Running head: SKIN CANCER 1

Skin Cancer in Washington County, Utah

McKenzie Harmon

Brigham Young University-Idaho

SKIN CANCER 2

Skin Cancer in Washington County

Defining the Population

When people hear the word cancer they start to get anxious because they do not

understand it. There has been much research that has been conducted on cancer, but there is still

much to learn about it. There are many different types of cancer. Skin cancer is the most

common type of cancer in the United States (Centers for Disease Control and Prevention [CDC],

2018). There are multiple types of skin cancer. According to the CDC (2018), the two most

common types of skin cancer are basal and squamous cell cancers. Melanoma is the third most

universal type of skin cancer, but it is the deadliest out of these three types (CDC, 2018).

According to the CDC (2018), overexposure to ultraviolet lights (UV) from tanning beds

increases the likelihood of all three types of skin cancer. Melanoma develops from melanocytes

(CDC, 2018). Melanocytes are the cells that give color to the skin (CDC, 2018). Melanocytes

can create noncancerous growths called moles (CDC, 2018). Skin cancer forms when there is

abnormal growth of skin cells after the cells have been damaged due to UV radiation (Skin

Cancer Foundation, 2018). If people protect their skin from UV light they are less likely to

develop skin cancer.

It is important for people to understand what skin cancer is and how it can be prevented.

Skin cancer mostly occurs due to environmental factors, but genetics can play a role (National

Human Genome Research Institution [NIH], 2012). Skin cancer does not appear overnight.

Continuous exposure to UV light will increase the likelihood of people being diagnosed with

skin cancer. Skin cancer is mostly diagnosed in people over the age of 50 (NIH, 2012).

According to the National Human Genome Research Institution [NIH] (2012), the damaging

effects of UV radiation begins at an earlier age. According to the CDC (2018), the rates of 18-

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30-year-old white non-Hispanic female in 2010 who used artificial UV radiation to tan were

between 22-32 percent. Thirty-two percent are between the ages of 18-21 years old (CDC, 2018).

Thirty percent are between the ages of 22-25 (CDC, 2018). Twenty-two percent are between the

ages of 26-29 (CDC, 2018). A major source of artificial UV radiation can come from tanning

beds. It is essential to teach younger populations to avoid tanning beds. UV radiation can damage

DNA which results in a mutation in the genetic code (NIH, 2012). Once cells have been

damaged by UV light the damaged cells may start to multiply. The damaged cells can affect

other tissues and the cancer may spread (American Cancer Society, 2017). It is important to

protect the skin now from overexposure so that there are not devasting consequences down the

road.

Skin cancer is a large health concern because more people are diagnosed with skin cancer

each year than any other cancer (Skin Cancer Foundation, 2018). According to the Skin Cancer

Foundation (2018), treatment and diagnosis of nonmelanoma skin cancer has increased by 77

percent from 1994 to 2014. Melanoma is the most dangerous of the three types of skin cancer.

According to Utah’s Health Department the rate of melanoma has increased from 20.5 per

100,000 in 2000 to 42.4 per 100,000 in 2014 (Public Health Indicator Based Information System

[IBIS], 2017). The graph below shows the growth of melanoma rates in the state of Utah.

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There are more cases of skin cancer being diagnosed every year. Many of these skin

cancer cases are being tied to indoor tanning beds (Skin Cancer Foundation, 2018). The Skin

Cancer Foundation (2018) explains that more than 419,000 cases in a year are linked to indoor

tanning beds. The 419,000 cases include 245,000 basal cell carcinoma, 168,000 squamous cell

carcinoma and 6,200 melanomas (Skin Cancer Foundation, 2018). According to the Skin Cancer

Foundation (2018), there are 15 states plus the District of Columbia that have prohibited

residents under the age of 18 access to tanning salons. This is a health concern because so many

people are going to tanning salons to darken their skin tone and are not being warned about the

dangers. Tanning beds increase the UV radiation exposure. It is important to educate the

community about the consequences that occur from overexposure to UV radiation.

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Healthy People 2020

The goal for Healthy People 2020 for cancer states, “reduce the new number of cancer

cases, as well as illness, disability and death caused by cancer” (Healthy People 2020, 2018, para

1). There are specific objectives to help obtain this goal. One of the objectives is C-20 which

states, “increase the proportion of persons who participate in behaviors that reduce their exposure

to harmful ultraviolet (UV) irradiation and avoid sunburn” (Healthy People 2020, 2018). Listed

under that objective are subtopics. Objective C-20.4 states, “Reduce the proportion of adults age

18 years and older who report artificial sources of ultraviolet light (UV) for tanning” (Healthy

People 2020, 2018). In this objective the baseline is 5.6 percent of adults age 18 and older report

using artificial sources of ultraviolet light (UV) for tanning in 2010 (Healthy People 2020, 2018).

The target percentage for 2020 is 3.6 percent (Healthy People 2020, 2018). On the chart below it

shows how the percentage of people 18 years or older are reporting the use of artificial sources

of UV light for tanning.

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According to Healthy People 2020 (2018), it states, the amount of people reporting the use of

artificial light for tanning over the age of 18 years old has decreased by 2 percent since 2010.

Specific Population

The population that will be assessed are 18-30-year-old male and female Caucasians

living in Washington County, Utah, who have an increase risk of skin cancer due to the use of

artificial light by using tanning beds.

