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When people ask me how I got into the field of dermatology/oncology nursing and skin cancer prevention, I reflect back on a childhood memory. From the red headtime I was in kindergarten, I would delight in telling my friends “I can see your epidermis” delivered as one of those obnoxious taunts. Their reactions showed me that I had correctly guessed that they did not know that “epidermis” was the medical term for the skin. Today, I wonder if I was just being a vocabulary bully or having a flash of my future professional life.
Fast forward 50 years and I am still choosing vocabulary words to make an impact on people. Today, however, I am not trying to taunt with my words but rather to educate and motivate children about sun safety. Because my training and experience has taught me that sun damage in childhood leads to skin cancers in later life, this is where education and motivation must begin. For this reason, I started Children's Melanoma Prevention Foundation in 2003.
Experts now estimate that there will be 3.5 million new cases of skin cancer this year alone. One person dies every 45 minutes from this preventable disease. Prevention is the key to reversing this frightening trend. And it must begin in childhood.
Tragically, skin cancer in the last thirty years is steadily rising among children. This trend is most likely due to the increased incidents of sunburn among children and the popularity of indoor tanning among teens. This, coupled with my firsthand experience in caring for patients dying of skin cancer, is why the foundation’s work is so important to me personally.
The Children’s Melanoma Prevention Foundation was founded to teach children and their caretakers safe and proven methods of sun protection and skin cancer prevention. How do we do this? Specifically, we teach children about the factors that affect UV intensity and skin sensitivity, as well as proven methods of sun protection and skin cancer recognition. We do this not through fear tactics but rather through fun and informative activities. Each year we teach thousands of children, teachers, nurses, and parents in the hope that we can empower them to practice what we preach, Be Safe. Be SunAWARE.

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As I reflect on my summer internship with the Children’s Melanoma Prevention Foundation, I know MNN 1I will embark on my journey as a health educator and future nurse with a new and evolving tool kit. Below, I have listed just a few tips I learned throughout the summer. I have gained valuable experience during the twelve weeks I spent connecting with healthcare professionals, educating members of the community on sun safety, and representing CMPF.
1. Always lead by example.
I struggle to always live a SunAWARE life. I enjoy the warmth of the sun beating on my shoulders. Because of this, I don’t always appreciate and welcome the shade. While educating individuals about proper sun protection, I tell them to seek shade. Exhibiting and educating outdoors without shade, sends the wrong message. I am becoming more aware of caring for my own skin while teaching individuals how to protect their skin.
2. Wear many hats. Be prepared to adapt when necessary.
I recall the first presentation I did on my own. I was prepared for very small groups (2-3 people at a time) to come up to me to learn about proper sunscreen application and sun safety. When I arrived, I found out that I was going to be doing a presentation in front of 20 lifeguard and park staff. I was not prepared and very nervous. After providing the staff with a bumpy sun safety training, I left learning a valuable lesson. Always be prepared for anything and have a backup plan. I spent the rest of my internship building my confidence as an educator by preparing for presentations and creating back up activities.
3. Always have fun.
I enjoyed interacting with members of the community while working with the SunAWARE education team. By using the UV camera system and making the events interctive, individuals were engaged and had fun learning about proper sun safety tips.
4. Remember, wearing sunscreen doesn’t have to stink.
Growing up, I would often opt out of wearing sunscreen if I wasn’t outside for a long period of time because I hated the smell. While exhibiting with CMPF, much to my surprise, I found a sunscreen that actually smells great! Now I apply sunscreen every day. It is important to find a sunscreen that you enjoy wearing.
5. Education is the key to prevention.
Through my summer internship, with the guidance of CMPF staff, I taught individuals at farmers’ markets, schools, pools, and beaches. While I provided them with information on how to prevent sun damage and skin cancer, the prevention continues when they educate those they love about what they learned at CMPF events.

