save your skin

Diagnosis: Melanoma and Other Skin Cancers

There are several different routes to being diagnosed with melanoma. The first step is generally a physical screening, during which your physician will check your skin for moles or other abnormalities and ask questions, such as if there have been any changes in your skin or moles, or the length of time you have had certain moles. In order to accurately answer these questions, it helps to self-examine your skin monthly to keep track of any changes; more information on moles and skin self-examinations can be found here. During the appointment, your physician will likely also ask you about your medical history, if you have a history of getting sunburned or using tanning beds, whether there has been skin cancer in your family, and other similar inquiries.

If a physician finds something of concern on your skin, they may perform additional tests. These tests are outlined below in some detail:


Is the process of using a hand-held microscope, computer imaging or a dermatoscope to more closely examine a lesion. Your physician might apply mineral oil to the lesion to lessen light reflection on the skin.


Is a process in which cells or tissue of concern are removed from the body to be tested for cancer cells. Depending on the size and location of the lesion, either an incisional or excisional biopsy will be performed. An incisional biopsy is the removal of part of the lesion because the location or size of the lesion renders a complete removal impossible. An excisional biopsy is the removal of the entire lesion, plus a small margin of surrounding normal tissue.

Biopsies are also often performed on the lymph nodes surrounding the cancer site, given that cancerous fluid is likely to move through them. The closest lymph node(s) to the cancer site is the sentinel node(s). As the most likely place a cancer will first spread, the sentinel node(s) and sentinel node biopsies (SLNB) are important for melanoma staging and prognosis. SLNB is often used when clinical evidence that cancer has spread to other lymph nodes is lacking. SLNB will generally not be performed in cases where the patient has stage 1A melanoma, melanoma in situ, metastatic melanoma, locally advanced melanoma that has spread to a lymph node, or has already had surgery on a lymph node. Ideally, an SLNB will be performed at the same time as another surgery. If cancer cells are present in the sentinel lymph node, it is likely that some of the lymph node biopsy procedures outlined below will be performed. If no cancer cells are present, it is unlikely that cancer has spread to the lymph nodes.

There are several other forms of lymph node related biopsy. A surgical lymph node biopsy involves the surgical removal of lymph nodes to see if they contain cancer cells. This is usually preceded by a fine needle aspiration (FNA) biopsy, in which fluid from a lymph node is removed and tested. There is also the lymph node dissection, in which all of the lymph nodes surrounding the cancer site are removed. This surgery is usually performed if the cancer has metastasized to the lymph nodes.

Understanding your Pathology Report – WEBINAR RECORDING AVAILABLE:

To diagnose diseases such as cancer, a sample of tissue called a biopsy is taken from a patient and examined by a pathologist to determine if cancer is present. A pathologist will then examine specimens removed during surgery (resections) for conditions such as cancer, to determine whether the tumour is benign or cancerous, and if cancerous, the exact cell type, grade and stage of the tumour. The pathologist, who is a member of your medical team, writes the pathology report that your treating doctor uses to provide the best care for you as a patient. In this webinar, Dr. Alan Spatz provides insight on understanding your pathology report so that you can play an active role in your treatment. Click here to view the recording on youTubeWith Dr. Alan Spatz, MD  Director, Pathology Department, Jewish General Hospital & Professor, Pathology and Oncology, McGill University

During your treatments, you may receive other tests to determine whether your melanoma has metastasized to other places in the body. These include x-rays, ultrasounds, blood tests, CT scans, or MRIs.

Thank you for reading; we hope this post answers some of the questions you might have had about the diagnosis procedures for melanoma and other skin cancers. If you would like more information, you can look at one of our sources below. While methods of diagnosing skin cancer are relatively universal, be aware that not every website we source content from is Canadian.

Works Cited

About Melanoma: Signs and Symptoms of Melanoma”. NCCN Guidelines for Patients: Melanoma. 2014: National Comprehensive Cancer Network Foundation.

Diagnosing Melanoma”. Canadian Cancer Society.