Ethnicity. According to the 2017 Census, most of the population in Washington county

are White. Alone they make up 93.7 percent (United States Census Bureau, 2017). Black or

African American alone make up 0.8 percent of Washington county (United States Census

Bureau, 2017). American Indian or Alaska Native alone make up 1.7 percent of the population

(United States Census Bureau, 2017). Asian alone make up 0.9 percent of the population (United

States Census Bureau, 2017). Native Hawaiian and other Pacific Islander alone make up 0.9

percent of the population (United States Census Bureau, 2017).

(QuickFacts, 2017)

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Gender. The ratio of males to females in Washington county are pretty even in the

population. There are a few more females in Washington county than males. There are about a

1,000 more females (Suburban Stats, 2017).

Education. There is a university in Washington county. The name of the university is

Dixie State. The graph below shows what degrees are most pursued at Dixie State University.

According to DataUSA (2015), the majority of the students are completing a General Studies

degree at Dixie State University. DataUSA (2015) states, there are more females than males that

attend Dixie State University. In 2015, there were 1,493 female students and 1,372 male students

that graduated from Dixie State University (DataUSA, 2015). Dixie State University was

founded in 1911 and there concurrent enrollment is 8,350 students (Dixie State University,

2018).

(DataUSA, 2015)

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Community

Washington county is in Southwest Utah. According to the Washington County

Historical Society (2018), Anasazi Indians inhabited Washington county until 1300 A.D. The

Paiute Indians arrived between 1100 and 1200 A.D. and still live in Washington county to this

day (Washington County Historical Society, 2018). In 1849 Brigham Young sent Elder Parley P.

Pratt and 50 other missionaries to southern Utah (Washington County Historical Society, 2018).

When Elder Pratt arrived, he felt impressed to have further settlement down in southern Utah

(Washington County Historical Society, 2018). Washington county was formed in March of

1852 (Washington County Historical Society, 2018). It was named after President George

Washington (Washington County Historical Society, 2018).

(Google Maps, n.d.)

Household income. The average household income has increased in Washington county

from $50,774 to $52,865 per year in 2016 (DataUSA, 2016). The median property value in

Washington county is $221,700 which is 1.08 percent greater than the national median property

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which is $205,000 (DataUSA, 2016). Between 2015 to 2016 the median property value increased

from $212,600 to $221,700 (DataUSA, 2016). Since the household income has increased along

with property value the poverty rate has increased (DataUSA, 2016). According to

CensusReporter (2016), the poverty level in Washington county is 13.3 percent. The poverty rate

in Washington county is 1.3 times greater than the poverty level in the state of Utah which is

10.3 percent (CensusReporter, 2016). The graph below shows the different amount of household

incomes and the percentage of people in each category.

(DataUSA, 2016)

Religion. According to Sperlings (n.d), 77.97 percent of people in St. George, Utah, the

largest city in Washington county, have a religious affiliation. Most of the 77.97 percent affiliate

with the Church of Jesus Christ of Latter Day Saints (Sperlings, n.d.). There are about 4.36

percent that affiliate with the Catholic Church, and 1.04 percent affiliate with a Christian faith

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(Sperlings, n.d.). The following graph shows the different religious affiliations in St. George,

Utah (Sperlings, n.d.).

(Sperlings, n.d.)

Marital status. According to the CensusReporter (2016), 57 percent of the community

are married. This statistic is higher than the martial status for the United States which is 49

percent (CensusReporter, 2016). There are between 25-33 percent of the community in

Washington county that have never been married (CensusReporter, 2016). Between 7-10 percent

of the community members are divorced (CensusReporter, 2016). The widowed rate is between

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2-8 percent (CensusReporter, 2016). Below is a graph that demonstrates the marital status of the

community of Washington county.

(CensusReporter, 2016)

Age. According to DataUSA (2016), the median age for Washington county has

increased for natives. Students attending Dixie State University in St. George, Utah, were not

included in the median age, unless they were born in Washington county (DataUSA, 2016). The

median age for Washington county is 34.5 years old (DataUSA, 2016). The graph below shows

the different age ranges for community members born in Washington county.

Activities in the community. One of the most popular places to visit in Washington

county is Zions National Park. Zions National Park became a national park in 1919 and was

renamed by President Woodrow Wilson (National Parks Conservation Association [NPCA],

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2018). The original name of the park was Mukuntuweap named after a southern Paiute by John

Wesley Powell in 1872 (NPCA, 2018). The name in Paiute means “straight canyon” or “straight

river” (NPCA, 2018). Zion has many trails that visitors can hike and enjoy the beautiful scenery.

Zion National Park averages about 2.7 million visitors per year (Las Vegas Review Journal,

2017). According to Las Vegas Review Journal (2017), Zion National Park hit a record of 4.4

million visitors by the end of November.

Plan

To generate data, two key informants will be interviewed. The first key-informant is an

Oncologist that works at the Intermountain Hospital in St. George who specializes in medical

oncology. The second key-informant will be a manager at a Tanning Salon in St. George, Utah.

The windshield survey will be conducted while riding in public transportation. The windshield

will observe how many tanning salons are in St. George, Utah. An additional interview will be

conducted with a person who was diagnosed with skin cancer. The individual is above the age of

30 and lives outside of Washington county. A final observational survey will be conducted. The

observational survey will include three different stores. The survey will observe how many

different sun protective items each store sells. Other resources that will be used to collect data

are Healthy People 2020, Centers for Disease Control and Prevention (CDC), The Skin Cancer

Foundation and National Human Genome Research Institution.

