Cancer is nobody’s favorite topic, but in the high desert of Moab skin cancer is a very real danger for outdoor guides and residents of Utah.
It’s the most common type of cancer in the U.S. and is caused by nothing more than the sun. Every year 5 million people are treated at a cost of more than $8 billion. Utah has a 70% higher rate of skin cancer than the U.S. average, with 1,057 new cases in 2015.
Any kind of cancer is a scary thought, but luckily melanoma is somewhat preventable. Anyone who spends time outdoors is at risk for sun damage, but guides (who often work long days in the direct sun) are especially at risk. Despite its commonality, outdoor guides along the Colorado River and in Moab aren’t always giving skin health much consideration in their day-to-day lives, even when they spend 13 hours a day in the direct sun.
“On a scale of one to 10? Two,” said river guide Keefe Doherty, when asked how much thought he puts into his skin’s health. He is a third-generation guide and a lifetime river rafter. “I’m busy rigging.”
Doherty and another local guide, Ben Watts, said “The general consensus is that we’re all too broke to do anything about it even if we get diagnosed, so why bother?”
“I pretend like none of that stuff is real,” Watts said, who works as a river and 4x4 off-road guide. “’cause I probably have melanoma.”
Wearing hats, sunscreen and covering up when in the sun is the best way to prevent the UV damage that causes skin damage. Choose a sunscreen with at least an SPF of 30, and SPF 60 is recommended for people who will be outdoors for prolonged periods of time.
If you see a concerning spot, have a doctor check it out. Melanoma can be diagnosed as soon as symptoms appear, and treatment is more successful for cases that are caught early. Screenings are offered by the Moab Free Health Clinic and Moab Regional Hospital.
For seasonal guides, on July 24 there is a free skin screening at the Moab Free Health Clinic, 380 N. 500 West, from 10 a.m. to noon. Volunteer dermatologist Dr. Leroy “Art” Weber will be traveling to Moab from Grand Junction, Colorado, to hold the clinic.
Angela Settle, development director at the Moab Free Health Clinic, said the clinic’s mission is to keep people healthy, especially seasonal guides living and working in the Moab area.
“Utah is no. 1 in the U.S. for melanoma rates,” she said. “We want to focus on the outdoor companies because they are at highest risk for developing melanoma, as is anyone who lives in Utah.”
Settle said services at the clinic are offered to river, Jeep, climbing and biking guides.
“We serve individuals who do not have health insurance. Oftentimes the guide companies, as with most of the tourism-based companies, do not offer health insurance,” she said. “That makes an additional barrier to seeking care because you have to pay for it all out of pocket.”
She said that most people usually don’t pay attention to their skin unless it begins to hurt, and she said the Moab Free Health Clinic hopes its free skin screening will help to raise awareness of the issue.
“Unless it’s brought to your attention, it’s very easily overlooked,” Settle said. “The guides are the real drivers in our economy because they are the ones supporting our tourism economy and we want to take care of those folks just as much as they take care of us.”
Another clinic is planned for September and Settle said Weber is committed to screening “all of the guides in Moab.”
Local businesses are making donations to the clinic this year to provide the free screenings and cover the lab costs, including Moab Garage Company, Sheri Griffith River Expeditions, Moab Jett, Poison Spider Bicycles, Western River Expeditions, Adrift Adventures, Tex’s Riverways and Moab Cliffs & Canyons.
To help identify symptoms the Centers for Disease Control released “The A-B-C-D-E’s of melanoma.” If you have a new mole or spot show up, look to see if the spot is irregularly shaped. Does it have multiple parts? Is the edge jagged? Is the spot uneven in color? Is it larger than a pea? If it displays any of these characteristics, you should get it examined by a medical professional.
The local hospital can provide skin screenings as a part of a yearly check-up examination. Luckily, the Moab Regional Hospital is well equipped to handle cases of skin cancer, and it offers low-cost skin screenings every year.
“One in five will get skin cancer,” said Laurie Peter, the director of marketing at Moab Regional Hospital.
Bob Jones was one of those cases. He moved to Moab in 1983 and is on the hospital’s medical board. He wanted to share his story about how he was diagnosed with melanoma in 2015.
His family practice doctor noticed a suspicious red spot on his head, which, after a biopsy, was determined to be skin cancer. Jones said he immediately began to seek treatment at the Huntsman Cancer Institute at the University of Utah.
At the time, there was little treatment available for melanoma patients searching for cures. There were treatments with radiation therapy, chemotherapy and surgery to help fight it. However, chemotherapy and radiation come with negative side effects and surgery isn’t guaranteed to remove all of the cancerous cells.
Jones was staring down what he called “an eventual spiral towards death.”
He had six lymph nodes removed and began radiation treatment with five sessions per week in Salt Lake City. He managed the drive in the winter months, scheduling his commute before between the morning and afternoon rush hours. After 30 treatments he was declared in remission.
The story doesn’t end there, though. Melanoma is almost certain to return. And a year later, it did, by metastasizing in his liver and lungs. Chemotherapy was the only remaining option, and he said he couldn’t take that because it destroys the healthy cells in the body as well as the cancerous cells.
“It kills you or the cancer … whichever comes first,” Jones said.
In the intervening year, the U.S. Food and Drug Administration had approved a new drug called Keytruda that helps the immune system to fight the cancer.
Every three weeks, Jones would receive an infusion and a gauntlet of blood tests, MRIs and CAT scans. It wasn’t cheap. Being a relatively new and experimental drug, each injection cost $43,000. Luckily, it was covered by his insurance.
Being a member of the hospital board, he realized that the actual treatment could be performed in Moab. Most of the work isn’t done by doctors, but rather technicians trained to use specific machines. Rather than drive up to Salt Lake City, Jones began to work with the doctors to send treatment schedules and results between the hospitals with local technicians. After 18 infusions of the new drug and intensive testing, he was declared in remission and has remained in remission.
Jones was lucky. With a medical background, he had the ability to navigate the system with confidence. Not everyone has that luxury. Treatments can be taxing, and patients who may be suffering from other ailments, or elderly patients, may not be able to figure out the networks of doctors, hospitals, treatments, scans and check-ups. That’s why Moab Regional Hospital is creating a new position: patient navigator.
The patient navigator’s job is to make the impersonal world of medicine more accessible by serving as a middle man who can get to know patients and help guide them through their care.
The Moab Regional Hospital is certainly an exception to the general perception of small town hospitals, Jones said. It has new scanning machines and well-trained technicians.
Jones said he thinks that Moab has “a really good opportunity to not have people traveling all over the West for treatments.”
“They should check here and see if we’ve got the technical ability to do the treatments, even if you have to have a specialist somewhere else diagnose what that treatment will be,” Jones said.
In the meantime, he continues to live an active lifestyle; he kayaks, plays basketball and sails when he can.
Remission doesn’t mean cancer is gone, only that it’s dormant for a while. Nevertheless, Jones is hopeful.
“Will it come back? Maybe. But I’m a lot more confident that it can be beat,” he said.
[Disclosure: Moab Sun News reporter David Capo is a seasonal guide in Moab.]