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Save Your Skin Weekly Flashback [July 30th-August 5th]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! We’ve shared quite a few things with you this week, including this document overviewing public Federal, Provincial, and Territorial drug benefit programs across Canada, and two other reads we loved: this Huffington Post blog by our friend Natalie Richardson over at The Impatient Patient, and this excellent New York Times article that provides some human context to the general success of immunotherapy treatments. We also posted blogs on why you shouldn’t partake in the DIY sunscreen phenomenon, and an overview of what to look for when you self examine your skin for moles.



Here are some other links we shared with you this week:

This piece in the Chicago Tribune reporting that the U.S. Preventative Services Task Force has declined to recommend regular full-body screening for skin cancers

This 24/7 Wall St article about skin cancer occurrence by state, including a ranked list

This National Cancer Institute guide to moles!

This OncLive piece probing the complex nature of the melanoma genome

This article in the Vancouver Sun about the dire need for dermatologists in B.C.

This piece on Cut Your Cancer Risk debunking the mythical windburn!

This Steele & Drex interview with Meteorologist Claire Martin about her recent, rare melanoma diagnosis

This Immuno-Oncology News piece about the immunotherapy combo of ipilimumab and T-VEC and it’s success with advanced melanoma patients

This BioCanRX piece about Save Your Skin Founder Kathy Barnard’s presence at the 2016 Summit for Cancer Immunotherapy in Halifax

This American Association for Cancer Research piece in Science Daily about a Centre of Integrated Oncology study which suggests combining the immunotherapy treatment ipilimumab with local treatments can increase the survival rate of melanoma patients

This CBS New York story about immunotherapy combinations



Thanks for reading, stay sun safe out there!


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Moles and Skin Self-Examination

Moles are the most common indication of melanoma and other skin cancers; luckily, they can be kept track of with skin self-examinations. According to the National Cancer Institute, those with more than 50 common moles have an increased chance of developing melanoma (“Common Moles, Dysplastic Nevi, and Risk of Melanoma”), which is why it is important to self-examine your skin (and your loved one’s skin!) every month.

There are no hard and fast visual rules about which moles might and might not develop into melanoma, however there are some guidelines you can follow when self-examining your skin to judge if any of your moles should be checked out by a physician.

Firstly, there are two kinds of moles. Common moles are, as the name suggests, common and less likely to develop into skin cancer (even though instances of common moles developing into melanoma do occur). The other kind of mole, the dysplastic nevus (plural nevi), has an abnormal appearance in comparison to the common mole. While dysplastic nevi are more likely to develop into skin cancer than common moles are, dysplastic nevi are not a definite sign of skin cancer. However, it is important to pay particular attention to changes in dysplastic nevi during your self-examinations.

Check out our page Skin Check Guide for more information!

The National Cancer Institute recommends that you look for the following changes in both common moles and dysplastic nevi, and to see a physician if any one of them occurs:

  • The color changes
  • It gets smaller or bigger
  • It changes in shape, texture, or height
  • The skin on the surface becomes dry or scaly
  • It becomes hard or feels lumpy
  • It starts to itch
  • It bleeds or oozes

(“Common Moles, Dysplastic Nevi, and Risk of Melanoma”. National Cancer Institute)

In addition to these changes, there are some more obvious signs that a mole may be developing into melanoma. Be aware that there are several types of melanoma and skin cancer, which manifest in disparate ways; it is important to track all changes on your skin, even if they do not appear to be indicative of melanoma. A good rule to follow here is the ABCDE’s of early melanoma detection, which the National Cancer Institute identifies as the following:

  • Asymmetry. The shape of one half does not match the other half.
  • Border that is irregular. The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
  • Color that is uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
  • Diameter. There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than 6 millimeters wide (about 1/4 inch wide).
  • Evolving. The mole has changed over the past few weeks or months.