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Part 2 Health AssessmentPrimary Data

Key informant. As part of the assessment and gathering data, an Oncologist who works

for Intermountain Health Care was interviewed about skin cancer.

Oncologist at Intermountain Health Care

How frequently do people age 18-30 years old

screen for skin cancer?

Hardly ever. Most people age 18-30 years old

believe there are no health problems.

At what age should people start screening for

skin cancer?

The average person in the population should

have their first screening around age 40. If

they have a history of skin cancer in their

family, then they should be screened earlier.

How often do you recommend people to be

screened for skin cancer?

If the person is at a high risk for skin cancer,

then they should have an annual screening.

People who have fair skin, light color hair,

have a family history of skin cancer, or

burned a lot in their younger years are at a

higher risk for skin cancer. Primary doctors

usually complete the screenings.

How are tanning beds increasing the

likelihood of people being diagnosed with

skin cancer?

Tanning beds put people at a higher risk for

skin cancer because of the overexposure to

ultraviolet light. They are coming out more

with spray tans, so people do not spend as

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much time in tanning beds.

What is the common age range for people to

be diagnosed with skin cancer?

People are usually diagnosed with skin cancer

in their 50’s and 60’s. Skin cancer is a disease

of the elderly.

What are some alternatives from tanning beds

that you would recommend to your patients?

A lot of places now do spray tans. More

places are selling tanning lotions.

Is there a certain race/ethnicity that is more

likely to be diagnosed with skin cancer?

People with fair skin are more likely to be

diagnosed with skin cancer. Though, there are

Hispanics and African Americans that are

diagnosed with skin cancer.

What are some signs and symptoms of skin

cancer that people should be aware of?

People should be looking for new spots.

When they examine their moles, they should

use the ABCDE model. They should be

looking for asymmetry, borders, color

changes, diameter, and evolving.

Can people do self-checks at home for skin

cancer?

Yes, they can. It is recommended that people

look over their skin at least once a month.

What are some signs you advise people to

look for while doing self-checks?

People should be looking for changes in any

of their moles. They should be looking for

any new spots. They should complete the self-

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checks with a partner because some places are

hard to see.

What education do you provide for people

ages 18-30 regarding skin cancer?

The main thing is prevention. It should be

mandatory that people wear sunscreen to

protect their skin. Appling sunscreen should

be part of their daily routine. People should

wear hats more often when they are outside.

How long do screenings last? Primary doctors take about 5 minutes to do a

screening. They are reviewing the patients

skin for new spots. Dermatologists sometimes

will complete a more intense screening. They

will do skin mapping. Dermatologists will

take pictures of every mole the patient has on

their body. They will compare the pictures

from each visit. Dermatologists will perform

skin mapping on patients that are at a higher

risk for skin cancer.

As part of the assessment and gathering data, an employee from Planet Beach Spray &

Spa was interviewed to learn about tanning beds.

Planet Beach Spray & Spa Employee

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How often in a month do people visit a

tanning salon?

People on average visit tanning salons at least

3 times a week.

What is the average age of the visitors in the

tanning salon?

The average age of the visitors is 18 to 45

years old.

On average how long are the sessions in the

tanning beds?

There are two types of tanning beds in our

salon. We have tanning beds that go for 10

minutes and others that go for 30 minutes.

The tanning beds that go for 10 minutes have

a stronger light. The tanning beds that go for

30 minutes do not have as strong of light.

Which gender is more inclined to visit tanning

salons?

About 50 percent of our guests are males and

50 percent are females. Males ages 30-55

years old are more inclined to visit tanning

salons.

Is there a type of lotion that people can use to

protect their skin before using the tanning

bed?

There are tanning lotions that are offered at

the store. It is recommended to use tanning

lotions because people will have better

results.

Which race/ethnicity visits your tanning salon

more frequently?

Ninety percent of their visitors are Caucasian,

5 percent are Hispanic, and 5 percent are

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other races.

Interviews. The following person was interviewed because they were diagnosed with

skin cancer. The person interviewed lives outside of Washington county and is above the age of

30.

Adult Tested Positive for Skin Cancer

When you were told you might have skin

cancer what went through your mind?

I was very scared. The spot was on my nose. I

thought that the doctor would have to do

major surgery on my nose. I was afraid my

nose would be deformed after the surgery. I

was nervous after hearing the word cancer.

How did you feel when you tested positive for

skin cancer?

I was scared. I had heard that if you do not

take care of skin cancer that it can spread to

other parts of your body. It can destroy other

organs.

Have you changed any behaviors since you

have been tested positive for skin cancer?

I wear sunscreen every day. When I am

outside and there is a lot of sun, I will wear a

hat.

What recommendations did the doctor give

you after the lesion was removed?

He told me to wear sunscreen every day. He

told me to wear a hat whenever I am outside.

Before you were tested for skin cancer would

you wear sunscreen or a hat whenever you

I would try to wear sunscreen, but I did not

wear it every day. I would sometimes wear a

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were outside in the sun? hat.

Did you spend time in the sun trying to tan? Yes, I did.

Did you ever visit a tanning salon? No.

Did you go to a dermatologist or a hospital to

be tested for skin cancer?

I went to a dermatologist office. I showed the

dermatologist the spot on my nose and he said

that I had nothing to be worried about. He

found another spot on my nose and did a

biopsy on that spot. The other spot tested

positive for skin cancer.

What part of the body was tested for skin

cancer?

