1994_05 Insight May 1994

              May 4,1994
CALIFORNIA STATE UNIVERSITY. FRE8NO
nM-
Cancer: not just a mole,
everyone risks melanoma
*****
Page 9
iNSIGHT
Continued from Page 1
lower legs and in men, on the trunk or
heads and neck.
The disease begins in melanocytes,
or skin cells which produce the dark
protective pigment called melanin.
When the skin is exposed to sun,
melanoma cells produce the melanin,
making the skin darker. The darker or
suntanned skin then acts as partial
protection against the sun.
When the skin repeatedly is exposed to sun, melanoma cells continue to produce melanin, which is
why skin cancer appears as shades of
tan, brown and black.
ous than other types of skin cancer, is
its tendency to spread and destroy
nearby tissues and organs. Once colonics of melanoma cells reach vital
internal organs and grow, they are
very difficult to treat. When melanoma spreads, it most often affects
new locations of the skin, lymph
nodes, lungs, liver, brain or bones.
This is when melanoma becomes a
lethal form of cancer.
Who gets melanoma?
"Everybody can get melanoma,"
Ayoub said, "but some people are
more likely to get it than others."
Melanoma most often occur in
Caucasians, according to statistics
from the American Cancer Institute.
"Fair-skinned people with blonde
hair and blue or green eyes have a
greater risk of skin cancer," said Russ
Mclntyre, registered nurse at Saint
Agnes Hospital in Fresno.
Other high-risk groups are people
with skin that burns and freckles easily or have many or atypical moles.
The average adult has between 10
and 40 moles, according to the melanoma research report.
The risk of melanoma is also related to genetics. A family history of
melanoma includes a greater risk, especially when combined with other
high-risk characteristics.
But the danger of melanoma is not
limited to these groups.
"One is never totally protected,"
said Ayoub. "Everybody needs protection, no matter what color."
Ayoub said it was once believed
that dark brown or black skin was a
guarantee against melanoma. But research has shown that no one can be
considered free from the risk.
People with dark brown and black
skin can also develop this cancer,
especially on the palms of the hands,
the soles of the feet and under the
rruls.
Warning signs
Dermatologists often refer to the
" ABCD" warning signs of melanoma
in moles, asymmetry, border, color
and diamatcr. Changes of any of these
characteristics in a mole should be
examined by a dermotologist.
Other signs of melanoma are scaling, oozing or bleeding of a mole or a
change of the way the mole feels. It
may become hard, lumpy, itchy, swollen or tender. The mole w ay be flat or
parts may be raised above the skin
surface.
It can also appear as a new mole on
the body, as it did with Cederquist.
"Itwas definitely amolcthathadn't
been there before." she said.
Cederquist's cancerous mole
tics of melanoma. The color was un-
Asmmetry
The shape of one half
does not match the other.
JDorder
The edges are ragged,
notched or blurred
v-»olo
'dor
The color is uneven.
Shades of black, brown
or tan are present.
Areas of white, red
or blue may be seen.
Dia
Ziameter
There is a change in size.
even, with shadesoflighterand darker
brown and its edges were blurred.
"I was pretty sure there was something wrong. It wasn't particularly
big, but it had a strange shape and
color, and it kind of felt like a bump
on my leg. It was different than other
moles on my body," Ccdcrquist said.
What causes melanoma?
"More than 90 percent of skin cancer cases are directly related to the
effect of the sun," Ayoud said.
She said scientists have identified
ultraviolet radiation (UV) from the
sun as the single most important risk
factor of melanoma and other skin
cancers.
"I guess I enjoyed the sun too
much," Cederquist said.
And studies show the incidence of
melanoma has risen over the past 50
years, during which time Americans
have increased their sun exposure dramatically.
"Oui* lifestyle has changed,"
Cederquist said, referring to more
outdoor recreational
more emphasis on tanning.
But tanning alone is not the only
factor. Other factors influencing exposure to UV are wind, humidity,
heat, season and time of day. The
greatest exposure of UV radiation
occurs during summertime, between
10 a.m. and 2 p.m.