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Growing up as a redhead, I always knew that I needed to wear sunscreen and stay covered to protect my skin. Even though I thought that I knew how to KELLY MURPHY PROFILEkeep my skin healthy year-round, I recall many summer nights lying in bed as the skin on my back peeled off in sheets, in too much pain to move. However, I didn’t realize the real danger of sunburns until I did a summer internship with the Children’s Melanoma Prevention Foundation.

Redheads, like myself, are a rarity comprising only 2-6% of the total population of the United States. This summer, I learned that people with red hair developed melanoma 10 to 100 times more often than people without redhair. Boston researchers found redheads have a genetic mutation in the melanocytes, pigment producing cells. This mutation affects the melanin and doesn’t let the skin tan and doesn’t protect the cells from UV damage (Collins, NIH, 2013). This increases the likelihood of red heads developing skin cancer including melanoma, the deadliest form of skin cancer. Melanoma is responsible for 75% of all skin cancer deaths even though it is often preventable.

So what does all of this mean for those of us with fair skin and red hair? We need to take special precautions. Listed are practical tips for living a SunAWARE life.
1. Researchers state that proper daily use of a broad spectrum sunscreen with an SPF of at least 15 reduces the risk of developing melanoma by 50% (JCO, 2011). It is recommended to use a whole handful for the whole body. It is important to reapply sunscreen every two hours as sunscreen effectiveness decreases as it is degraded when exposed to UV light. Pay close attention to areas of the skin that are not covered with clothing.
2. Wear a wide brimmed hat which covers the face, ears, and neck. Most skin cancers develop on the tips of the ears and nose. Use extra caution to protect these vulnerable areas.
3. Avoid indoor tanning. There is no such thing as a healthy tan. A tan is actually evidence of skin damage. People who use a tanning bed before age 35 increase their risk for melanoma by 75%.
4. Redheads should Inspect their skin for new growths or changes and see a dermatologist or healthcare provider for any concerns.
5. Make sure the sunglasses you are wearing block UV light. Sunglasses without this protection could cause photokeratitis, sunburn of the eye, and could lead to melanoma of the eye. Use eye protection year-round.

With the incidence of skin cancer steadily increasing, it is important to take this information and educate those who you love. I learned through my internship that most skin cancers are preventable. By providing those you care about with this valuable information, you could save a life.

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Last summer, I worked with CMPF and learned about their UV reflectance camera that they use to illustrate sun damage. I was so thrilled when they brought the camera to my high school this spring for a health fair. It was fun for me to see the reaction of my classmates when they saw their skin on the monitor.

UV reflectance photography highlights pigment changes from sun exposure. The way that it works is that the camera has specialized light filters that helps to visualize excess melanin that isn’t necessarily visible on the skin’s surface. It also helps visualize melanin deposited in the skin. Melanin, or pigment, is kind of like your body’s natural sunscreen that stands between your cells’ very important DNA and the sun’s potentially dangerous photons (light energy). The more melanin one has the less sun sensitive they are. Freckles and moles are the result of excess melanin production that is most often related to overexposure to UV light. Both freckles and moles serve as the indicator of sun sensitivity and skin cancer risk. However, it is important to realize that even-toned skin can actually have DNA damage secondary to overexposure to the burning or tanning rays too.

UV reflectance photography is an extremely useful tool for showing people how damaging the sun can be. The distribution of freckles across the nose and cheeks is a clear indicator of the effect of the UV rays on the skin. Freckles develop most commonly on the nose and cheeks because they are in a direct line with the sun when it is strongest at midday and over their heads. This is also the most common site for skin cancer to develop.

My classmates reacted with shock when they saw how damaged their skin was. The foundation teacher also used the camera to demonstrate that sunscreen provides a barrier between the skin and UV Rays. When the student applied a chemical sunscreen to their skin it appeared black and the SunAWARE teacher was able to illustrate if my classmate missed a spot. It’s terrific technology that provides two important lessons about sun safety. For an illustration of this technology go to: https://www.youtube.com/watch?time_continue=1&v=o9BqrSAHbTc

Below is an example of UV reflectance photography. The left photograph shows the persons skin as we usually see it, which at surface value does not appear too damaged. The photograph on the right is the UV photo. Notice the darker gray spots, they are freckles (sun damage) on his face that is concentrated in areas of high UV exposure. These photographs help illustrate changes from the sun and the need for sun protection.

