Skip Hawkins never thought it would happen to him. Even though he spent decades working outdoors, the 56-year-old pool plasterer didn’t give the slightly discolored spot on his cheek much consideration.
A routine checkup raised suspicions, but Hawkins remained unfazed. Still, his doctor insisted that he see a dermatologist. The pool industry veteran finally relented and a biopsy was taken.
“It was melanoma,” says Hawkins, co-owner of Kerber Brothers Pool Plastering in Norwalk, Calif.
After consulting with several skin cancer specialists and plastic surgeons, the news got worse. The surgery would be complicated, and Hawkins couldn’t find a doctor who felt comfortable performing the risky procedure. On top of it all, one dermatologist warned him that he wouldn’t last much longer if it wasn’t handled soon.
“He said I’d be dead in six months,” Hawkins recalls. “That freaked me out and stopped me right in my tracks.”
Following a recommendation, he went to the John Wayne Cancer Institute in Santa Monica, Calif. Doctors at the research facility removed the melanoma, saved his life and restored his face to almost as good as new.
Though Hawkins managed to dodge the proverbial bullet, the rate of all skin cancer incidents in the United States has surged an alarming 26 percent from 1993 to 2003, according to the American Cancer Society. The odds of contracting the illness are far worse for pool builders, subcontractors, plasterers and service technicians, who spend most of their workdays outdoors. In a recent survey of industry professionals conducted by Pool & Spa News, 24 percent of the respondents revealed that someone on their staff had been diagnosed with the disease. Yet, only 3 percent said they offer a comprehensive training/education program for employees.
The statistics are staggering. More than 1.5 million new cases of skin cancer are diagnosed each year in the United States. For men over age 50, it’s the No. 1 disease, ahead of prostate, lung and colon cancer, according to the Skin Cancer Foundation in New York. Understanding the threat and learning how to take measures against it may be the key to helping outdoor workers stay out of harm’s way.
Skin Cancer 101
Most skin cancers are classified as nonmelanoma. They can occur in basal or squamous cells, which are located at the base of the outer layer of skin. These types of cancer generally appear on sun-exposed areas of the body, such as the face, neck and ears. They can be fast or slow growing, depending on the type, but generally don’t spread to other parts of the body — though there are plenty of exceptions to this rule.
Melanoma comprises the smallest percentage of skin cancer cases, but it is the most deadly form of the disease. It begins in cells known as melanin. These cells provide pigmentation and protect the deeper layers of skin from harmful ultraviolet rays.
Studies indicate a strong correlation between melanoma and the amount of sun exposure an individual received as a teen or young adult. Conversely, cancers affecting basal and squamous cells appear to stem from repeated exposure to the sun’s ultraviolet rays over a long period of time.
“Most people who develop melanoma can remember having severe sunburn in that location on their body at some point in their life,” says Min-Wei Christine Lee, M.D., M.P.H., a dermatologic surgeon and director of The East Bay Laser & Skin Care Center in Walnut Creek, Calif. “That’s why the No. 1 area for melanoma in men is on the back and for women on the rear of the legs. These are the areas that receive the greatest number of sunburns.”
On the other hand, a significant number of people develop melanoma on parts of the body never exposed to the sun, Lee notes. This is largely due to genetic risk factors.
The profile of an individual at higher risk for skin cancer would be a middle-aged male with light-colored hair and a family history of the disease. A proliferation of moles and sensitivity to sun exposure also increases his odds.
“Some people are, indeed, more at risk. But the biggest factor is still intense, intimate sun exposure,” says Martin A. Weinstock, M.D., Ph.D., chairman of the Skin Cancer Advisory Group at the American Cancer Society.
Everyone under the sun
No one knows about sun exposure better than Joyce Zeigler. When she was 31, the former pool service tech and self-described sun worshipper was diagnosed with an advanced stage of melanoma and told she had less than six months to live.
Despite the doctors’ dire predictions, radical surgery saved Zeigler’s life.
Surgeons cut a grapefruit-size hole in her back to remove the cancer. Six months later, another case of melanoma was discovered near Zeigler’s eyebrow, and more surgery was required.
“I loved working on pools,” she says. “I loved being out in the sun. I moved to Florida when I was 5 years old, and became an outdoors and water person.”
Zeigler was extremely lucky. In the United States, one person dies from skin cancer — primarily melanoma — every hour, according to the Skin Cancer Foundation. In addition, one in five Americans and one in three Caucasians will develop some form of the disease over the course of a lifetime.
Those numbers are on the rise. Incidence rates of melanoma increased 25 percent from 1993 to 2003, the American Cancer Society points out. More recently, they went up 10 percent from 2004 to 2005, according to the Colette Coyne Melanoma Awareness Campaign, a cancer foundation in New Hyde Park, N.Y.
Following Zeigler’s recovery, the doctors told her that she should no longer work outdoors. “The pool industry was my whole life, and I didn’t want to give it up,” she says.
Zeigler managed to find indoor pool industry jobs, first in distribution and more recently in sales. Today, she talks about cancer prevention to anyone who will listen. “When I see the service and repair guys, I tell them what happened to me,” she says. “I say, ‘You can’t do it like this. It will kill you. Where’s your sunscreen? Where’s your hat?’”
Any doubts that outdoor workers are at a higher risk were put to rest by a study conducted by the Marshfield Clinic in Marshfield, Wis. “Outdoor workers have a higher prevalence of skin cancer,” says Steven R. Kirkhorn, M.D., M.P.H., who oversaw the study in 1995. He is medical director of the clinic’s National Farm Medicine Center and Department of Dermatology.