The power of UV also varies according to altitude and latitude. The
amount of UV radiation reaching the
earth increases at higher altitudes and
decreases with d istance from the Equator.
Also snow, sand and water increase
exposure, because they reflect UV
radiation.
11V i« so nnwerful that even though
only a small amount of the sun's u v*
radiation reaches the earth's surface,
it can cause major damage to the skin.
Fortunately, most of it is absorbed
by the ozone layer. However, scientists are concerned that the ozone layer
is thinning, which means allowing
more UV radiation to reach the earth,
causing a higher risk of melanoma.
"This is the skin cancer of the future," Ayoub said.
Protection
The U.S. Department of Health
and Human Services recommend sun
protection factor (SPF) 15 to be applied 30 minutes before sun exposure.
Rating from 2 to 15 SPF is required
by The U.S. Food and Drug Administration to be printed on all sunscreen
containers. The higher the SPF rating,
the higher the protection against UV
radiation.
"The danger is always present,"
Ayoub said. "Even when you're out
walking your dog, you're exposed to
ultraviolet radiation damaging to your
skin."
Ayoub said protection is necessary
for everybody at all times when exposed to sun.
Precautions should be followed
even on overcast days, because UV
radiation is still reaching the earth
about 80 percent as much as on a clear
day.
Cederquist said she knows she has
exaggerated suntanning.
"1 used to love being in the sun,"
she said, "but it's not worth it."
"I'm just happy they removed the
mole and the cancer is gone. I just
wish I knew before, because you never
know — it might come back."
Cederquist said she follows dermatologists' guidelines and always
uses high SPF when outside.
Her 10-inch long scar on her right
shin rcmindshcrcvery morning of the
power of the sun.
"I would be stupid not to take prc-
now," Cederquist said.
Natural, artificial sun
equally cancer causing
Christina Fonseca
 hood for developing skin cancer later in life.
INSIGHT "Bythctimewe'relOyearsold.we'veallhadallthe
sun exposure that we need." said Mariam Sleven,
administrative director for the Saint Agnes Cancer
Center.
According to research by the American Cancer
When Betsy got back from her tanning appointment, her roommate said to her, "Gee, you're really
tan." Betsy quickly replied, "Thanks!" Like Betsy,
many people mistakenly equate a suntan with good    Society, people are most exposed to UV radiation
looks and good health. What they don't realize is that    during childhood.
Betsy may have gotten a "killer" tan. Leo Schmike, spokesman for the American Cancer
Many people believe that by using a tanning bed. Society, said most adults work indoors so they just
they will get a "safe tan." When, in fact, a study done don't have the time to b£exposed to the sun's harmful
by the Council on Scientific Affairs has shown that rays. Although, an American Academy of Dermatology survey found that over two m illion people a day use
tanning salons, so the
^m^^i^mmmmm^^^ adult exposure is on the
rise, as is skin cancer.
reopie should be made
aware of the fact that
sunlight and tanning
booths are both hostile
to the skin."
—Jane Kardashian
uc — we can t say, 'stay
out of the sun completely,' that just
wouldn't be practical,"
Sleven said. "People really need to limit their
exposure to the sun, especially during the peak
hours. In Fresno, that's
from 10 o'clock in the
morning to about three
o'clock in the afternoon."
"We need to pay attention to how long wc
and not just that, wc need take
booths and lamps, has
been one reason for the
noma in the last 20 years.
Since 1973. reported
melanoma has increased
more than 80 percent.
"Melanoma is on the
rise because people tend
to have more time for
recreation and they
spend a lot more time
outdoors and the ozone
layer is getting depleted," said Dr. Jane	
Kardashian, a Fresno umiiMHBBBMBBBiiiiiiiiiiii™
dermatologist.