(“Common Moles, Dysplastic Nevi, and Risk of Melanoma”. National Cancer Institute)


Tips for an effective self-examination

Now that you have an idea of what to look for, it’s important to get the most out of your monthly self-examination as possible. Here are some tips for being as thorough as possible:

  • Use a full length and handheld mirror
  • Perform your self-examination in a well lit area
  • Have someone else check areas you can’t see
  • Write down and take photos of any new discoveries, such as changes or new moles; this will be helpful if you need to contact your physician
  • Remember to check often forgotten areas such as: fingernails and toenails, scalp (using a comb and/or blowdryer), the bottoms of feet and in between toes, ears, and underarms

Thank you for reading, and we hope this post encourages awareness and skin self-examinations! If you would like more information, look to one of our sources below. While the principles of self-examination are universal, be aware that not every website we source content from is Canadian.


Common Moles, Dysplastic Nevi, and Risk of Melanoma”. National Cancer Institute. 11.01.11.

How to Check your Skin for Skin Cancer”. National Cancer Institute. 09.16.11.

About Melanoma: Signs and Symptoms of Melanoma”. NCCN Guidelines for Patients: Melanoma. 2014: National Comprehensive Cancer Network Foundation.

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Don’t Try this at Home: DIY Sunscreen


As much as we love a good DIY project, sunscreen is something that is best left to medical professionals!

If you google or pinterest “DIY sunscreen,” you might be surprised at the amount of homemade recipes that come up for a medical product. The motivation behind making sunscreen from scratch- other than cutting costs- is ingredient control. While it makes sense to be concerned about what chemicals could be absorbed into your skin from sunscreen, it is important to remember that all sunscreens go through rigorous Health Canada testing before they are allowed on the market. There are also organic sunscreens such as Badger, Climb On, and Sun Stuff, available for purchase in most drugstores and online.

While utilizing natural ingredients such as shea butter and various oils (such as coconut or avocado) doesn’t raise concerns about chemical composition, regulation of consistency and quality is difficult in a homemade product, and there is no guarantee that these ingredients include SPF- which endows sunscreen with UV protection. As UV exposure is the greatest risk factor for melanoma and other skin cancers (Canadian Cancer Society, “Risk factors for melanoma“), sunscreen without SPF is essentially worthless. Additionally, commercial sunscreens contain preservatives, while homemade sunscreens have the ability to spawn mould, which may not be visible to the user.

While some natural oils, such as coconut oil, can provide some UV protection, the Mayo Clinic estimates that coconut oil is capable of blocking only 20% of the sun’s rays, while the American Academy of Dermatology recommends using a sunscreen with SPF 30 or higher for adequate protection (Mayo Clinic, “Myth or Fact: Coconut is an effective sunscreen”). Additionally, most sunscreens on the market provide both UVA (longer wave) and UBV (shorter wave) protection, something that is highly unlikely in a homemade sunscreen.

Melanoma is a preventable disease, and part of ensuring that you are protected against the sun is by wearing Health Canada approved sunscreen! If you’re interested in hearing a dermatologist’s perspective, check out PR Web’s spot with Dr. Mitchel Goldman.



Badger, “Why you Can’t Count on DIY Sunscreens“.

Canadian Cancer Society, “Risk factors for melanoma“.

Health Canada, “Sunscreen Monograph- Version 2.0“.

Mayo Clinic, “Myth or Fact: Coconut is an effective sunscreen“.

Pr Web, “Leading Dermatologist Warns Against Dangers of Homemade Sunscreen“.



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Save Your Skin Weekly Flashback! [July 23rd-19th]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! This week, we’re pleased to announce our involvement with the United Way employee and workplace campaigns, meaning you can now donate to Save Your Skin if your workplace has a United Way Campaign! More information can be found here. If you haven’t already, be sure to check out our partnership with Innovicares, Canada’s only free manufacturer and patient benefit plan here, and our most recent blog post “The UV Index and You“.


Here are some links we shared with you this week:

This article in The Globe and Mail with tips on being a better patient!

This article in Medscape reporting the possibility of neurotoxicity side effects from immunotherapy treatment of advanced melanoma

This story in the Daily Globe that highlights the importance of checking your skin to increase your chances of early melanoma diagnosis

This PSA featuring the cast of The Big Bang Theory, on behalf of the Claire Marie Foundation! Article via the Baltimore Sun.

This article in Science Daily about a study which saw improved survival when Ilipimumab was combined with local treatments!

