According to the American Cancer Society, July is UV Safety Month. More than one million people are diagnosed with skin cancer each year. Over 65 percent of melanomas are believed to be directly related to ultraviolet (UV) rays received from the sun (through direct exposure or indirect exposure through clouds or glass).
This made me think fondly of a dear patient of mine who was diagnosed with metastatic melanoma. He is an avid golfer and, like more than 50 percent of men, did not use sun protection. This, along with genetics and other factors, was very likely partly responsible for his diagnosis. Men older than 50 years of age are more than twice more likely to develop and die from melanoma than women.
He was prescribed vemurafenib (Zelboraf), a new medication just released in the past year for metastatic melanoma, for patients tested as BRAF-positive (confirmed with BRAF V600E mutation). Zelboraf inhibits this BRAF V600E protein kinase, which results in the inhibition of tumor cell proliferation. Response is usually seen within four months of starting this regimen, per past clinical trials.
This golfer did a great job of tolerating the drug. However, he forgot one day to use his sunscreen before playing nine rounds of golf in the late fall season. Guess what happened? Nope, not a birdy. It was the bird of another feather: phototoxicity!
The next day, he was in our office looking like a New England lobster that just scrambled up on shore: red from head to toe, with secondary skin lesions of papules. He said he was in discomfort and the main symptom was itchiness and skin sensitivity. He was taking full-dose Zelboraf at the time, so we started him on Benadryl and hydrocortisone cream. It took over two weeks for the rash to even start to resolve, and his Zelboraf dose had to be reduced due to the rash worsening in the first week after sun exposure, despite the use of Benadryl and the hydrocortisone cream.
He was "bummed" by the fact that he couldn’t play any more golf until this symptom resolved. Fortunately, he was able to increase his dose of Zelboraf back to full dose about a month later. Apparently, a photosensitivity rash is a common side effect of this new drug, according to the many healthcare providers, pharmacists, and experts I collaborated with on behalf of this patient.
Getting in the zone
The ozone layer shields the Earth from harmful ultraviolet (UV) radiation; however, with continued ozone depletion, as well as seasonal and weather variations, the amount of UV radiation that reaches the earth varies. The UV Index indicates the strength of solar UV radiation on a scale from 1 (low) to 11+ (extremely high). The higher the UV Index, the higher the risk of sun overexposure, which can happen very quickly, especially without proper preventive measures.
In May, the Food and Drug Administration released a sun protection preventative guide for consumers. It can be accessed, downloaded, and printed, to be provided to everyone in your clinic.
In addition, there are other online tools that can provide more timely and live information. Every day, the predicted UV Index is calculated by the National Weather Service, and this forecast is published each mid-afternoon (Eastern time) via the Environmental Protection Agency’s Website.
Through the
SunWise program, you can also download the smartphone app, sign up for UV email alerts, and embed the UV Web widget on your facility's Website, if you'd like.
References:
- American Cancer Society (2012). Retrieved at: http://www.cancer.org/Healthy/BeSafeintheSun/index?gclid=CMrDqNz-h7ECFYTAKgodiDMqyw.
- Environmental Protection Agency (2012). Retrieved at: http://www.epa.gov/sunwise/uvindex.html
- Food and Drug Administration (2012). Retrieved at: http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM143731.pdf.
- Gobel, B.H., Triest-Robertson, S., & Vogel, W.H. (2009). Advanced Oncology Nursing Certification Review and Resource Manual. Oncology Nursing Society. Pittsburgh, Pennsylvania.
- Newton, S., Hickey, M. & Marrs, J. (2009) Mosby’s Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice. Mosby Elsevier. St. Louis, Missouri.
- Skin Care Foundation (2012). Retrieved at: http://www.skincancer.org/prevention/sun-protection/prevention-guidelines.
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