"People should be made aware of the fact that arc in the sun
sunlight and tanning booths are both hostile to the precautions when wc do go out," Sleven said,
skin. There is a misconception that 'While I can't get The American Academy of Dermatology suggests
a tan outside. 1 can go to a tanning booth and that's a using the "slip, slap, slop" method. That means slip on
safe tan,'" Kardashian said. a lone-sleeve shirt. slaD on ? wirir-hrimrrwi h*i and
"The bottom line is there is no 'safe tan' because a slop on some sunscreen,
tan is really a representation of dead skin — it's just It is very important that you use all three compo-
pigmented dead skin. You are going to prematurely nents of this method because sunscreen doesn't block
age your skin and expose yourself to skin cancers out 100 percent of the UV rays. It's like a screen door
down the line if you continue to tan." trying to keep out the breeze, irjustVan't do it.
A 1989 study by the Skin Cancer Foundation re- "There's no such thing as a total block. Itdependson
vealcd that people that use tanning beds one to three the SPF, or the sun protective factor, of the sunscreen,"
times a year had twice the risk of developing mela- Kardashian said. "If it's a low number then you don't
noma; those who used them four times a year had get as much protection and you'll tan through that."
nearly four times the risk; and those who used the "They have SPF 4, which I really don't think pro-
machines more man 10 times a year had more than vides much protection at all, and they have SPF 50,
eight times the risk. which provides much more protection," Kardashian
In a 1990 study, the Skin Cancer Foundation found said. "What that represents is a ration of the amount of
that people that have tanning beds or lamps in their time you can stay out with the sunscreen versus the
homes have even a higher risk of skin cancer than amount of time you can stay out without a sunscreen
those who go to commercial tanning parlors because and get burnt."
home tanning beds are not regulated or restricted. "Forcxample.lct'ssay you stay out for five minutes
The Food and Drug Administration found that beforcyougetyourfirstpinkingrcaction.ihenyouput
radiation from tanning booths can be more intense at a sunscreen on and you go out in the same time of day
the surface of the skin and thus, produces its effect in and you're wearing a SPF 15. Well, you can stay out 5
a shorter amount of time. A high dose of radiation minutes times 15, which is roughly 75 minutes, versus
during a short time causes sunburn, which in turn, is the 5 minutes before you would start to get pink,"
more likely to cause skin cancer. Kardashian said.
Most people don't realize that a suntan is a sign of Dr. Kardashian has been practicing in Fresno for 10
skin damage. And with more exposure to harmful UV years. She has seen about 50,000 patients,
radiation, comes more damage to the skin. A person "On a normal week, 1 usually pick up about 10 to 15
who keeps going out and getting sunburns on top of basal cells. This has been a very bad month, I just
sunburns has a greater risk of getting skin cancer. picked up two melanomas," she said.
Studies show that the amount of sun a person is "Whin 1 say, 'bad,' I mean 1 don't like to sec that
exposed to during childhood is crucial to the likcli- because it can be a very fatal type of skin cancer."
Waste: Serious penalties for violations of waste treatment law
Continued from Page 1
St. Agnes, said there arc further classifications that are common at local
hospitals.
Medical waste classifications
Chemical wastes are products
brought into the hospital's waste system. An example is B5 fixative, a
chemical mixture of mercuro chloride, sodium acetate and distilled
water which is used in labs to add
clarity to microscopic slides used in
tissue sampling, he said.
Esparza said the hospital generates a gallon of the fixative every two
months. "Wc don't use a lot of the
product because of the way it has to
be disposed," he said.
Thcmcrcurochloride is transported
and recycled at a Texas site registered
to receive mercury, Esparza said.
AccordingtoDean Mitchell,chemistry professor at CSUF. exposure to
mercury can cause deafness and explosive speech patterns.
"(Mercury)doescertainly have two
effects." Mitchell said. "It goes to the
brain and affects the centers there."
Broken themometers emit a significant concentration of mercury, he
said.
"My understanding is that they can
be quite toxic," Mitchell said. "Blood
borne pathogens and radioactive materials are certainly of danger. Some
exposure effects are not known. Almost all environmental contaminants
can have health effects."
