Some people drive by a beach lined with bodies tanning under the summer sun and see the ultimate expression of Southern California's hedonistic lifestyle. Dermatologists such as Dr. Daniel Gross see future patients.
"I think to myself, 'Geez, why would people do that, hurt their skin?' " he said. "I have absolutely no desire to lay on the beach and damage my skin. I'm too busy treating all the problems."
For Gross and other dermatologists in the San Fernando Valley, the problems have included a veritable tidal wave of tumors. "I've seen an enormous amount of skin cancer," said Gross, who practices in Tarzana. "It has become my practice."
Extensive publicity in recent years of the dangers of sun exposure may have induced many Americans to protect themselves from the dangerous ultraviolet rays. But with another hot Valley summer upon us and with an alarming increase in the incidence of melanoma, the most serious form of skin cancer, Gross and his colleagues are urging people to be more vigilant than ever.
"There are still a lot of people doing tanning salons in spite of all the publicity," said Dr. Norman Brooks, an Encino-based dermatologist. "A lot of teens and young adults still believe the ideal appearance is a tan."
While it is not easy to gauge the severity of the skin cancer problem in the Valley, the region is in line with national trends--perhaps even more so given its climate and large population of white people who tend to be more susceptible than other ethnic groups to the disease.
"It's warm in the San Fernando Valley, even compared with other areas of Los Angeles," Gross said. "If anything, the lifestyle involves more sun exposure and less clothing."
According to a recent state report, nearly 2,500 people were diagnosed with melanoma in Los Angeles County between 1988 and 1990. That translates into a rate of 9.3 cases per 100,000 of the population. But given its relatively large proportion of whites, the Valley could have a rate as high as the statewide rate of 10.4 or even the statewide rate for whites of 13.7.
Rates for the two non-melanoma cancers--basal cell and squamous cell--are 18 times higher than the melanoma rate.
Local dermatologists have plenty of circumstantial evidence of the severity of the problem, particularly in the case of melanomas. "I've seen three new melanoma patients this week," Brooks said recently. "It's almost unbelievable."
"When I first began practicing, I saw one melanoma every few years," agreed Gross, who is also an associate clinical professor of dermatology at UCLA. "Now I see one every few months. The number of melanomas has increased dramatically and that's borne out by the medical literature."
Experts are still groping to explain the increase: It could be those bygone years of unprotected sun exposure coming home to roost after a long incubation period or the result of ozone layer depletion. But Valley specialists have no doubt about the seriousness of melanoma, particularly if it is not diagnosed at an early stage.
Dr. Allan Wirtzer, a Van Nuys dermatologist, recalled the recent case of a 29-year-old whose wife had been nagging him about a growth on his face for a year. "By the time he came to see me, it had metastasized to his nose and it was too late. Now he's living out his last days."
Dawn, a patient of Gross who declined to give her last name, can also vouch for the importance of early detection. After noticing a pimple on her cheek, she waited several months before seeing Gross who diagnosed it as a basal cell carcinoma. The Encino resident then underwent nearly an hour's surgery to have it removed and was left with a large scar. "The cancer had gone deeper," she explained.
Surgical removal of tumors is still the most common form of treatment. But specialists in the Valley are offering a wide range of alternatives, including everything from fruit or "alpha-hydroxy" acids that have proven effective in treating pre-cancerous lesions to a technique called "Derm-Abrasion," which involves sanding down the skin with a spinning wheel made of diamond chips.
Brooks is a fervent advocate of a procedure called Mohs Microscopic Surgery, developed by a University of Wisconsin specialist and most commonly used to treat recurring skin cancers. Often combined with an application of zinc chloride to kill the cancerous cells, the surgery "allows you to trace the root of the cancer and preserve tissue at the same time," he said.
According to Gross, cure rates are improving through a combination of prompt diagnosis and treatment. But while patients can be hopeful of a lifetime cure, experts stress that prevention is the key to battling skin cancer. "The overwhelming majority of cancers I've treated were avoidable," Gross said.
For most people, prevention is as simple as using sunscreen. Wirtzer even advocates putting it on every morning, rather than just at the beach or just on sunny days. "When you're living in Southern California, there's no day that's inappropriate to use sunscreen," he said. "Men can use it like an after shave, women like a moisturizer."
Staying out of the sun between the zenith hours of 10 a.m. to 3 p.m., wearing wide-brimmed hats, and regularly examining your own skin are other measures commonly recommended by the specialists. Of course, that might mean forgoing the deep tan of yesteryear and the compliments that go with it. But the alternative could be far worse.
As Wirtzer put it, "Our skin develops a tan as a result of an injury. No tan is a safe tan."
According to recent statistics, skin cancer is increasing at an alarming rate in the United States. While all three forms of the disease are being diagnosed with growing frequency, experts say the increase in melanoma--the most serious form--is particularly worrying. Melanoma rates in Los Angeles County are lower than the state as a whole although that may reflect a lower proportion of whites who are more susceptible to skin cancer than people of darker-skinned ethnicities. Experts are hoping that a combination of early diagnosis and new advanced treatments will reduce melanoma mortality.
MELANOMA IN L.A. COUNTY AND CALIFORNIA Cases per 100,000 people, 1988-90
Total Cases: L.A. County: 9.3 California: 10.4
Whites: L.A. County: 14.9 California: 13.7
Hispanic: L.A. County: 2 California: 2.5
Ages 60-64: L.A. County: 26.6 California: 26.3
SKIN CANCER IN THE UNITED STATES
* 1n 1993, over 700,000 new cases of skin cancer will be diagnosed, afflicting more people than any form of cancer. * In 1993, an estimated 9,100 people will die of skin cancer. Of those, 75% will die of malignant melonama. * Non-melanoma skin cancer is 18 times more common than melanoma. * The number of melanoma cases has nearly doubled in the last decade, whereas the population has increased by only 11%. * Malignant melanoma is the most frequent cancer in women in the United States aged 25-29.
ADVANCED TREATMENTS * Injectable Chemotherapy: One form uses interferon * Mohs Microsopic Surgery: Involves targeted scraping of skin layers * Alpha-Hydroxy Acids: Is effective with pre-cancerous lesions * Derm-Abrasion: Involves sanding away of skin with abrasive surface
Source: California Department of Health Services; Skin Cancer Foundation