“We did find that melanomas tend to be related to the accumulated effects of the sun,” Kirkhorn says.
But, as Zeigler has seen, the message can be difficult to get across. Many workers are in their early to mid-20s, and believe they’re “invincible and will live forever,” according to Javier Payan, president of Payan Pool Service in El Cajon, Calif., and the San Diego County regional director at the Independent Pool & Spa Service Association.
Getting the message
Alan Smith always thought he was one of the indestructible ones. He began a career in his late teens as a pool plasterer and thought nothing of working long summer days without a shirt or hat.
Thirty years later, Smith noticed a strange bump on his neck. Doctors soon discovered that the veteran plasterer had developed squamous cell skin cancer, which had spread to his lymph nodes. They gave him less than a 30 percent chance of survival.
The irony of the diagnosis was that one of Smith’s best friends had recently passed away from the same disease, and Smith knew firsthand the severity of the illness. “I remember praying to God, saying that I can handle anything but what my friend went through,” recalls Smith, who owns Alan Smith Pool Plastering in Orange, Calif.
Like Hawkins, Smith’s research led him to the John Wayne Cancer Institute. He underwent chemo and radiation therapy in massive doses and lost more than 60 pounds. A feeding tube was inserted into his stomach for almost six months.
After the treatments, a series of biopsies on Smith’s neck revealed he was in remission. He not only survived, but was able to return to the helm of his thriving business, as well as his duties as chairman of the Research Committee with the National Plasterers Council, based in Port Charlotte, Fla.
The episode changed Smith’s life, and he was determined to help others. The result was a partnership between NPC and the John Wayne Cancer Institute to create the National Good Turn Program, which raises money for cancer research. NPC members are asked to make contributions to the institute, and additional funds are raised at the group’s annual conference through its popular auction. Members bid on items donated by manufacturers and material providers. The group raised nearly $200,000 at its 2007 conference.
In addition, NPC continues to offer cancer screenings at industry trade shows across the nation. “We don’t have a doctor, but we use a light that’s shone on the face and arms, and it can detect [skin cancer],” says Mitch Brooks, NPC’s executive director. “I think this year we will have even more information on skin cancer along with preventive tips.”
Brooks hopes to expand Good Turn into a cooperative program with other industry organizations. “It’s a big part of our agenda,” he says.
The rest of the pool and spa industry has been slow to embrace skin cancer awareness and prevention. A grass-roots effort to spread the news currently is under way by some organizations, but these endeavors have met with varying degrees of success.
For example, California trade shows such as the Western Pool & Spa Show and Pool Industry Expo cater to the service side of the business. At one time, both had booths dedicated to disseminating skin cancer information, but the programs fizzled when outside support dwindled.
“At the Western Pool & Spa Show, we used to have a booth with a dermatologist,” says Cal Terry, WPSS president. “The doctor eventually wanted to get paid. We couldn’t get anyone to come in for free. It’s a shame because we had this tent where guys could go in and take off their shirts, and get a quick examination.”
Bill Hoy, PIE’s co-executive director, says the show worked with the American Cancer Society approximately 10 years ago. PIE had a booth where someone passed out informational brochures. Eventually it became difficult to get volunteers, though.
“I think it’s needed; no question about it,” Hoy says. “I would definitely like to bring it back. We have a call in to the American Cancer Society, and we’re waiting to hear back from them.”
The Northeast Spa & Pool Association in Morganville, N.J., offers material on the dangers of sun exposure as part of one of its classes, says Paulette Pitrak, the group’s deputy executive director. However, at NESPA’s Atlantic City Pool & Spa Show, there are no classes or informational offerings about the risks of skin cancer. She’s hoping this will soon change.
“We [have a booth where] we do health testing, things like blood pressure, and cholesterol and blood sugar levels,” Pitrak says. “Maybe we can add a skin examination.”
The pool and spa industry in Florida also is aware of the problem, but has yet to implement any formal skin-cancer education. “As a state, Florida recognizes that [the threat of skin cancer] is part of our lives,” says Wendy Parker, director of marketing at the Florida Swimming Pool Association in Sarasota. “As an association, we’ve gone back and forth about it and have thought about adding something to our annual Florida Pool & Spa Show, maybe something on the show floor.
“In Florida, we hear so much about it, and those who grow up here are taught about it often,” she adds. “Maybe you don’t hear about it as much in other states, but we do have a lot of new people moving in all the time and they need to be educated.”
For Hawkins, the word can’t get out fast enough. He spoke about his skin cancer ordeal at an NPC conference several years ago and says he was stunned at the lack of knowledge pool contractors had on the subject.
“I don’t think they talk about it much at all,” Hawkins says. “A lot of guys came up to me very concerned. I spoke to people for three hours after my speech. I said if they’re concerned, they need to go see a professional, especially if they’re out in the sun all the time. I go to a dermatologist twice a year now and keep track of every mole or spot on my body.”
Only time will tell if Hawkins’ message gets through to members of the industry who need it the most.
- By the numbers
Skin cancer statistics and survey results.
- In the minority
Skin cancer affects everyone.
- Fighting back
Four ways you can reduce the risk of skin cancer.
Check with these organizations for more information about skin cancer, from prevention strategies to making contributions:
John Wayne Cancer Institute Santa Monica, Calif.
Skin Cancer Foundation
American Academy of Dermatology
American Cancer Society
National Plasterers Council
Good Turn Program
Port Charlotte, Fla.