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Special Report~ Time to take skin cancer seriously. N.H. has seventh highest rate in nation
By Michelle Kingston

Sunday, June 2, 2013

Ashley and her son Cole, 2 years old, sit under an umbrella at Hampton Beach Thursday afternoon.
(Ryan McBride/ Staff photographer)

DOVER — It can happen to anyone.

Skin cancer is not just a blue-eyed, fair-skinned, redheaded disease.

While the chances increase in Caucasians, skin cancer accounts for 2-4 percent of all cancers in Asians and 1-2 percent of all cancers in African Americans and Asian Indians, according to The Skin Cancer Foundation.

With summer just around the corner, people of all eye, skin and hair colors should take proper precautions, as 3.5 million new cases of skin cancer are diagnosed annually.

According to the New Hampshire Department of Health and Human Services, the number of cases of melanoma, the deadliest form of skin cancer, has increased more than any other cancer in both New Hampshire and the United States over the past 30 years.

In 2013, an estimated 350 New Hampshire residents will be diagnosed with melanoma and about 40 people will die from the disease. New Hampshire had the seventh-highest melanoma mortality rate in the country from 2001 to 2005 and the second-highest rate of new melanoma diagnoses.

A woman wears a hat and enjoys the sun at the beach in Hampton Thursday afternoon.
(Ryan McBride/ Staff photographer)

Someone dies from skin cancer, which is an uncontrolled growth of skin cells caused by DNA damage, every hour in the United States, according to The Skin Cancer Foundation.

Long gone are the days of slathering on baby oil before heading to the beach, unaware of the permanent damage a blistering sunburn could have on a life.

Did you know a person’s risk for melanoma doubles after just five sunburns?

Because melanoma is the only cancer of the seven most common cancers whose incidence is increasing, dermatologists and researchers are working hard to raise awareness of harmful effects of the sun.

According to Dr. James Campbell, a dermatologist at Dermatology and Skin Health in Dover, the increase in melanoma is only partly due to people exposing themselves to increased doses of ultraviolet radiation by tanning indoors and outdoors. The other major reason for the increase is higher detection rates. Dermatologists know how to detect skin cancers quicker and earlier than before.

“A higher detection rate is actually great,” Campbell said, “as long as the mortality rate is going down.”

Examples of thin melanomas.
(Courtesy photo)

Dr. Molly Chartier, of Northeast Dermatology in Portsmouth said, “The earlier you catch a melanoma and the thinner it is, the better the chances (of survival).

“If a melanoma is not caught when it is trapped in the top layer of the skin, it does have the potential to spread and be lethal,” she said. “The thicker it is, the more dangerous it is.”

Chartier said the more fair-skinned a person is, the more vigilant they need to be, but she warned that dark-skinned people also burn.

To reduce your risk of skin cancer, it is important to wear sunscreen, a hat, protective clothing and to not use indoor tanning beds, according to dermatologists.


While Campbell prefers Neutrogena sunscreen himself, he said he would recommend any brand to a patient, as long as they wear it.

“It is more about what is most comfortable for them,” he said.

He advises doing outdoor activities before 10 a.m. or after 4 p.m. to avoid the sun’s strongest rays. If a person is going to be outside between those hours, Campbell recommends putting on sunscreen 30 minutes before going outside and applying it before dressing to avoid missing a spot. He said an ounce of sunscreen is the proper amount to apply, and it should generally be reapplied every two hours regardless of the SPF. Sunscreen should be reapplied more often if you are swimming or sweating.

Courtesy photo An intermediate melanoma.

Look for sunscreens that have zinc oxide and titanium dioxide, as these are physical blockers that reflect light. Another ingredient to look for is mexoryl, which is a chemical blocker that absorbs energy.

A 2011 FDA ruling that took effect in June 2012 set many new standards and guidelines for commercially available sunscreens.

SPF 50 is now the highest rating and sunscreens can only be water-resistant, not waterproof. Sunscreens over SPF 15 and labeled “broad spectrum,” giving you protection from both UVA and UVB rays, are now labeled to state they help reduce skin cancer and premature skin aging.

Sunscreens not labeled “broad spectrum” and are below SPF 15 now come with a warning that reads, “Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer and early skin aging.”

If those messages remind you of cigarette labels, it is no coincidence. The Skin Cancer Foundation says ultraviolet radiation is a proven human carcinogen and tanning beds are now listed as dangerous cancer-causing substances — just like cigarettes.