My nose.

Why did you get the lesion tested? I was putting on my make-up one morning. I

found a spot on my nose that was losing

color. I went to a dermatologist and they said

that I did not need to worry. I went to the eye

doctor for another appointment, and the eye

doctor advised that I get the spot on my nose

checked out. I went to a specialist who

specializes in facial reconstruction surgery.

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They tested the spot on my nose, and it tested

positive for skin cancer.

Windshield survey. As part of the windshield survey, public transportation was taken to

count the number of tanning salons in St. George, Utah. St. George is the largest city in

Washington county. During the windshield survey six tanning salons were spotted throughout

the city. According to the map below, there are 16 tanning salons in St. George, Utah.

(Google Maps, n.d.)

Observation. An additional survey was conducted in St. George, Utah. Three different

stores were visited to observe how many kinds of items they sell to protect people from the sun.

For example, sunscreen, hat, or bandanas. The three stores that were observed were Walmart,

Walgreens, and Sportsman’s Wearhouse. The following items listed below were found in each

individual store.

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Stores Items

Walmart Walmart sells umbrellas for outside patio

furniture, 10 different types of sunscreen,

canopies, baseball caps, sunglasses, sun

visors, wide brim hats, and bandanas.

Walgreens Walgreens sells 7 different types of

sunscreen, sunglasses, baby boats to cover

your baby while swimming, and beach

umbrellas.

Sportsman’s Wearhouse Sportsman’s Wearhouse sells camping chairs

with canopies, patio umbrellas, 3 types of

sunscreen, baseball caps, wide brim hats,

bandanas, sunglasses, neck gaiters, cowboy

hats, and sun visors.

Secondary Data

Demographics. According to the United States Census Bureau (2016), 7.5 percent of the

members in Washington county under the age of 65 have a disability. About 11.6 percent of the

community under the age of 65 do not have health insurance (United States Census Bureau,

2016). According to DataUSA (2016), males and females ages 6-17 in Washington county are

more likely to have health insurance. Below is a table that lists of the percentage of males and

females that have health insurance. The table breaks down the different age groups.

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(DataUSA, 2016)

According to DataUSA (2016), the average amount of Medicare reimbursements per

person in 2014 was $8,435 dollars, which increased from $8,395 in 2013 (DataUSA, 2016).

Medicare is a Federal program that assists older people with medical expenses (DataUSA, 2016).

The chart below shows how the reimbursements rates have changed in Washington county

compared to the national rates.

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(DataUSA, 2016)

Government agencies. According to the CDC (2018), UV light comes from the sun or

tanning beds. When people use tanning beds the UV light goes through different layers of skin

down to the inner layer where melanin is produced (CDC, 2018). Melanin gives the skin the

appearance of a darker shade (CDC, 2018). When skin cells produce more pigment from the

melanin it is a sign of injury (CDC, 2018). The skin tans after it has been exposed to more UV

light (CDC, 2018). According to the CDC (2018), every time someone tans using a tanning bed,

they are increasing their risk of skin cancer. There are certain people more at risk for skin cancer.

According to the CDC (2018), the risk factors are: lighter skin, family history of skin cancer,

history of sunburns, history of indoor tanning, overexposure to sun through work or play, blue or

green eyes, blonde or red hair, and skin that burns easily.

UV light increases the risk of skin cancer (CDC, 2018). There are ways that the skin can

be protected so that the risk of skin cancer does not increase. Some of the ways our skin can be

protected is by wearing broad spectrum sunscreen, at least SPF 15 or higher (CDC, 2018). The

CDC (2018) recommends that people stay in the shade during the later morning hours and mid-

afternoon. Another recommendation by the CDC (2018) is to wear wide brim hats, sunglasses,

and other protective clothing.

According to the CDC (2018), it is important to protect your skin from UV rays to

decrease your chances of getting skin cancer. According to the CDC (2018), in 2015 only 71

percent of adults reported using at least one type of protection, such as sunscreen, hat, or seeking

shade, when out in the sun. Only 61 percent of people ages 18-24 years old used at least one type

of sun protective method (CDC, 2018). Seventy-two percent of people ages 25 and above

reported using at least one type of sun protective method (CDC, 2018). Among teens 13 percent

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of females and 7 percent of males reported to routinely wear sunscreen while out in the sun

(CDC, 2018).

Other. According to the Skin Cancer Foundation (2018), that family history plays a role

in developing melanoma skin cancer. It is estimated that 1 out of every 10 patients diagnosed

with melanoma have a family member who was also diagnosed with melanoma (Skin Cancer

Foundation, 2018). According to the Skin Cancer Foundation (2018,) people who have first

degree relatives, such as mother, father, children, or sibling, who have been diagnosed with

melanoma have a 50 percent higher chance of being diagnosed with melanoma.

Local, State, and National Data

Tanning beds. According to the Simon (2015), tanning beds increase the likelihood of

getting skin cancer. Most people believe that tanning beds are safer than tanning outdoors, but

tanning beds still expose people to UV rays that cause most skin cancer (Simon, 2015).

According to the CDC (2015), adolescents who use tanning beds will increase their chances of

getting skin cancer when they are older. According to the Melanoma Research Foundation

(2018), people who use tanning beds before the age of 30 increase their risk of being diagnosed

with melanoma skin cancer by 75 percent. According to GoogleMaps (n.d.), there are 26 tanning

salons in Washington county. In the state of Utah there are about 100 tanning salons

(GoogleMaps, n.d.). According to SunTan (2018), there are about 20,000 tanning salons in the

United States.