This CBS News story about melanoma rates in young people

This article in the LA Times suggesting that the current screening system for skin cancer might be inadequate



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The UV Index and You

If you ever need scientific motivation to put on sunscreen, let the UV index be your guide! As UV radiation is the greatest risk factor for the development of melanoma and other skin cancers, the UV Index is an important tool for sun safety and the prevention of skin cancers. The UV Index is dictated by the strength of UV rays in a particular area, along with the UV reflection off of snow and sand in that area. The UV index changes throughout the day, but is the highest (like the summer heat!) at midday.

The UV Index ranges generally ranges 1-11, though higher UV is possible on exceptionally hot days. As the chart below demonstrates, taking sun precautions are recommended for UV Index levels of 3 or higher. These precautions can include limiting your time in the sun or seeking shade, applying sunscreen, and wearing UV protective clothing, sunglasses, or a hat; don’t forget to reapply that sunscreen every two hours, and more frequently if you are swimming, exercising, or near reflective surfaces such as snow or sand! Because the UV Index is often indicative of heat, we also recommend keeping hydrated to avoid conditions such as heatstroke. When the UV Index reaches 6 or greater, it is officially a ‘high’ UV Index, and it is imperative that these sun safety precautions be followed.

Screen Shot 2016-07-22 at 1.29.37 PM

(“UV Index”, Canadian Cancer SocietyUV Index“, Web)

Referencing the UV Index so you know how to prepare for the day is simple, as there are several UV Index apps and websites! Life has a great list of UV Index apps which you can check out here.  If you want to look for the UV Index online, The Weather Network has a UV Index in its weather forecast, as does AccuWeather, and the Government of Canada website has a daily UV Index Forecast for many Canadian cities.

Now that you have the UV Index at your fingertips, there’s no excuse for not being exercising precautions when the UV Index is higher than 2! Thanks for reading, and stay sun safe out there!

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Save Your Skin Weekly Flashback! [July 16th-22nd]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! We’ve got a lot of links to share with you this week, but we’d first like to call your attention to our partnership with Innovicares, Canada’s only free manufacturer and patient benefit plan! You can learn more here. We are also running a sunburn survey, and would love for you to take it! You can fill it out here. If you’re looking to brush up on your melanoma knowledge, we’ve been sharing this Aim at Melanoma list of statistics. We also shared with you that Aim at Melanoma is running a free nurse on call service that can be reached at or 1-877-246-2635! Cool, huh?

(WorkSafe BC, “Sun Safety at Work: Employers”)


Here are some links we shared with you this week:

This Sydney Morning Herald piece criticizing health advice from celebrities

This Centers for Disease Control and Prevention guide to protecting children from the sun

This article in Melanoma News Today announcing that researchers have identified ways melanoma tumours can bypass immune checkpoints, leading to new research opportunities

This article on 680 CJOB citing Manitoba as one of Canada’s leaders in cancer diagnosis and treatment. Way to go, Manitoba!

This National Institutes of Health article about keeping elderly people safe from heatstroke, and some general tips to stay safe on hot days

This OncLive peer exchange video about incorporating prognostic factors into melanoma (with more videos below!)

This patient testimonial from Leo Pharma Global about living with actinic keratosis

This article in Australia’s ABC News about Keytruda’s success in almost 50% of patients!

This OncLive article reporting that long-term follow up has shown that Sonidegib can be beneficial for basal cell carcinoma

This Leo Pharma Global informational video about actinic keratosis

This article in Science Daily reporting that, despite the 2013 ban, indoor tanning rates of persons under 17 in New Jersey have not declined

This OncLive article reporting the benefit of Vismodegib in basal cell carcinoma patients

This Science Daily article announcing that Spanish researchers have uncovered some genetic reasons why men are more susceptible to skin cancer than women!