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This image shows the effectiveness of SPF 50 sunscreen using a UV reflectance camera. Solid dark represents well-distributed sunscreen and protected skin.

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If you have the opportunity to see your skin through one of these super cool cameras, be sure to know what you’re looking at and, more importantly, ask questions if you don’t! There are ways to correct damage that has already been done, and of course to prevent further damage, always be SunAWARE.

Quincy High Girls UV

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Long before I was born, back when my parents were dating my mom noticed a strange mole on my dad’s back. He didn’t think it was a big deal but she was quickly concerned and told him to get it checked out. Sure enough, it turned out to be a bad case of melanoma. He had to have surgery to remove it and it left him with a huge thick scar. It runs down most of his back to the right of his spine.

I am reminded of this story constantly during the summer, and it honestly scares me every time that I think about it. I know that because I have a strong family history for melanoma, which all of my grandparents have had by now as well, I am at risk for getting it too. However, the fact that my parents have always been on my back about protecting myself against the harmful sun rays gives me hope that I will be okay. My Dad's scar is a good reminder to be cautious.

Being a redhead, I am constantly reminded that my pale skin is very susceptible to sun damage. Starting in the Spring, my parents always tell me as I’m about to go outside, “Remember your sunscreen!” Going to the beach or pool, I hear, “You better be wearing a swim shirt and a hat!” Through my involvement in the Children’s Melanoma Prevention Foundation, I am now able to better understand the real dangers of melanoma and how it may be prevented. I have learned that sunscreen, hats, and swim shirts may be a pain, but they really are useful in preventing painful sunburns and lowering the risk of melanoma and other skin cancers. I have also learned the importance of checking my skin for changes.

I am so thankful that my mom was able to catch my dad’s cancerous mole before he got sick. Thank you, Dad for being an amazing father and role model. Happy Father’s Day!

Hello! I am Kelly Murphy, the summer intern with CMPF. I am currently studying Public Health at Central Michigan  KellyUniversity in Mount Pleasant, MI. Upon graduation from CMU in August, I will be studying nursing. I am eager to broaden my knowledge of public health with CMPF this summer.
The cultural diversity and experiences I have gained during my first two weeks at CMPF are invaluable. On my second day, I was given the wonderful opportunity to represent CMPF at an after school health fair in Quincy. I have to admit that I was nervous going into this assignment. Many of the parents spoke English as a second language. Despite the language barrier, I was still able to get the message out about the importance of being Sun AWARE. This experience has been my most memorable thus far.
I have connected with many individuals and gained new insight into the relationship between public health and nursing. In addition to assisting with school programs, I have attended a public hearing for amendments to the anti-tanning law and the North Shore Community Health Network Meeting. I have gained new understanding of the direct and indirect action of nonprofit organizations and foundations. I am looking forward to growing as a public health educator and future nurse during my summer with CMPF.

More than 5 million Americans are diagnosed with skin cancer each year, making it the #1 cancer in the United States. Although $8 billion dollars is spent annually on treating skin cancer, we still loose one person every 45 minutes to the disease. Nurses play an important role in educating patients and their communities about skin cancer prevention.

In 2014, the U.S. Surgeon General, Admiral Boris Lushniak, issued a Call to Action (CTA) to Prevent Skin Cancer. He declared that skin cancer was a major public health problem for Americans. The CTA included five strategic goals to educate, advocate, research and protect Americans from skin cancer.

The Surgeon General’s Call to Action Goals:
1) increasing opportunities for sun protection in outdoor settings;
2) providing individuals with information to make informed, healthy choices about UV exposure;
3) promoting policies that advance the national goal of preventing skin cancer;
4) reducing harm from indoor tanning;
5) strengthening research, surveillance, monitoring, and evaluation related to skin cancer prevention.

