CVAHEC Student Project Reports

Laura McGevna
Freeman Scholar Program 2006

Vermonters are outdoor people. Indeed, our culture is intrinsically coupled to Nature. Our dairy farmers are loyal to the land, even through the toughest of times. We spend our summers on Lake Champlain, our Spring days hiking on Camel's Hump; we are drawn to the foliage in the Fall, and we are undaunted by sub-zero temperatures as long as there is snow for us to ski at Smuggler's Notch. Though there is much enthusiasm for the outdoors, unfortunately, many Vermonters do not exercise the same enthusiasm for adequately protecting themselves from the sun. Sadly, the Healthy Vermonters 2010 campaign reported that the rate of Melanoma in our state is higher than the national average. Our clinicians were not surprised.

During the academic year, I became interested in the etiology of cancer, and the progression from sun exposure to pathology. I undertook to work with Dr. Marcus Bosenberg and Dr. Deborah Cook in Dermatopathology, to learn the course of the disease and the science behind it. On the advice of Dr. Mimi Reardon and Dr. Bosenberg, I contacted a local, highly respected dermatologist who invited me to shadow him in his clinical hours.

Being present in Dr. Partilo's office taught me a great deal about cancer pathology. By the end of four weeks, I could discern a benign seborrheic keratoses from a lesion suspicious for melanoma. More surprisingly, I learned that skin cancer is potentially his most frequent diagnoses, from the most benign basal cell to a more problematic squamous cell to the often lethal melanoma. Perhaps the most important discovery that the four weeks proffered was the critical nature of regular skin examinations, especially among high risk populations.

Dr. Partilo implored his patients to come to his office at least once a year, or to request a skin exam from a primary care physician so that they might catch a lesion in its earliest stages. He constantly underscored the need to wear sun block every day, to remain out of the sun in peak hours and to avoid blistering burns. Unfortunately, many of his patients were reared in a culture where tan was equated with healthy; others had long ago resigned themselves to a life of "chasing" lesions; and still others were simply apathetic. Dr. Partilo expressed to me that most damage is done early in life, and that many of the cancers that we removed in the clinic were the remains of burns his patients had received long ago. Therefore, if any lasting change was to be made to our consciousness, it would have to begin early. With that understanding, I returned to the Pathology Department.

I spent hours with Dr. Cook and Dr. Bosenberg under the microscope examining the cellular pathologies that were the foundations of skin cancer. The two physicians taught me a great deal about sun damage, cellular changes and the progression to disease. Under their instruction, I came to understand how even the most superficial of sun burns could eventually transform into a loathsome, uncontrollable lesion. Indeed, I watched as many in Dr. Partilo's office shrugged at actinic keratoses - scaly papules and plaques that are considered by many to be the earliest form of squamous cell carcinoma - and then examined the microscopic slides of the same form of cancer travel down the nerve of a man who had ignored the lesion on his face for too long. By the end of the operation to remove the lesion, we learned that he had lost his cheek and much of his nose.

After a few weeks in Pathology and Dermatology, I was moved to bring my knowledge to the community - the youger the audience, the better. Living in Winooski, I have passed many hours in the sun around the community pool, and known many sunburned children. Nevertheless, when I arrived at the pool to speak to the kids about sun poisoning and dangerous sunburns, I was horrified by the lack of sun block available and the terrible burns on their tiny faces and backs. On one of my visits, I spent the afternoon handing out sunscreen to the children - donated by the VCC - along with lanyards and activity books that explained safer ways to enjoy the outdoors. The children and I made solar bead necklaces and bracelets under canopies, and then stepped into the sun to demonstrate the effects of UV rays. I explained that the same rays that changed the color of the bracelets also damaged their skin. We then applied sun block to the beads, in an effort to have them better understand how to shield their skin. By the end of the afternoon, the children were helping each other apply sun block, and pledging to wear SPF all summer long. I returned to the Farmer's Market the following week to hand out our sunscreen and educate other members of the community.

This summer afforded me an incredible opportunity. I became more connected to my community, and inordinately aware of the minor changes in the composition of our skin that eventually threaten disease. It was among the most valuable experiences of my life, as it was the first time I could judiciously evaluate a skin pathology, speak with confidence to others about skin cancer prevention and know the importance of community medicine.

The following is a list of children, with their hometown and age that pledged to wear sunscreen for the remainder of the summer:

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The views expressed in the Student Project Reports are those of the authors and do not necessarily reflect the views of Champlain Valley Area Health Education Center.