Skin Cancer Risk

 Exposure to UV radiation from the sun will change the structure and composition of the skin, the loss of skin elasticity (elastosis) and thickening of the skin (keratoses). UVB radiation at the cellular level (membrane, protein and DNA), DNA damage which is the beginning of keratinosites and melanosites which in its development can be skin cancer. There are 3 types of skin cancer that can be distinguished namely Basal Cell Carcinoma (BCC), Squamos Cell Carcinoma (SCC) and Cutaneous Malignant Melanoma (CMM). Of the three types of cancer, the CMM is derived from pigment cells (melano-cytes) is a type of malignant tumor. While the BCC and SCC derived from keratinocytes, is a type of tumor is not malignant, 98% can be cured.

Characteristics of the population with the greatest risk of skin cancer is if you have moles (moles) a lot, with white spots and easily burned by the sun's rays are the type I and albino skin. Most skin cancers in the calf area, hands and neck with three types: nodular, superficial spreading lentigo and freckles. Of the third type, nodular type of the most dangerous because it is fast growing and fatal. incidence of skin cancer has increased every year. It is believed by environmental experts, because of the increase ultraviolet radiation from sun exposure due to ozone layer depletion in the stratosphere. 

Epidemiological studies, which have been made, obtained information that the type of basal cell carcinoma (BCC) is common in Caucasian whites (generally around 90 cases per 105 population per year in northwest Europe), approximately 15 cases per 105 population per year for this type of SCC and 10 cases per 105 population per year for this type of CMM. The number of cases for residents of Australia of 9.8 per 100,000 (men) and 5.0 per 100,000 (women) per year for skin cancer type CMM with the percentage of mortality between 40-60%. Greatest risk of skin cancer for all skin types, is exposure to UV radiation in childhood. Therefore protect children from exposure to sunlight.

Self Protection From UV Radiation

To protect yourself from UV radiation one of the easiest ways to wear dark colored clothes or by wearing a special lotion with sunscreen that can be applied to the hands, feet and neck because the clothes made of cotton and polyester fairly effectively absorb UV radiation, therefore some kind of lotion, so that UV radiation on the skin can be dependent on the value of minimizing the SPF (Sun Protection Factor). SPF value is the comparison between the dose of UV radiation received by the skin without a protective cotton / lotion (ED) at a dose of UV radiation received by a protective skin with a cotton / lotion (EDM), and expressed by the following equation: ED

   

Examples for lotion with an SPF value of 10, then the UV radiation on the skin only 1 / 10 of UV radiation that comes and the 9 / 10 part is absorbed by the lotion. The higher the SPF value for the fabric or lotion, the smaller the UV radiation on the skin. This means more secure from the dangers of UV radiation .

Remember every 1% thinning of the ozone layer by pollution Clorotluoro Carbon (CFC) can increase the risk of skin cancer. BCC and SCC 3% around 1.7%, needs to be further improved our concern for the earth that we live is the socializing that begins CFC regressive free program from home.

 Influence of color on the absorption of UV radiation for the clothes of cotton and polyester.

Catton fabrics		Polyester fabric
Color	SPF	Color	SPF
White Sky blue Black Navy blue	12 18 32 37	White Rosy Green Scarlet Black	16 19 19 29 34

SPF values ​​are expressed as erythema effective UVR transmitted and absorbed.

SPF	Effective UV is absorbed (%)	Effective UV is passed (%)
10 20 30 40 50	90 95 96,7 97,5 98	10 5,0 3,3 2,5 2,0

Ultraviolet radiation (UVR)

Ultraviolet radiation (UVR) during passage through the layer of ozone in the stratosphere mostly absorbed by ozone, so the UVA and UVB rays that reach the earth's surface becomes less. UVC photolysis interact with oxygen produces ozone. this is because the biological effects of ultraviolet B radiation is greater than ultraviolet A radiation, so the concentration of pan environmentalists and environmental epidemiology is devoted to observing UVB from time to time, although the percentage of ultraviolet A radiation is much higher when compared with a ratio of 95% UVB and 5%. Ultraviolet radiation reaches the earth's surface depends on latitude, altitude and the presence of cloud or aerosol particles. Area near the equator, have the highest intensity when compared to the northern and southern hemispher. The presence of clouds and air pollution (in the form of smoke or water vapor particles), can lower the UVB. The influence of clouds on the irradiation of the spiral can be approximated by a factor F: F = 1 to 0.056 C.

C is the total cloud index which ranges between 00-10. Value of 10 for thick clouds covering the sky completely. For dense clouds, ultraviolet radiation down to 44% for direct radiation. The estimated reduction in ultraviolet B radiation (UVB) because the cloud based on satellite measurements of backscattering with UVB which is 30% at 60 ° latitude, 10% at 20 ° and 20% on the equator. The relative intensities of ultra-violet B radiation from time to time is not fixed, the maximum at noon (12.00) and minimum in the morning and afternoon (at 06.00 and 19.00).

European population is estimated to have exposure to UVB radiation ranges between 210-390 MED, depending on the type of work (outside / inside the room).

The estimated annual doses of  UVB from some activities

Activities	Annual doses of  UVB (MED)
Working outdoors (including exposure of on the weekend) Working indoors (including exposure of on the weekend) 2 weeks vacation in the Mediterranean Sunbathing on the beach 15 hours	270 90 100 20

The Minimum Erythema Dose for Human Skin Types.