By law, biohazardous waste is
stored in red bags and specially
marked containers. At St. Agnes,
Esparza estimates that 800 to 1,000
pounds of biohazardous waste is gen-
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crated weekly.
Anything that can poke or cut an
individual is deemed sharps waste
and is biohazardous, he said. Scalpels, test plates and test tubes are
among sharps waste.
An onsite storage facility holds
medical waste at St. Agnes. According to the Medical Waste Management Act, a facility generating 20 or
more pounds of medical waste per
month must not store it for more than
seven days.
After seven days, the waste must
be picked up and transported by a
licensed medical waste hauler.
Esparza said chemotherapy waste,
which is mainly a mixture of raw
drugs, arc identified in separate yellow buckets.
The hospital generates about five
gallons every two months.
Radioactive waste, which is produced by nuclear medicine, is kept in
a storage building apart from the
biohazardous and chemical waste. By
law, radioactive waste can be kept
onsite for 90 days.
According to Esparza, a technician
periodically checks the radioactive
waste for activity.
If the waste is not active, it can be
disposed with the regular solid waste,
he said.
Recognizable human body pans or
tissues and surgical specimens are
deemed pathological waste and must
be incinerated. Amputation and autopsy remains arc examples of pathological waste.
Waste treatment
Incineration is the method for treat-
1280 degrees for 45 minutes.
"There arc a lot of safety precautions involved in a process like this,"
Pierce said. "Safely is a big issue."
Following sterilization, the waste
is compacted, deemed as solid waste,
and then transported to a solid waste
ing pathological and chemotherapy    landfill, where it is buried.
waste, said Nita Pierce, director of
environmental services at Valley
Children's Hospital.
Chateau Fresno, a landfill operated
by BFI, is designated to accept medical waste. "The general public is not
California has incineration plants    exposed to processed medical waste
in Oakland, Rancho Cordova and
Colton that are registered to accept
pathological and chemotherapy waste,
according to Al Raymond, district
manager of BFI Medical Waste Systems, which transports medical waste
for health care facilities.
Autoclaving and steam sterilization are methods by which all
biohazardous waste, except chemotherapy, chemical and pathological
waste, is rendered non-hazardous.
Pierce said.
Because Valley Children's Hospital specializes in the treatment of
that is dumped in the landfill,"
Raymond said. "We continue to take
precautions that the general public
docs not come in contact with that
waste."
Pierce said hospitals arc responsible for medical waste from "cradle
to grave."
Valley Children's Hospital has a
contract with BFI for pathological
waste disposal. Pierce declined to state
how much the facility pays for removal and disposal.
"Once the chemical comes into
your facility, any repercussions bc-
youngsters, Pierce said the facility    come your responsibility," she said.
generates a lot of infectious waste,
which is autoclavcd.
The Medical Waste Management
Act stipulates that steam sterilization
must take place at 250 degrees for at
least a half hour. At Valley Children's
Hospital, sterilization is done onsite
All hospital employees are trained
handle medical waste and training
il continuous, she said.
Employees are outfitted with protective gloves, gowns, lab coats and
respirators according to the type of
waste they arc handling. Pierce said.
Enforcement of the Act
State law regarding medical waste
has just begun to evolve within the
past couple of years. One of the ramifications of the Medical Waste Management Act is that it has become
difficult to keep track of the amounts
of medical waste generated locally,
said Jerry Perctto. manager for the
Fresno County DcvclopmcntScrviccs
and Resources.
Once medical waste is autoclavcd
and compacted, it becomes classified
as solid waste, he said. Therefore.
Perctto said, exact amounts of medical waste arc hard to determine.
According to Schott, facilities that
generate, transport and store medical
waste in Fresno arc regulated by die
state health department. An annual
inspection is carried out by the department to check for compliance with
the law.
Violations of the law can be stiff.
The pcnalites range from suspension
to revocation of medical waste permits, he sajd.
Schotfsaid facilities in Fresno were
inspected at the beginning of the year,
but he was not aware of any violations.
"Generally, in practice, most of the
people in the health care community
arc inclined to do things the right
way." Schott said.
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