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
SKIN CANCER 9
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
SKIN CANCER 10
(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
SKIN CANCER 11
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.
SKIN CANCER 13
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
SKIN CANCER 14
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-
SKIN CANCER 15
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
SKIN CANCER 18
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.
SKIN CANCER 20
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.
SKIN CANCER 21
(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
SKIN CANCER 25
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
SKIN CANCER 30
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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