Ethnicity. There are many different risk factors for skin cancer. According to Cancer

Center Treatment of America (2018), Caucasians have the highest risk for skin cancer. During

the interview with the Oncologist, he stated that people with fair skin are more likely to be

diagnosed with skin cancer (D. Haslem, personal communication, May 22, 2018). Most of the

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population in Washington County is Caucasian. According to the Census Bureau (2017),

Caucasians make up 93.7 percent of the population in Washington county. According to the

Census Bureau (2017), Caucasians make up 91.1 percent of the population in the state of Utah.

In the United States Caucasians make up 76.9 percent of the population (Census Bureau, 2017).

Skin cancer screenings. During the interview with the Oncologist, he discussed how

people who are at higher risk for skin cancer, such as: people with lighter skin, lighter hair color,

or have a history of skin cancer should be screened annually for skin cancer (D. Haslem,

personal communication, May 22, 2018). According to the American Cancer Society (2018),

people who are at a higher risk for skin cancer should be screened more frequently than people

who are not at a high risk. It is best to talk to your physician about how often you should have

your skin screened for cancer (American Cancer Society, 2018). Many doctors will recommend a

monthly self-check of the skin (American Cancer Society, 2018). During the interview with the

Oncologist, he recommended using a partner to check all parts of the body (D. Haslem, personal

communication, May 22, 2018). Skin cancer screenings can be done with your primary doctor or

a Dermatologist (D. Haslem, personal communication, May 22, 2018). According to

GoogleMaps (n.d.), there are 8 dermatologist offices in Washington county. According to

GoogleMaps (n.d.), there are about 57 dermatologist offices in the state of Utah. According to

the Dermatology Market Overview (2013), there are around 9,600 dermatologists in the United

States and 7,800 dermatology practices.

Melanoma skin cancer. According to the CDC (2018), skin cancer is the most common

type of cancer in the United States. The three most common types of skin cancer are basal cell

carcinoma, squamous cell carcinoma, and melanoma (American Academy of Dermatology

Association [AAD], 2018). According to the AAD (2018), melanoma is the deadliest type of

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skin cancer. It appears as a dark spot or a mole (AAD, 2018). By understanding the ABCDE

model, people will be able to recognize signs of melanoma skin cancer (AAD, 2018). According

the AAD (2018) the ABCDE model stands for asymmetry, border, color, diameter, and evolving.

In Washington county between the years 2012-2014 43.1 people per 100,000 people were

diagnosed with melanoma skin cancer (Public Health Indicator Based Information System

[IBIS], 2017). According to the CDC (2017), in the year 2014 between 25.9 - 42.3 people for

every 100,000 people were diagnosed with melanoma skin cancer in the state of Utah. In 2014 it

was reported that 1.9 females out of every 100,000 people were diagnosed with melanoma skin

cancer in the United States (Institute for Health Metrics and Evaluation, 2016). According to the

Institute for Health Metrics and Evaluation (2016), in 2014, 4.5 males for every 100,000 people

were diagnosed with melanoma skin cancer. In the United States it is estimated that 91,270 new

cases of melanoma skin cancer will be diagnosed in 2018 (National Cancer Institute [NIH],

2018). According to the National Cancer Institute (2018), the earlier melanoma is caught, the

higher the survival rate. Eighty four percent of melanomas are caught in the localized stage

(NIH, 2018). Localized refers to one primary spot (NIH, 2018). According to the NIH (2018), in

2014 the survival rate for localized melanoma skin cancer is 98.4 percent. In the interview with

the Oncologist, it is best to go see a doctor if you see a new spot or a new mole on your body (D.

Haslem, personal communication, May 22, 2018). The following charts below show the

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percentage diagnoses in different stages of melanoma cancer.

(NIH, 2018)

The following graph shows the five-year survival rates of the different stages melanoma

cancer diagnosed in the year 2014.

(NIH, 2018)

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Melanoma on the rise. According to the Skin Cancer Foundation (2018), melanoma skin

cancer rates are rising. From 2008-2018 the percentage of people diagnosed annually with

melanoma increased by 53 percent (Skin Cancer Foundation, 2018). It is estimated that 9,320

people will die from melanoma skin cancer in the year 2018 (Skin Cancer Foundation, 2018).

Washington county rates have stayed stable over the past 4 years from 2010-2014 (National

Cancer Institute, 2014). According to the National Cancer Institute (2014), the incident rate for

melanoma skin cancer in Washington county is 38.7 cases per 100,000 people. According to the

Public Health Indicator Based Information System (2017), reported in 2014 melanoma skin

cancer rates have reached all-time high in the state of Utah, up to 42.3 cases per 100,000 people

from 22.3 cases per 100,000 people in 1999. The graph below illustrates the increasing rates of

melanoma skin cancer in the state of Utah.

(Public Health Indicator Based Information System, 2017)

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Part 3: Data Interpretation

Similarities

A similarity between the primary data and secondary data are the warning signs

surrounding the usage of tanning beds. Tanning beds put people at a higher risk for skin cancer

because of the overexposure to ultraviolet light (D. Haslem, personal communication, May 22,

2018). The Melanoma Research Foundation (2018) explains that people who use tanning beds

before the age of 30 increase their risk of being diagnosed with melanoma skin cancer by 75

percent. Tanning salons are attracting the younger population. From the interview with the Planet

Beach employee, the researcher learned the average age of the visitors is 18 to 45 years old

(personal communication, May 18, 2018). While conducting the windshield survey, six tanning

salons were discovered in St. George, Utah.