The Surgeon General’s CTA has been an important step forward in galvanizing all stakeholders to take action to prevent skin cancer. One nursing organization, the Dermatology Nurses Association (DNA), has responded to the CTA by issuing an official Position Statement that includes strategies to address the national CTA goals. DNA issued a press release on May 2, 2016, outlining its position on the CTA and recognizing its efforts in support of May as the official Melanoma Awareness month in the U.S.

The DNA’s official position is to use the SunAWARE acronym and materials to promote the Surgeon General’s Call to Action by educating our patients, individuals, colleagues, teachers, administrators, lawmakers, town planners, and others to Be Safe, Be SunAWARE!

The SunAWARE acronym is comprised of five easy steps, in order of prevention priority:

Avoiding unprotected UV exposure, seek shade, and never indoor tan.
Wear sun protective clothing, including broad brimmed hats, long sleeves, pants and sunglasses.
Apply adequate amounts of a BROAD SPECTRUM sunscreen and reapply at least every two hours.
Routinely check your whole body for new and changing growths, and report suspicious changes to a health care provider.
Educate your family and community about sun protection and skin cancer prevention.

Reference:
Call to Action: http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html.

DNA Position Statement on the Call to Action:
http://www.dnanurse.org/docs/5216pressrelease.pdf

1. UV intensity peaks mid-day and on the Summer Solstice (June 21st in the Northern Hemisphere). Therefore it is easier, on average, to sunburn in May CMPF 8511 r6F 1than August.
➢ This is important because the UV Index is a measure of sun damage risk. To lean more download a free UV app (EPA, UVUS) on your smartphone.
2. Sunscreen is an over–the-counter medication with a dose and frequency of application. To use this medication properly: apply a handful of BROAD SPECTRUM product to cover the entire body, 15 minutes prior to sun exposure, and reapply every 2 hours or more often if perspiring or exposed to water.
➢ This is important to know because if you apply 1/3 of the sunscreen dose then you get 1/3 of the protection. Most sunburns in sunscreen users are due to inadequate dosing and failure to reapply.
3. In 2010, the Institute of Medicine reissued their dietary reference for vitamin D, recommending that we obtain the required dose from food and oral supplements not sun exposure.
➢ This is important because only the most damaging, midday, burning (UVB) rays, are capable of metabolizing vitamin D in the skin.
4. Sun protection clothing is superior to sunscreen in providing UV protection.
➢ This is important because the UPF (Ultraviolet Protection Factor) in specialized clothing, unlike sunscreen, never loses its UV protection.
5. A tan is a compensatory protective mechanism and a sign of sun damage.
➢ This is important to know because a tan develops following overexposure to UV radiation when our melanocytes (pigment producing cells) release additional melanin to protect us from further damage.
6. We are not born with freckles but rather a genetic predisposition to develop them.
➢ This is important because freckles develop at sites of overexposure and are a sign of sun damage and skin cancer risk.
7. Moles come in different types and impart different risks for skin cancer.
➢ This is important because a congenital mole (present at birth), or typical (small, round, symmetrical, even color) and atypical (larger than an eraser head, irregular in shape or color) have varying degrees of malignant potential.
8. 1/3 of melanomas in men develop on their back.
➢ This is important because men need to “Watch their Back” or have someone else look for new or changing growths.
9. Melanoma has increased in children by 2% per year for the past thirty years and 72% of melanoma cases in children occur in teenage girls between 15 to 19 years old.
➢ This is important because American girls are exposing themselves to UV rays (natural and artificial sources) starting at a very young age to achieve a tan.
10. Most people do not realize that the Surgeon General issued a Call to Action to Prevent Skin Cancer in 2014.
➢ This is important because the Surgeon General has called on all Americans to learn about UV radiation and protect themselves from overexposure.

Hingham educator Susan Keyes knows all too well the pain and misery that melanoma can mean for a family. From 1995-1997, she underwent a grueling treatment regimen for metastatic melanoma. Against the odds, she survived—although she can never be in the sun again—and became committed to helping others understand prevention of the disease so that they can protect themselves and their loved ones.

