Moffitt Momentum

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Skin Cancer Knows No Limits

It’s a common misperception that people with darker skin do not get skin cancer, but it is not true. The fact is that skin cancer rates are increasing among minority groups in the United States.

“African-Americans and all races – regardless of skin color – are susceptible to melanoma and other forms of skin cancer, although in most skin cancer types the incidence rate is lower in African-Americans,” says Vernon Sondak, M.D., department chair and program leader, Cutaneous Oncology, at Moffitt Cancer Center.

Even more troubling – melanoma, the most serious form of skin cancer, is more likely to be diagnosed at a later stage in blacks and Hispanics, according to study findings published in the June 2006 issue of the Archives of Dermatology. The study was based on an analysis of melanoma cases reported to the Florida Cancer Data System for residents of Miami-Dade County from 1997 to 2002.

Authors of a University of Miami study that was published in the July 2008 issue of Cancer Control, the Journal of the Moffitt Cancer Center, indicated that public health education and prevention efforts have led to earlier detection of melanoma in the white population. However, in the United States there has not been an improvement in early melanoma diagnosis among blacks or Hispanics. Earlier diagnosis of melanoma, when the disease is easier to treat and cure, will improve melanoma survival in minority populations.

“People need to understand that the sun is not their friend,” says Dr. Sondak. “No matter your skin tone, everyone is at risk for developing skin cancer.”

Any amount of sun exposure that changes the appearance of your skin is doing damage, both in the short term and long term, to your body.

Skin cancer may show up differently on dark-skinned individuals than on Caucasians because of the differences in skin pigmentation, notes Dr. Sondak. This factor can make it more difficult for doctors to diagnose, which leads to later detection and treatment.  It’s important to be aware and get a screening anytime there is a concern.

Melanoma Survivor Cautions Against "False Security"
“All of the information on melanoma lists fair-skinned Caucasians for being at high risk. This gives others a false sense of security,” says Jacqueline (“Jackie”) Smith, an African-American melanoma survivor. Smith, now completing her Ph.D. at Syracuse University in New York, knows first-hand how serious melanoma can be.

She had been misdiagnosed and told by doctors that the lump in her groin was nothing to worry about. She knew something wasn’t right and persistently sought more information and finally had a biopsy. Shortly after starting her doctoral program she was diagnosed with melanoma. She returned home to Florida and came to Moffitt Cancer Center for surgery and additional treatment. Today her life is back on track, and she is an advocate for skin cancer prevention and early detection. “Everyone needs to protect themselves against sun damage. It takes seconds to put on sunscreen but few use it regularly,” says Smith. “It is important that we start taking preventive measures with our health.”

Moffitt Cancer Center’s 2007 annual report (“Moffitt In Motion”) describes Smith’s experience, along with innovative melanoma research being conducted at Moffitt.

Sun Damage Prevention Is Essential
“Along with more effective prevention habits, people should also be more proactive in detecting possible skin cancers,” says Dr. Sondak. “When not detected early enough, melanoma is one of the toughest forms of cancer that we treat at Moffitt. You should become more familiar with your skin and visit your dermatologist on a regular basis to detect any suspicious changes.”

Anyone who is going to be out in the sun for any period of time needs to wear the proper attire that provides sun protection and liberally apply sunscreen that blocks UVA and UVB rays, notes Dr. Sondak. In addition to skin cancer prevention measures, including covering up, using sunscreen with a sun protection factor (SPF) of 15 or higher and limiting direct exposure during midday, it’s essential to examine your own skin regularly and have your doctor carefully check your skin during part of your routine cancer-related checkups.

Moffitt Leads The Way In Skin Cancer Prevention Awareness
Moffitt is taking skin cancer prevention out into the community through a number of educational outreach programs.

The M-POWER Program Health Educators provide workshops on skin cancer for both adults and children. M-POWER stands for “Moffitt Program for Outreach Wellness Education & Resources.”