Another similarity between the primary and secondary data are the risk factors for skin

cancer. The CDC (2018) states risk factors for skin cancer are the following: lighter skin, family

history of skin cancer, history of sunburns, history of indoor tanning, overexposure to sun

through work or play, blue or green eyes, blonde or red hair, and skin that burns easily. During

the interview with the Oncologist, he explained that people who are at a higher risk of skin

cancer should be screened annually (D. Haslem, personal communication, May 22, 2018). He

stated that risk factors for skin cancer are fair skin, light color hair, family history of skin cancer,

and/or burned a lot in their younger years (D. Haslem, personal communication, May 22, 2018).

During the interview with the adult diagnosed with skin cancer, they noticed on their own

a new spot on their nose (A. Cottrell, personal communication, May 24, 2018). The Oncologist

recommended that monthly self-checks be conducted by individuals in the community (D.

Haslem, personal communication, May 22, 2018). Monthly self-checks should include looking

SKIN CANCER 29

for new spots and examining moles using the ABCDE model (D. Haslem, personal

communication, May 22, 2018). The American Cancer Society (2018) also encourages people in

the community to complete self-checks monthly as recommended by their physician.

Differences

The Skin Cancer Foundation (2018) recommended that people be screened for skin

cancer on an annual basis. During the interview with the Oncologist, he talked about how people

who are not at a high risk for skin cancer should begin their screenings at the age of 40 (D.

Haslem, personal communication, May 22, 2018). The Oncologist explained that people who are

at a higher risk should complete skin cancer screenings at an earlier age (D. Haslem, personal

communication, May 22, 2018). Secondary sources did not specify what age should people begin

to be screened for skin cancer. The American Cancer Society (2018) recommends that people

who are at a higher risk should be screened more frequently.

One of the risk factors for skin cancer is family history (D. Haslem, personal

communication, May 22, 2018). Secondary sources, such as the Skin Cancer Foundation, (2018)

explain that family history of skin cancer plays a bigger role with melanoma skin cancer. The

Skin Cancer Foundation (2018) states that people who have first degree relatives, such as

mother, father, children, or sibling who have been diagnosed with melanoma have a 50 percent

higher chance of being diagnosed with melanoma.

There are three types of skin cancer (CDC, 2018). The CDC (2018) explains that

melanoma is the most dangerous type of skin cancer. Melanoma is the least common type of skin

cancer out of the three (CDC, 2018). Secondary sources such as the Skin Cancer Foundation

(2018) states melanoma rates have increased by 53 percent since 2008. The Oncologist did not

talk about how melanoma cases have increased in the past 10 years. The Public Health Indicator

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Based Information System (2017) reported in 2014 melanoma skin cancer rates have reached all-

time high in the state of Utah, up to 42.3 cases per 100,000 people from 22.3 cases per 100,000

people in 1999.

Strength of the Population

Throughout the interview with the Oncologist, he discussed the importance of teaching

prevention techniques to people 18-30 years old (D. Haslem, personal communication, May 22,

2018). An observational study was conducted to observe how many different sun protective

items stores are selling to the public. Sportsman’s Warehouse had the most items. Sportsman’s

Warehouse had 10 different sun protective items available to the public. Some of those items

included the following: sunscreen, wide brim hats, bandanas, camping chairs with a canopy, and

sun visors.

Skin cancer screenings can be conducted by primary care providers or dermatologists (D.

Haslem, personal communication, May 22, 2018). A map of Washington County showed 8

different dermatologist offices (GoogleMaps, n.d.). The adult who was diagnosed with skin

cancer was asked who they went to see after finding a new spot (A. Cottrell, personal

communication, May 24, 2018). The adult said they went to their dermatologist’s office to have

the new spot checked (A. Cottrell, personal communication, May 24, 2018). Dermatologists can

do a more in-depth skin cancer screening (D. Haslem, personal communication, May 22, 2018).

The United States Census Bureau (2016) states that 11.6 percent of the population under

the age of 65 do not have health insurance. Eighty eight percent of the population have health

insurance to cover the screenings for skin cancer (United States Census, 2016). Without

sufficient health insurance to cover the costs of the screening, some people forgo the exam. In

the course of the interview, the Oncologist explained that in a screening doctors are looking for

SKIN CANCER 31

new spots (D. Haslem, personal communication, May 22, 2018). The screenings last about five

minutes according to the information received by the Oncologist (D. Haslem, personal

communication, May 22, 2018).

Challenges of the Population

A risk factor for skin cancer is fair skin (D. Haslem, personal communication, May 22,

2018). The population of Washington county is 93.7 percent Caucasian (United States Census

Bureau, 2017). An employee for Planet Beach was asked about the type of people that attend

their tanning salon. They responded by explaining that about 90 percent of their clientele are

Caucasian (personal communication, May 18, 2018). The employee also explained that on

average people will visit their facility about 3 times a week.

A windshield survey was conducted to observe how many tanning salons are available to

the public. During the windshield survey, six different tanning salons were spotted in St. George,

Utah. Reviewing a map of St. George, 16 different tanning salons were located (GoogleMaps,

n.d.). There is a high number of tanning salons easily accessible in St. George.