International Commission on non-ionizing radiation protection field (ICNIRP) and the International Commission on Illumination (CIE) to recommend maximum limits for skin that is expressed with a minimum erythema dose (MED) associated with exposure to UV radiation. MED is defined as the radiant exposure of monochromatic radiation at maximum spectrum for erythema (~ 200 nm) of about 150-2000 Jm-2 depending on the type of skin. Frequently the value of effective exposure of 300 Jm-2 is used as a value of 1 MED for the purpose of protection of whites.

Types of Skin	The Color of Skin	Sensitivity to UV	The Minimum Erytheme Dose of UV (Jm-2)	Sunburn
I	White	Very Sensitive	150-300	Highly Flammable, Without Blackish
II	White	Very Sensitive	250-350	HighlyFlammable, Blackish
III	White	Sensitive	300-500	Changes to Light Brown Skin
IV	Light Brown	Sensitive Enough	450-600	Fire at a Minimum Changes The Skin to Brown
V	Brown	Less Sensitive	600-100	Rarely Burn, Changes Color to Dark Brown
VI	Dark Brown, Black	Not Sensitive	1000-2000	No Burning, Changes Color to Black

Ultraviolet Radiation from the Sun and Skin Cancer Risk ( UVA, UVB, UVC )

In daily life, God has met all the needs we are, one of them is the sunlight, according to necessary and benefical to the body. The sun's rays contain ultraviolet B radiation (UVB) in small number of exposed skin and absorbed. It will stimulate the formation of vitamin D3. Therefore, in the spring time ( summer time ) in Europe, many peope are sunbathing to nourish the body.

But since the last two decades, the sun when the beginning is friendly indirect to be threat to health. It happens because the result of our own actions so that the layer of ozone in the stratosphere that serves to filter (filter) ultraviolet radiation (UVR) from year to year become thinner and thinner due to chemical pollution chlorofluoro carbon (CFC) derived from the engine cooling (air conditioners, refrigerators) and industry. Depletion of the ozone layer, will cause the higher the intensity of ultraviolet radiation that reach the earth. Several studies have reported that each decade (since 1970) the ozone layer to be reduced 3% and will increase the radiation exposure Ultraviolet by 12% in the earth's surface. An increase in the intensity of ultraviolet radiation, especially UVB, due to depletion of the ozone layer in the stratosphere will impact quite seriously on living beings on earth.

Ultraviolet radiation is electromagnetic radiation at wavelengths between 100 nm (equivalent to about 12 eV photon energy) to 400 nm (nano meters). Ultraviolet radiation emitted by the sun is divided into 3 regions namely UVA, UVB and UVC that depend on the wavelength and the biological effects.

The division of the ultraviolet radiation (UVR) and its relationship with biological effects.

Area	The Spectrum Range (nm)	Biological effects on the eye	Biological effects on the skin
UVC UVB  UVA	100 – 280 280 – 315  315 – 400	Photo of  keratin Photo of keratitis,Cataract Cataract	Anemia of Cancer Erythema Cancer Pigment darkening, Accelerated aging

Compression (emphasis) Oesophagus

Complaints due to the emphasis on the esophagus can be reduced by giving the radiation. Radiation intraesofagus ranging from proximal to distal limit of 5 cm from the narrowing of the esophagus. Dose: 5-8 Gy 1 cm from the axis of the radiation source. External radiation, given at a dose of 3-4 Gy. 

Compression bone marrow

Complaints due to compression of the bone marrow is usually a side effect of drugs or radiation. Leukopenia (Neutropeni) and thrombocytopenia are frequent complaints that arise. In mild impairment, improvements can occur without treatment as a process improvement (recovery) stem cell that occurs after about 21 days. Despite the gravity of such rare Neutropeni fever can often be cause of death. Giving G-CSF in conjunction with chemotherapy may accelerate the repair (recovery), which means can shorten the hospital but can not be prevent disruption in the stem cell is. Another alternative to deal with complaints due to suppression Stem cell function is the provision of transfusion, such as platelet transfusions to overcome thrombocytopenia.

Metastasis

Metastatic lung cancer can occur in the lung (intrapulmoner) and / or extrapulmonary (Extrapulmonary). Metastasis intrapulmoner requires no special action, whereas metastases extrapulmonary sometimes recover it. Complaints of pain or shortness of breath due to direct invasion tumor to the chest wall or ipsilateral mediastinal metastases are not considered, although sometimes it takes special measures to address the complaint. Metastases have been overcome if cause complaints but sometimes need immediate action is taken as a preventive effort, for example there has been metastasis to the spine. The principle of treatment for metastasis is more strived to improve the quality of life for sufferers.

Metastasis to Bone. 

Complaints that often occurs is pain and fractures. Pain due to metastatic to the bone can be overcome by administering radiation. If it is not possible then overcome with pain in administration of pain medication (cancer pain). Fractures (broken) bone metastases often occur due to long bones, the implementation of fractures due to metastasis is the same as in the case of fractures other.

Metastasis to the brain. 

KPKBS type adenocarcinomas frequently metastasize to the brain. Where possible then surgical intervention can be done to nodulsoliter in the brain. If there multipeinodul in the brain or Surgery is not done then the radiation may be an option. If it is not possible to surgery and radiation the complaint due to the emphasis in the head cavity can be reduced by steroit class of drug administration.

Metastasis to other organs. 

Management carried out in accordance with the complaints that arise.