As the head of the foreign language department for the Hingham Public Schools and a French teacher at the High School, Keyes has taken an active role in bringing an awareness of the dangers of tanning to students. She presented a gripping account of her struggle with melanoma to the entire high school at an assembly that was held in the spring of 2013. Known to her students as “Madam,” Keyes presented in a very matter-of-fact and even tone the agonizing effects of her treatment.

“It was so quiet in that auditorium that you could hear a pin drop,” she says. “The students were focused on what I was saying, and they really seemed to get the idea that this could happen to anyone.”

That presentation made an impact on Lea Concannon, who is now a senior co-captain of the HHS girls golf team. “Her whole statement really stuck with me, especially the timing of it during prom season when there is so much pressure to look your best and for some people that means tanning,” she says.

The golf team will be volunteering on March 19 at Putt for Prevention—a fundraiser for the Children’s Melanoma Prevention Foundation (CMPF) from 11 am to 4 pm on Saturday, March 19, at South Shore Skin Center in Norwell. All ages are invited to play an indoor 18-hole mini-golf course for $5 per player or $20 per family. The event is being sponsored by a number of South Shore businesses including Hingham Institution for Savings and Robin’s Nest.

“We are particularly excited about this event because it was created with kids in mind,” says Maryellen Maguire-Eisen, executive director and founder of CMPF. “Our organization is focused on kids, and we want as many kids as possible to come and have fun.”

Keyes became familiar with CMPF a few years ago, when Maguire-Eisen’s daughter Laura ended up being one of her French students at the high school. Keyes describes a “serendipitous moment” when she learned about the foundation through one of Laura’s assignments, which was written in French.

“After reading her essay, I spoke with Laura about the work her mother was doing and then introductions were made,” says Keyes, who became a CMPF board member in 2011. “I am uncomfortable talking about that part of my life, but if I can help one person, then it’s worth it,” she says.

More than 5 million people are diagnosed with skin cancer each year, and one person dies every 45 minutes from the disease in the United States. What makes melanoma particularly frustrating for medical professionals is that it is largely preventable and also very treatable when caught early. But in the later stages of the illness, cure rates are very low and the treatments are exceedingly difficult for patients and their families, Maguire-Eisen says.

In February, the state of Massachusetts passed a law banning anyone under the age of 18 from using or operating a tanning bed. Cancer activists, including the American Cancer Society and the CMPF, had been pushing for passage of this law for more than a decade because numerous studies had demonstrated a clear link between tanning and melanoma.

“Melanoma is now developing in very young women because the newer tanning machines are even stronger and more carcinogenic than they used to be,” says Maguire-Eisen, who testified at the hearings for this bill. “I am very pleased that children in Massachusetts will now be protected from this carcinogen at least until they are 18 years old.”

The Hingham-based CMPF is a non-profit, educational foundation established in 2003 that teaches children and their caregivers how to protect themselves from the harmful rays of the sun while enjoying outdoor activities. Each year, more than 50,000 students from kindergarten through 12th grade actively participate in presentations and projects provided by trained Foundation staff members at local schools, sailing clubs, day care centers and health clubs. All programming is provided free of charge to participants and is made possible by sponsorships and fundraising by the organization. More information is available at www.melanomaprevention.org.

Hello!Norbert

It's me, Norbert. I thought it would be fun to share some news about what I've been up to lately. The Norberthood has been a busy place!

I recently moved all the way across the country to sunny Los Angeles. I'm having fun, and being safe, in the sun. Last month I earned my renewal as a registered therapy dog and continue to volunteer to spread smiles & inspire kindness. I was recently featured in a Paper Magazine article and next month I am honored to be the cover dog for Animal Wellness Magazine.

A project I am excited about is the development of my Norbert Plush Toy which will be available this summer -- a life-size, soft, huggable plush that I hope will make people smile. More info is here: bit.ly/norplush

Thanks for checking in with me.

High-Five!
Norbie

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