Tanning salons are attracting younger generations. DataUSA (2016) concluded the

median age of the population in Washington county to be 34.5 years old. After the survey,

DataUSA (2016) concluded that people between the ages of 18-24 make up 8.8 percent of the

population. People ages 25-34 make up 11.3 percent of the population (DataUSA, 2016). The

only group that surpasses the 25-34-year-olds are 5-17 year olds (DataUSA, 2016). DataUSA

(2016) concluded that about 20.2 percent of the population are between the ages of 5-17. The

Skin Cancer Foundation (2018) explains that 15 different states have banned people under the

age of 18 from visiting tanning facilities.

Validating Information

SKIN CANCER 32

Secondary data has concluded that the median age of the population in Washington

county is 34.5 years old (DataUSA, 2016). The employee at Planet Beach explained that they

work more with the younger population (personal communication, May 18, 2018). The average

ages of their clientele are between 18-45 (personal communication, May 18, 2018). The

Oncologist stated that skin cancer is a disease of the elderly, but the usage of tanning beds at a

younger age increases the likelihood of being diagnosed with skin cancer (D. Haslem, personal

communication, May 22,2018).

It is recommended that people get screened for skin cancer once a year by their primary

care physician or a dermatologist (D. Haslem, personal communication, May 22, 2018). The

American Cancer Society (2018) encourages people to talk to their primary care doctor to see

when they should start screening for skin cancer. The CDC (2018) states the risk factors for skin

cancer are lighter skin, family history of skin cancer, history of sunburns, history of indoor

tanning, overexposure to sun through work or play, blue or green eyes, blonde or red hair, and

skin that burns easily. The Oncologist emphasized the greater the risk factors, the earlier

screening for skin cancer should begin (D. Haslem, personal communication, May 22, 2018).

Most of the population in Washington county has light skin (United States Census Bureau,

2017). Ninety three percent of the population in Washington county are white (United States

Census Bureau, 2017).

Protecting your skin from the sun will decrease the likelihood of getting skin cancer. The

CDC (2018) recommends that people apply broad spectrum sunscreen while outdoors. They also

recommend wearing a wide brim hat and to stand in the shade to avoid direct sunlight (CDC,

2018). The Oncologist in his interview spoke the importance of wearing sunscreen. He explained

that sunscreen should be part of people’s every day routine (D. Haslem, personal

SKIN CANCER 33

communication, May 22, 2018). He concluded the interview by explaining that teaching

adolescents about the importance of protecting their skin from the sun will decrease skin cancer

rates (D. Haslem, personal communication, May 22, 2018).

SKIN CANCER 34

Part 4Cancer Screenings

Area of improvement. Through the process of gathering information from primary and

secondary sources, the researcher learned it is important for individuals who are at a higher risk

for skin cancer to start screening earlier. A primary source recommended that people who are

low risk for skin cancer should begin screening around age 40 (D. Haslem, personal

communication, May 22, 2018). Skin cancer that is detected early can be removed so that it does

not spread. It is important that people are screened on an annual basis so that new spots can be

looked at by a physician.

In addition to yearly exams, doctors should encourage their patients to do monthly self-

checks. Monthly self-checks allow people to look for new spots or moles on their body. It has

been advised to use a partner for places that are difficult to examine (D. Haslem, personal

communication, May 22, 2018). People should be following the ABCDE model during the

monthly-self checks. A is for asymmetry, B is for border, C is for color, D is for diameter, and E

is for evolving (D. Haslem, personal communication, May 22, 2018). If a person discovers a new

spot they should report it to their doctor right away. Nurses should validate that patients

understand the education that was provided. It would be best to have the patient teach the nurse

the ABCDE model so that nurse can validate the patient understands the details.

Recommendation. Doctors and dermatologists should educate their patients on the

importance of screening for skin cancer. They should encourage their patients to set an

appointment at least once a year to be screened for skin cancer. During the appointment the

patient should be educated about skin cancer screenings and self-examinations. Screening allow

doctors to look over the patient’s skin for new spots. They can document any changes they notice

on the patient’s skin. They should discuss what they are looking for during the screening. The

SKIN CANCER 35

more people understand the importance of skin cancer screening, the more they will be

compliant to completing self-exams and setting appointments. Additionally, the doctor or

dermatologist should explain the ABCDE model for monthly skin checks. Doctors should give a

pamphlet with written of the ABCDE model so that patients may understand what to look for

during their monthly self-checks. After doctors have explained the ABCDE model, nurses should

validate the patients understanding of the education provided. Nurses may ask patients to

demonstrate how they would complete monthly self-checks.

Evaluation. After implementing the recommendation, surveys will be offered to patients.

Statistics will be gathered to assess how many more patients getting their yearly skin cancer

screenings. The baseline number of screenings before the recommendation will be compared to

the number after the recommendation to assess if educating patients about yearly skin cancer

screenings impacts the rate of skin cancer screenings performed. Surveys will be offered to

patients at the end of their screening visit, regarding the education they received about monthly

skin checks and the ABCDE model. The survey will ask if their doctor explained how to

complete a monthly exam, and if they provided detailed instructions about the ABCDE model.

Nurses can provide additional education about the ABCDE model. They can help answer any

questions the patients might have about the monthly skin-checks. If responses to the surveys

concluded that their doctor or dermatologist discussed the importance of yearly and monthly skin

checks then the recommendation was successful. If statistics show a rise in the number of

patients getting their yearly exams, then the recommendation was successful.