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Cameron Institute’s Dr. John A. Bachynsky Offers Angle on Drug Pricing in Canada

In a recent post by the Cameron Institute, Dr. John A. Bachynsky suggests that “there are a growing number of gaps in coverage that calls for some form of universal, comprehensive, national drug coverage to fill these gaps” (Bachynsky 5). These ‘gaps,’ Bachynsky maintains, are caused by the provincial health ministries’ focus on price reduction while not considering the need for specific drugs; he opens the piece with an example wherein a drug priced at $600,000 for only two patients is considered ‘unaffordable’ while a ‘cheaper’ drug can have greater overall costs while being distributed to more patients. Instead, “Canadian government drug plans use the comparison with older, generic drugs ‘which do the same thing’ at a lower price” (4), as opposed to introducing more specific, improved drugs into the market. According to Bachynsky, the government does so by supporting multiple groups that restrict access to drugs and none that improve access, and labelling the prices of new drugs as ‘cost increases’ while there is no prior price to compare it to (3,4).

Naturally, blanket marketing drugs to a population with varied medical needs is problematic, especially for Canadians that are being medicated for long-term chronic illnesses. As Bachynsky points out, the problem with even reasonable drug prices is that they are utilized most often by only a segment of the population, but in high amounts. As Canadians have to pay for medical prescriptions out of pocket, with or without medical insurance, these ongoing costs can be financially draining; Bachynsky states that 25% of the chronically ill patients in Canada attempt to lower costs by stretching or skipping their medication (5), which is inadvisable even if they are using the ideal drug. The “universal, comprehensive, national […] coverage” that Bachynsky calls for is to aid this percentage (5), whom he suggests national assistance programs were initially created to protect.

While medication costs are legitimately high for the average Canadian citizen, they are not as troublesome for the government as provincial bodies would have you believe; Bachynsky cites drug expenditures as only 8% of government health care costs (6). Health care costs for the government have increased via the technological advancement and increase in litigation that comes with the unique and improved drugs the pharmaceutical industry is developing. While this is ‘too costly’ for the government, Bachynsky points out that “use of new technology has increased physician and hospital expense to an even greater degree but there is no outcry over excessive costs or sustainability” (7). The alternative treatments for a patient with no appropriate drugs for their condition utilize the latter technologies in a manner that is expensive, inefficient, and distressing for the patient, with measures such as hospital care, tests, referrals and surgeries. This realization begs the question: “why can we fund a lot of less effective procedures without complaint but not afford to pay for medication that does a better job and is preferred by the patient” (7).

The problem with reducing medication costs, while this would be to the benefit of both the government and the patient, is that pharmaceuticals are less likely to market drugs at a lower price point. Thus, the government’s solution to cut costs directly affects the patient; Bachynsky cites the example of “proposed therapeutic substitution” (10), in which the government will only cover the lowest-cost medical therapy for a variety of related illnesses. If a patient wants the more expensive treatment that is specific to their illness, they have to cover the cost.

As the burden of medication costs is something not experienced by the entire Canadian populace, the relationship between pharmaceuticals and government can go unconsidered by many in a nation that boasts free health care. Thanks to Doctor Bachynsky for writing an angle on that relationship! You can read the original post here.


Works Cited

Bachynsky, John A. “Opinion: Drug Prices are Too High!?” Cameron Institute. Cameron Institute (2016).

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Save Your Skin Weekly Flashback! [July 9th-15th]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! We’ve been very prolific on social media this week, as you’ll see by the links below, and we posted a blog about regional melanoma statistics in Canada, which you can check out here. If you’re just discovering Save Your Skin, or you haven’t looked recently, be sure to drop in on our survivorship initiative I’m Living Proof– we’re working on translating all survivor stories into French!



Here are some links we shared with you this week:

This Medivizor article about the effects of stereotactic radiosurgery on brain metastasized melanoma

This article in The Brownsville Herald about Super Ray and the Sunbeatables- a sun safety curriculum being rolled out in six Texas primary school districts!