A thick melanoma. The worst kind. (Courtesy photo)


Taylor Huynh, the salon director at Rochester’s Sun Tan City, one of the indoor tanning salons in a chain with locations throughout New England, said she lets all of her clients know that none of the lotions and products they sell have SPF in them.

“There is always a risk (of burning or getting skin cancer),” she said. “But we do everything we can to protect our clients.”

Huynh said that Sun Tan City never overexposes their clients, which is what causes skin cancer. She said that New Hampshire tanning salons are all Smart Tan Certified, meaning the directors go through training programs to learn about how the skin tans and how to protect it.

But according to dermatologist Dr. Campbell, there is no such thing as a safe tan because tanning is the skin’s response to trying to protect itself.

According to The Skin Cancer Foundation, people who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent.

“There is no reason to ever go into a tanning bed,” Dr. Chartier said.

Dr. Jose Montero, Director of Public Health at the New Hampshire Department of Health and Human Services, said in a public statement that there has been an increase in young women in New Hampshire being overexposed to UV radiation.

Nearly 30 million people tan indoors in the United States every year. Two to three million of them are teens and 71 percent of them are women.

“Fortunately, skin cancer is highly curable if found early and it can be prevented,” Montero said. “The best way to detect skin cancer early is to examine your skin regularly and recognize changes in moles and skin growths.”


Dr. Campbell recommends taking photos of your skin, or at least examining it once a month to see if any new spots have formed. The back of the legs is the most common place for skin cancer on women and the chest and back are the most common parts of the body to find skin cancer on men. Campbell recommends having someone else look at these parts of the body for you and learn to detect any new spots.

Campbell said the reason why these are the most common parts of the body for skin cancer is because of history. Women were wearing skirts, showing their legs, and men were doing outdoor labor, most likely without a shirt on. He said the most common spots may change over time, as, for example, the amount of clothing worn at the beach has dramatically changed over the years.

While there are areas of the body where skin cancer is most commonly found, it can appear anywhere. Campbell said dermatologists do not know why yet, but melanomas in African Americans, Asians, Filipinos, Indonesians and native Hawaiians most often occur on nonexposed skin with less pigmentation, with 60 to 75 percent of tumors being on the palms of the hands, soles of the feet or around the nails.

The Melanoma Research Foundation said Bob Marley, the popular Jamaican singer and songwriter, died of complications from Acral Lentiginous Melanoma that originated under his toenail and metastasized to other parts of his body.

Detecting melanoma early and removing it before it can spread to regional lymph nodes or other organs increases a person’s survival rate by 98 percent. The survival rate falls to 62 percent when the melanoma reaches the lymph nodes and plunges to 15 percent when the disease metastasizes to distant organs.

It is important to note that there are many types of skin cancers, including less deadly forms, such as basal cell and squamous cell carcinoma. While it is rarer for these types of cancers to spread to lymph nodes, they are nevertheless very common and are responsible for 3,170 deaths a year in the United States. The safe thing is to visit a doctor if you notice anything new or unusual on your skin.

The signs and symptoms of melanoma can be spotted by remembering the alphabet. If a freckle or mole is (A) asymmetrical (meaning one half of the spot is unlike the other), that is one warning sign. Others things to look for are a spot (B) border that is irregular, scalloped or poorly defined; (C) color that varies from one area to another; (D) diameter greater than 6 millimeters, and a mole or skin lesion that is (E) evolving, changing or looks different from others.


Routine skin screening by a dermatologist will detect skin cancers early and could save your life. Unlike other cancers, skin cancers can be easy to detect with the human eye. Dr. Campbell said he loves his job because, given the opportunity, he can detect cancer before it has a chance to spread.

One in five Americans will develop skin cancer in the course of a lifetime, so taking precautions, checking your skin often and scheduling routine dermatologist screenings is important, as skin cancer is preventable.

Dr. Chartier said that as people continue to work desk jobs rather than outdoor jobs, there is a higher prevalence of melanoma.

“Intermittent sun exposures,” she said, on people who go on weekend getaways or short vacations are more likely to cause melanoma than those who are outside in the sun all day long, all year long.

“ ... Beach and pool activities can be enjoyed safely as long as people take some extra precautions,” Perry Robins, MD, President of The Skin Cancer Foundation, said in a public statement.

However, Dr. Campbell said to just be aware of the reality of skin cancer.

“If you are around enough and you are pale enough, you’re likely to get something,” he said. “It’s mileage. Your skin is like a cab; the meter is always running when you are outside.”

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