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Nearly 1.5 million new skin cancers are diagnosed in the United States each year, which represents more than half of all new U.S. cancer diagnoses. Approximately 10 000 people die annually of skin cancer in the United States; one an hour from melanoma and one every 4 hours from nonmelanoma skin cancer. There are three main types of skin cancer: basal cell carcinoma (79% of skin cancers), squamous cell carcinoma (14%), and melanoma (5%). Other skin cancer types comprise the remaining 2%. While melanoma accounts for only 5% of skin cancer diagnoses, it accounts for 75% of skin cancer deaths. Basal and squamous cell carcinomas are considerably less lethal, but these tumors are associated with significant morbidity. As with most malignancies, the incidence of skin cancer increases with age. Owing to their sheer numbers, the public health burden from skin cancer is great.

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One in five people in the United States and one in three Caucasians will develop skin cancer during their lifetime. Since 1960, the incidence of skin cancer has risen by 4% to 8% per year. It continues to rise faster than any other cancer, and skin cancer has been labeled as “today's epidemic” in the lay press. It is likely that much of the data on the incidence and prevalence of skin cancer are an underestimation, as many biopsies of nonmelanoma skin cancer are interpreted in physicians’ offices, and thus go unreported to hospital-based registries.

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Both genetic and environmental risk factors are implicated in the development of skin cancer. The most common known environmental risk factor is chronic and/or acute intense intermittent ultraviolet light exposure in the form of sunlight, artificial tanning devices (tanning booths), and sunburns. The Centers for Disease Control Behavior Risk Factor Surveillance System data report that nearly 32% of all adults (57% of those aged 18–29) and more than 40% of children in the United States develop at least one sunburn annually. Ultraviolet B (UVB), at wavelengths between 290 to 320 nm, causes most of what we see as sun tanning and sun burns and is responsible for much of the actinic skin damage caused by sunlight. Ultraviolet A (UVA), 320 to 400 nm penetrates more deeply into the skin and is also an important factor in photoaging and skin cancers. UVB radiation induces skin cancer by a variety of mechanisms including direct DNA damage, damage to DNA repair systems, and alteration of the local cutaneous immune system. Some of the strongest evidence that implicates ultraviolet light as being important in the etiology of skin cancer comes from epidemiologic and experimental data correlating the incidence of tumors with the degree of pigmentary protection. Fair-skinned individuals with blue or green eyes and red, blonde, or light brown hair are at highest risk. These patients also typically tan poorly and sunburn and freckle easily. The risk of skin cancer varies with race and ethnic group with Caucasians of Celtic ancestry having the highest incidence rates. Skin ...

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