SKIN CANCER 36

Education

Area of improvement. During the interview with a primary source, they expressed the

importance of educating young adults about prevention of skin cancer (D. Haslem, personal

communication, May 22, 2018). Skin cancer affects older generations. Decisions made at a

younger age can affect chances of being diagnosed with skin cancer later in life. Some of those

choices include using tanning beds or not wearing sunscreen or hats when outside. Tanning beds

should be avoided because people are more exposed to direct UV light for a longer period. From

interviewing a primary source at tanning salon, the researcher learned the average age of visitors

are 19-45 years old (personal communication, May 18, 2018). Exposure to a higher

concentration of UV light from tanning beds increases the chance of getting skin cancer.

Recommendation. Prevention courses should be offered to the community. All members

of the community will be invited, but it should be encouraged that people ages 18-35 attend the

course. The public health department, clinics, hospitals, and insurance companies should let

people know about the prevention course for skin cancer. The course should go over the dangers

of using a tanning bed. It should also include how people can protect their skin when outside in

the sun. For example, the course would include the importance of wearing broad spectrum

sunscreen, a hat or a bandana, and to avoid long exposure to the sun. The course should review

how the risk of skin cancer decrease by using these prevention tips.

Evaluation. After two years of implementing the course, statistics will be gathered

regarding skin cancer rates in Washington county. Statistics will also be gathered after 5 and 10

years after implementing the course. The statistics gathered will show how rates of skin cancer in

Washington county have changed. If the statistics remain the same, then the course will need to

be updated or be more widely advertised. If the rate of skin cancer in Washington county drops,

SKIN CANCER 37

then the course will continue to be offered for community members. Education is important for

prevention. Education allows people to make better decisions about their health.

Tanning Salons

Area of improvement. There are many tanning facilities available to people. When

people use tanning beds they increase the likelihood of getting skin cancer. There are different

types of tanning beds. From the interview with one of the primary sources, the researcher learned

that tanning salons have two different types of tanning beds (personal communication, May 18,

2018). One which uses a stronger concentration of UV light, which requires only a 10-minute

visit (personal communication, May 18, 2018). The other does not use a strong concentration of

UV light, which requires 30 minutes to obtain the same results (personal communication, May

18, 2018).

Recommendation. Before using a tanning bed, customers should be required to watch a

short video about the dangers of tanning beds. The video should educate them on how the risk of

skin cancer increase due to the usage of tanning beds. The video should include why it is

dangerous to be overexposed to UV light. The video would also include statistics concerning

skin cancer rates. The tanning salon should put signs up reminding customers of the risk of using

tanning beds. Signing a waiver at a tanning salon is not enough because most people do not read

about the warning signs. Tanning salons should encourage clients to use tanning lotions. Tanning

lotions do not exposure your skin to UV light.

Evaluation. After six months of implementing the recommendations, surveys would be

sent out to tanning salons. The surveys would inquire about the selling rates of tanning lotions.

The survey would determine the percentage of people who continue using the tanning beds after

watching the video. The percentage of clients who used tanning beds before implementing the

SKIN CANCER 38

video and the new statistics would be compared. If the percentage of people who use tanning

beds drops, then the recommendation was successful. If the percentage remains the same, then

the recommendation was not successful.

Reflection

While completing this project I learned why it is important to take care of our skin. We

can protect our skin by wearing broad spectrum sunscreen or a hat when we are outside. Most

people are diagnosed with skin cancer when they are between the ages of 50 to 60 years old.

People who do not protect their skin when they are in their 20s and 30s will be at a higher risk

for skin cancer. Tanning beds should be avoided. Tanning beds overexpose skin to UV light

which increases chances of skin cancer. I learned it is important to understand the risk factors of

skin cancer. If you are at a higher risk than you should begin skin cancer screenings before the

age of 40. Education can improve a nurse’s success in the workforce. The more educated we are

about skin cancer the better we will be able to educate patients on the risks of skin cancer. I want

to continue my education on skin cancer, so I can educate patients to the best of my ability.

I am more educated on the risk factors of skin cancer. While in the workforce, I want to

teach people about the risks for skin cancer. I learned that skin cancer can spread to other organs

in the body if is not removed. The more educated I am about the subject, the more details I will

be able to provide to patients. I hope to help people understand why it is important to be screened

on an annual basis. I will encourage people to do monthly skin checks. During the monthly skin

checks I would advise them to use the ABCDE model when examining their moles. I would

describe each letter of the model, and what signs they should be looking for during the self-

checks.

SKIN CANCER 39

I have learned that we should not judge people. We can only educate them on how to

prevent skin cancer. I have changed my thought process by becoming more educated about skin

cancer. Before starting this project, I did not understand the different risk factors for skin cancer.

I have learned that by seeking information from primary and secondary sources can help solidify

our knowledge. We cannot just look on the internet for answers. When reviewing secondary

sources, we need to validate that the source is credible. We must also talk to primary sources

such as doctors, dermatologists, and oncologists about skin cancer. Once we have gathered

information from primary and secondary sources, we than can compare the information we have

been given and make educated recommendations. As a future nurse, I want to help patients

understand how the can prevent skin cancer by understanding their risk. As part of my future

practice as a nurse I want to make sure patients understand the education that has been provided

for them. I will encourage patients to teach the principles they have learned. Finally, as a future

nurse, I hope to educate and empower the patients that I work with, so they can decrease the risk

of developing skin cancer.

SKIN CANCER 40

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