By ANN GREEN
Doctors have long known that fishers and other workers who spend a lot of time in the sun are at increased risk for skin problems — from rashes to skin cancer. In an East Carolina University study, nearly 25 percent of the North Carolina fishing community interviewed reported having skin disorders, according to North Carolina Sea Grant researcher David Griffith.
Despite having skin problems, fishers often don’t seek medical treatment for the maladies.
“Many fishermen say they can’t afford treatment for skin problems,” says William Burke, chief of Division of Dermatology, the Brody School of Medicine at East Carolina University. “Many don’t have any health insurance. We often reach the fishermen by educating their wives.”
To educate the North Carolina fishing community about skin problems, the N.C. Agromedicine Institute — a collaborative program between East Carolina University, North Carolina State University and N.C. A & T State University — is conducting a three-year pilot study. The institute, based at ECU in Greenville, also focuses on the occupational risks of foresters and farmers.
The skin cancer project, funded by the National Institute for Occupational Safety and Health, will provide educational materials for the fishing community. Griffith and Burke are the project’s co-investigators. Recently, North Carolina Sea Grant helped develop a skin cancer poster to distribute to fish houses and other places frequented by fishers.
“Many farmers and fishermen are aware of the dangers of the sun, but often believe that it does not affect their ability to work,” says East Carolina University medical student Chris Scott, who has made skin cancer prevention presentations throughout Eastern North Carolina. “By limiting their sun exposure, they can delay or cut their risk of skin cancer.”
Burke and others also are conducting skin cancer screenings in North Carolina, Alabama and Maryland. “So far, we have tested 59 fishers in North Carolina and found that many have precancerous lesions,” says Burke. He also has diagnosed five cases of skin cancer.
The two most common types of skin cancer are basal and squamous cell cancer. Basal cell cancer accounts for more than 90 percent of all skin cancers in the United States. These cancers are slow-growing and seldom spread to other parts of the body.
“Basal cell is treated surgically and is easy to treat if caught early,” says Burke. “It comes from cumulative exposure and damage from the sun — and has little chance of metastasizing.”
Squamous cell cancer also is caused by chronic outdoor activity. It is treated surgically and has little chance of metastasizing, unless it occurs on the lip where it has a higher chance of spreading, according to Burke.
Malignant melanoma, the most rapidly increasing form of cancer in the United States, causes approximately 75 percent of all skin cancer deaths. This disease can spread to other organs, most commonly to the lungs and liver.
“People who get a bad sunburn early at age 2 to 5 are more likely to get melanoma,” says Burke. “It is more common in fair-skinned people but can occur in black people. Almost all commercial fishermen in North Carolina are of Celtic descent or fair-skinned.”
Besides skin cancer, Burke has found numerous other skin problems in the fishing community.
“Most fishermen laugh if they are asked about skin problems because some kind of problem comes up almost daily,” says Burke. “One common problem is stingray injuries that can get infected if not treated properly and trauma to the skin from the pinching of crabs.”
Skin cancer is the most common form of cancer in the United States. More than one million cases likely were diagnosed in 2002, according to the Centers for Disease Control and Prevention.
In a Maryland study, fishers who spent a lot of time on the water had a 2.5 times higher risk of developing squamous cell carcinoma than those who spent less time in the sun.
To find out more about skin problems in North Carolina’s fishing community, Griffith is conducting a survey.
“The questionnaire will be mailed out to more than 300 commercial fishermen in the southeast region,” says Griffith, an ECU anthropologist. “We also will be interviewing health professionals about how often they see skin cancer in commercial fishermen.”
Cause of Skin Cancer
According to current estimates, 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. Although anyone can get skin cancer, the risk is greater for people who work outside and have fair skin that freckles easily — often those with red or blond hair or light-colored eyes.
The risk is also higher in places where there is intense year-round sunshine. In the United States, the highest incidence is in Arizona. Because eastern North Carolina receives high levels of UV radiation from the sun, residents are at high risk for skin cancer.
“The summer months are the worst because the sun is higher in the sky and less ultraviolet light is filtered,” says Burke. “However, the winter months aren’t safe because there is some ultraviolet light. I normally tell people to stay out of the sun from 10 to 3, but commercial fishermen can’t do this because of their work.”
Reflective ultraviolet radiation is as damaging as direct UV radiation. Water reflects up to 100 percent of UV radiation.
Typically, people don’t develop any type of skin cancer until after age 50. However, outdoor workers often develop it at an earlier age. Sun damage builds up slowly and quietly.
The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore than doesn’t heal. Skin cancers don’t all look the same. The cancer may start as a small, smooth, shiny, pale, or waxy lump, or it can appear as a firm red lump. Sometimes, the lump bleeds or develops a crust. Skin cancer also can start as a flat, red spot that is rough, dry or scaly.
Both basal and squamous cell cancers are found mainly on areas of the skin that are exposed to the sun — the head, face, neck, hands and arms. However, skin cancer can occur anywhere. Changes to moles also are worrisome.
To prevent skin cancer, follow these simple steps from the American Cancer Society.
SLIP on a long-sleeved shirt.
SLOP on sunscreen with SPF 15+ to 30+ for fair-skinned individuals. Lip balm with sunscreen also is recommended.
SLAP on a wide brim hat. Ears, noses and lips are common sites of skin cancer.
Prevention of melanoma is obviously the most desirable weapon against the disease. But if a lesion should develop, it is often curable if caught in the early stages. To aid in early recognition of any new or developing lesion, periodic self-examinations are helpful.
“Always remember when you’re working on the water, you’re also working on cancer,” says Burke. “Remember to protect your skin from the sun.”
For more information, call N.C. Agromedicine Institute, Brody School of Medicine at East Carolina University, 252/744-1000 or visit the Web: www. ncagromedicine.org. To order a skin cancer poster, call North Carolina Sea Grant, 919/515-2454 and ask for UNC-SG-02-10.
This article was published in the Early Summer 2003 issue of Coastwatch.
For contact information and reprint requests, visit ncseagrant.ncsu.edu/coastwatch/contact/.