“The workshops focus on ways in which everyone can work to be sun wise,” says Moffitt health educator LaShonda Coulbertson. “As part of these workshops we distribute brochures, and have worked in partnership with other agencies to provide sunscreen, glasses and activity books for kids.”

M-POWER also partners with the Mole Patrol team at Moffitt to provide lectures or screenings to underserved communities as requests are received. As part of larger health events targeting underserved communities, M-POWER does presentations on skin cancer prevention and sun safety.

Moffitt Patient/Family Testimonial:

Betty Crump: "I knew I had the best and everything would be fine."

By Alexandra Harris

Betty Crump’s excitement for life and appreciation for learning has always kept her active. When she began to experience strange, differing symptoms that over the years began to cause gradual debilitation, she knew something was wrong.

After seeing 27 doctors in three states and receiving multiple misdiagnoses, Crump was feeling discouraged. Following one particularly frustrating appointment, she remembered her neighbor, who had gone through a similar experience several years earlier and was very impressed by the care he received at a facility in Florida that specialized in spine problems.

By this time, Crump was experiencing falls leading to broken bones and paralysis on the right side of her body. She was willing to travel from her hometown in Anderson, S.C., so she called the institute her friend recommended and made an appointment with a doctor who immediately scheduled a brain and neck MRI and discovered a benign tumor at the top of her spine. As the tumor had grown, it pressed on the top of her spinal cord until there was almost no space for spinal fluid to pass through, thus causing the paralysis. The doctor stressed the importance of using a highly experienced neurosurgeon, as her case was a complicated one, and she was referred to Frank Vrionis, M.D., Ph.D., at Moffitt Cancer Center.

“I was so relieved when I got the diagnosis that someone finally knew what my problem was, even though it was a serious matter,” says Crump. “After meeting Dr. Vrionis, his primary nurse Mandy [Mandy Sullivan, R.N.], and the surgical team, I had total peace about it. I knew I had the best and everything would be fine.”

The delicate surgical procedure went according to plan, and her symptoms began improving immediately. The tumor, a meningioma, was resected completely through the side of her neck. After the surgery, she was moved to rehabilitation at a nearby hospital, where she was discharged just in time for her to make it home two days before Christmas 2005.

Back in S.C., she began therapy sessions three times a week and continued improving. Two weeks after she was home and in therapy, she was able to move around without the assistance of her walker. She and her husband Bobby Crump celebrated a special anniversary shortly after she returned home. “We made 50 years together three months after Moffitt,” she says.

Three and one-half years later, she is totally independent, living a normal life. In addition to her hobbies that include reading, writing, gardening and traveling, Crump is very involved in her church, where she participates in mission work, the choir, the senior citizens group and Sunday school. She also serves on her church personnel committee and writes a devotional speech each month.

Although she has experienced many grand things throughout her life, she considers the journey she went on because of her illness the greatest of all.

“Faith, wise minds with skilled hands and caring hearts can not only move mountains, but move impossible tumors as well,” she says. “I feel that God saved the best for me. It was meant for me to meet the people who took care of me at Moffitt.”

Melanoma Quiz:

Cancer Answers:

Q&A: The Facts About Melanoma

Q: Do I still need to protect myself from skin cancer if I’m African-American?

A: Yes. Although darker skin provides some protection from the sun's ultraviolet rays, you cannot afford to overlook sun protection. Skin cancer is less common among African-Americans, but it can be more deadly because it is not always detected early. Each day you will be out in the sun for a prolonged period apply a sunscreen or moisturizer with an SPF of 15 to 30. Be sure to reapply often when you are spending time in direct sunlight.

Symptom Checker: Change in the appearance of an existing mole

According to the National Cancer Institute, the first sign of melanoma often is a change in the size, shape, color, or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new mole. It may be black, abnormal, or “ugly looking.” Be sure to check your skin regularly for any changes. If you have a question or concern about something on your skin, see your doctor. Do not try to diagnose skin cancer yourself.

Thinking of “ABCD” can help you remember what to watch for:
A – asymmetrical. The shape of one side does not match that of the other side.
B – border. The border is irregular.
C – color. The color is uneven, and several shades of color may be present.
D – diameter. There is a change in size, usually an increase.

