancers. “Aldara has an 80 percent cure rate,” he says. “With conventional surgery, the cure rate is 93 to 95 percent.” Aldara also takes weeks to work and has side effects.

A Growing Problem
Skin cancer used to be considered an affliction mainly of older people, and indeed, it is rising among those over 50. Almost 80,000 Canadians are diagnosed each year with nonmelanoma skin cancer. Some 60,000 to 70,000 of these are basal cell, and the rest are squamous cell. If left untreated, these skin cancers may become invasive and require fairly major surgery. But they rarely metastasize and are relatively easy to cure if caught early.
Then there’s melanoma, the more dangerous type of skin cancer. About 4,500 new cases will be diagnosed this year, and almost 900 people will die of it. In the past two decades, the death rate for Canadians with melanoma has risen a frightening 41 percent in men—the highest increase of all cancers—and 23 percent in women. And while few studies have been done, there’s new evidence that the incidence of all three kinds of skin cancer is also growing among the young—to an extent doctors haven’t seen before.
“The trend is unmistakable,” says Dr. Mariusz Sapijaszko, a dermatologist at the Western Canada Dermatology Institute in Edmonton. “Younger and younger people are seeing us to diagnose and treat skin cancers. I have colleagues who, 15 years ago, rarely saw anybody under 30. But now we see at least a few a week, with a variety of skin cancers—primarily basal- and squamous-cell carcinomas, but occasionally melanoma. We’ve even had teenagers with skin cancers.”
A groundbreaking 2005 study by the Mayo Clinic in Minnesota showed a rise in the incidence of basal-cell and squamous-cell carcinomas in people under 40. The study got a lot of attention. Still, some have asked why we should worry about the increase since these cancers are so often curable. “A basal-cell or squamous-cell cancer may not be deadly,” says Dr. Leslie J. Christenson, a dermatological surgeon and the study’s lead author, “but the treatment can be very disfiguring. A large percentage of these tumours occur around the head and neck. If you’re a 30-year-old and now have a scar on your nose or upper lip or temple, it will impact you—on dates, at job interviews. That’s a big thing for a young person to live with for the rest of their life.”
Fera’s dermatologist biopsied her skin that same day, and as soon as the results were in, she was booked to be seen at Toronto Sunnybrook Regional