This article in EurekAlert about a study by the Melanoma Research Alliance and Brown University which found that pre-screening of patients for melanoma did not see an increase in dermatologist visits or surgical treatments

This article in High Times about the University of Canberra and Cann Pharmaceutical Australia’s efforts to develop medical-grade cannabis therapy to melanoma patients

The OHSU Dermatology War on Melanoma registration page

This article in The Skin Cancer Foundation Journal about keeping toddlers and babies sun safe

This piece from ABC 6 Action News in Philadelphia about melanoma development in adolescents

This eyelid melanoma case study in The New England Journal of Medicine

This Jama Dermatology review in which the partners of melanoma patients were trained in skin-examination and identifying potential new melanoma

This CBC News article about a gene variant that may cause redheads to have increased skin cancer risk

This New York Post guide to vetting the sunscreens you buy

pERC’s final recommendation for Cotellic and Zelboraf

This article in The Sydney Morning Herald about the increasing incidence of melanoma in Australia

This North Shore News piece about the Save Your Skin Foundation’s ten year anniversary and other achievements!


Thanks for reading, have a sun safe week!



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The Gender and Geography Statistics of Melanoma in Canada

Last week, we posted a broad overview of the past ten years in melanoma statistics, drawn from the Canadian Cancer Society’s documents Canadian Cancer Statistics 2014, Special Topic: Skin Cancers and 2015, Special Topic: Predictions of the Future Burden of Cancer in Canada. This week, we’re going to focus on more geographically specific statistics; what is the melanoma landscape in your province like?

If you read last week’s post, you’ll know that in Canada, males are generally more likely to be diagnosed with melanoma than females. Over the past 25 years, the age standardized incidence rate (ASIR) of melanoma in Canadian males increased on average 2% yearly, while the ASIR of females increased but 1.5%; however, this percentage has jumped to 2.5% over the past eight years for females, likely due to the advent of tanning salons (2014 79). Between 1993 and 2009, men have seen a lifetime risk increase of 0.8%, while the lifetime risk increase rose 0.7% for women (79). Mortality statistics indicate that the melanoma death rates among Canadian males and females are consistent with diagnosis rates; the age standardized mortality rates (ASMR) have risen 1.2% yearly for males, 0.4% for females.

The higher melanoma incidence rates among men are also generally consistent from province to province, with the exception of Saskatchewan, in which the ASIR in 2010 saw 9.5 melanoma cases in every 100,000 males and 11.3 in every 100,000 females (2014 93, “Table 7.1”).


(2014 93, “Table 7.1 Annual Percent Change in Age-Standardized Incidence Rates (ASIR) for Melanoma of the Skin by Province and Sex, 1986-2010”)

The comparative incidence rate of melanoma in men is consistently higher in every province (except Saskatchewan), though, as indicated by the annual percent change being greater for Canadian females by 0.6% overall, melanoma rates among women are catching up. The greatest discrepancy between males and females is on Prince Edward Island, which has the highest provincial rate of melanoma in Canada for males (93, “Table 7.1”). The demographic with the lowest melanoma rate in Canada, as of 2010, was women in Newfoundland and Labrador (93, “Table 7.1”).


(2014 93, “Table 7.2 Annual Percent Change in Age-Standardized Mortality Rates (ASMR) for Melanoma of the Skin by Province and Sex, 1986-2009”)


Thankfully, the age-standardized mortality rates (ASMR) for Canadians are considerably lower than the ASIR. “Table 7.2” indicates that while Nova Scotia has the highest melanoma mortality rate among both males and females, the mortality rates for both men and women on Prince Edward Island in 2009 were too low to be recorded, though “Table 7.1” cites PEI as having the highest incidence rate among Canadian provinces for men, and the second highest for women (the highest being Ontario). The mortality rate among women in Newfoundland and Labrador is also too low to be recorded; the lowest recorded mortality rates for both men and women are in Manitoba. It is notable that Quebec, while having one of the lower incidence rates among the provinces for both men and women, has similar mortality rates.

The Canadian Cancer Society states that “variations of melanoma prevalence by province […] largely reflect population size differences and but also differences in rates of melanoma diagnosis and survival” (2014 85), which are important factors to keep in mind when considering the above data. Thank you for reading, and thank you to the Canadian Cancer Society and their document Canadian Cancer Statistics 2014, Special Topic: Skin Cancers for the statistics!


Works Cited:
Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2014). Canadian Cancer Statistics 2014. Web.

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