Melanomas can vary greatly in how they look. Many show all of the ABCD features. However, some may show changes or abnormalities in only one or two of the ABCD features.

Moffitt Morsels – Healthy Recipes For Healthy Living

Breakfast Fruit Wrap:

Ingredients:

1 tortilla, preferably whole wheat
2 tsp. "fruit only" strawberry preserves
2 Tbsp. reduced fat ricotta cheese
1/3 - 1/2 cup sliced fresh strawberries
2 Tbsp. sliced almonds, toasted

Instructions:

On a flat surface, spread preserves on tortilla. Top with ricotta cheese. Carefully top with sliced fruit. Sprinkle with sliced almonds. Starting from one end, roll tightly. Wrap in foil for neater eating. Makes 1 fruit wrap. Variation: Spread tortilla with apricot preserves and use sliced fresh or canned, well-drained peaches.

Nutritional Information:

Per serving: 231 calories, 9 g fat (2 g saturated fat), 34 g carbohydrate, 9 g protein, 4 g dietary fiber, 213 mg sodium.

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Broccoli, Cherry Tomato and Watercress Salad:

Ingredients:

2 cups broccoli florets
1 Tbsp. red wine vinegar
1 Tbsp. olive oil
1/2 tsp. minced garlic
Salt and freshly ground black pepper to taste
2 cups cherry tomatoes, stems removed and cut in half
1 bunch watercress, long stems trimmed, coarsely chopped

Instructions:

In vegetable steamer set over boiling water, steam broccoli, covered, until tender, about 4 minutes. Rinse with cold water; drain well. In large bowl, whisk vinegar, olive oil, garlic, salt and black pepper. Add broccoli, tomatoes and watercress. Toss to blend. Serve immediately.

Nutritional Information:

Makes 4 servings. Per serving: 58 calories, 4 g total fat (<1 g saturated fat), 6 g carbohydrates, 2 g protein, 2 g dietary fiber, 20 mg sodium.

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Easy But Elegant Risotto:

Ingredients:

2 Tbsp. butter or transfat-free spread
1 small red onion, finely chopped
1 1/2 cups Arborio rice
3 Tbsp. fresh lemon juice
3 cups fat-free, reduced-sodium chicken broth
8 thin asparagus, cut in 1-inch pieces
1/2 lb. medium shrimp, shelled and halved lengthwise
1/2 lb. mussels, rinsed and drained, for garnish
Salt and freshly ground white pepper
1/ 4 cup freshly grated Grana or Parmesan cheese

Instructions:

Preheat the oven to 450 degrees. In a deep, oven-proof skillet, melt the butter over medium-high heat. Add the onion and rice. Stir until onion is translucent and rice is opaque, about 2 minutes. Add the lemon juice and cook until evaporated, stirring constantly. Pour in the broth and 1 cup water. Remove from heat.

Cover with a large sheet of foil, pressing it down to touch the surface of the liquid. Seal the foil around the rim of the pan. Cover pan with a tight lid. Bake the risotto 25 minutes.

Meanwhile, boil 1 cup water in a medium saucepan. Add the asparagus and cook 2 minutes. Transfer the asparagus to a bowl. Add the shrimp to the pot. When pink and curled, add them to the bowl. Place the mussels in the pot, cover and cook until opened, about 2 minutes. Drain and set aside.

Remove the risotto from the oven and place it on top of the stove. Slowly peel off the foil, starting from the side furthest from you. Mix in the cheese, asparagus and shrimp. (Use oven mitts to prevent steam burns.) Season to taste with salt and pepper. Serve in shallow soup bowls or plates, using the mussels as garnish.

Nutritional Information:

Makes 4 main-course servings. Per serving: 279 calories, 8 g total fat (5 g saturated fat), 32 g carbohydrate, 19 g protein, 1 g dietary fiber, 570 mg sodium.

Recipe Source:
American Institute for Cancer Research

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