San José, Costa Rica, since 1956

Skin cancer on the rise in sunny Costa Rica

Every year, the Costa Rican Social Security System (Caja) hospitalizes more than 400 patients because of skin cancer. It’s become one of the most dire health hazards in the country.

In 2010, doctors diagnosed more than 2,000 skin tumors, which caused 11 deaths.

Several years ago, Caja officials turned to the University of Costa Rica (UCR) for research on the incidence of skin cancer in the country. A UCR investigation found that during the past decade skin tumors have been the most common type of cancer in Costa Rica.

Between 2000 and 2004, more than 7,000 new cases were diagnosed. At the time, skin tumors represented 20 percent of all tumors diagnosed here. In the past seven years, this number has doubled.

“At the San Juan de Dios Hospital, not a day goes by without [doctors] diagnosing at least one, if not several, cases of skin cancer,” said Harry Hidalgo, the San José hospital’s chief dermatologist. Hidalgo also said he believes the Caja’s statistics on skin cancer are lower than the actual number. While the Caja keeps good records of hospitalized patients, they have very little information on patients who are treated in external visits at all public hospitals, Hidalgo said.

A number of foundations, hospital personnel and smaller organizations are working to create public awareness. Each year, these groups head up skin-protection campaigns during holidays, when people often head to the beaches.

Another recent initiative took place at La Católica Hospital in San José. Dermatology specialist Vanessa Fumero and a group of colleagues organized the second annual Early Skin Cancer Detection Campaign.

The initiative included a full day of free seminars on skin protection, and later, several doctors offered free skin examinations in order to promote early detection of skin tumors. Last year, 250 people showed up for this same initiative to get their skin examined by the volunteer dermatologists. This year, Fumero’s expectations were exceeded: 1,500 people attended the free checkups at La Católica Hospital. “We realize how much the country needs initiatives like this. It is a serious issue and people know now,” Fumero said.

The initiative isn’t the first of its kind. San Juan de Dios Hospital has been organizing skin cancer detection campaigns for the past nine years. “About 3,500 people have been tested,” Hidalgo said.

The campaigns also provide special training for general practitioners, which help with early cancer detection in a non-specialized setting.

Since 2004, the incidences of skin cancer in Costa Rica have increased by 54 percent. According to Caja statistics from 2008, residents most at risk live in the Central Valley and in the communities of Ciudad Quesada and Coto Brus, outside the valley. The provinces with the highest number of patients being treated for skin cancer are Heredia and Alajuela.

Three types of skin cancer exist: basal-cell carcinoma, squamous-cell carcinoma and melanoma. Although basal-cell carcinoma was most common among people older than 50, it is increasingly affecting younger people, including patients in their thirties. “Though it is still rare, we are starting to see cases of the three types of skin cancer in teenagers and young adults in their twenties,” Hidalgo said.

Basal-cell carcinoma becomes visible on the skin as a small spot caused by sun exposure. Squamous-cell cancer causes visible ulcers on the skin.

Although squamous-cell cancer has a 27 percent chance of metastasis, meaning that it can easily invade other organs and cause other sorts of cancer, melanoma is the most aggressive type of skin disease. “Melanoma is extremely dangerous since it has a 70 percent chance of causing metastasis,” Fumero said.

Melanoma appears on the skin as a black spot that may be located on any part of the body. However, studies show that melanoma has a tendency to appear on the lower legs in women and on the back and shoulders in men. The spot usually looks like a mole or bump on the skin.

“Nine years ago, when we started our early diagnosis campaigns, most cases were advanced. But today the cases we see are at much earlier stages,” said Hidalgo, who attributed the advance to greater public awareness of the issue.

All three types of skin cancer can be surgically treated. With early detection, the odds of curing skin cancer are high. However, once cancer reaches an advanced stage, fighting it and preventing metastasis to other organs becomes extremely difficult. “Though skin cancer is the most common type of cancer in Costa Rica, people do not seem to worry enough about prevention and early diagnosis,” said Fumero.

ABC’S Of Detecting Skin Cancer

Dermatologists recommend being extremely attentive to any changes appearing on the skin. An easy way to remember the kinds of changes to look for when checking any moles is the “ABCDE” guide.

“A” stands for asymmetry.

“B” is for border, or when the edges of moles are blurry or jagged.

“C” represents changes in color, including darkening, spreading, loss or multiple colors.

“D” stands for diameter. Doctors recommend getting checked when moles are larger than the size of a pencil eraser.

“E” represents elevation of moles raised above the skin or having a rough surface.

Pay attention to any skin changes, even if they do not hurt or itch.

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