The farther patients have to travel to a reach a doctor to diagnose their melanoma, the more likely they are to have thicker skin cancer at diagnosis, according to a study led by Karyn B. Stitzenberg M.D., M.P.H., of the School of Public Health, University of North Carolina at Chapel Hill.

Survival for patients with melanoma is dependent on the stage of the disease at diagnosis. As the depth of the tumor cells in the skin increases (known as the Breslow), the overall survival decreases. The researchers found that the median distance to a diagnosing physician was 8 miles and the median Breslow was 0.6 millimeters. For each one-mile increase in distance, the Breslow thickness increased by 0.6 percent.

Increased Breslow thickness was also associated with increase poverty and age. Sex, rurality and supply of dermatogists were not associated.

My sister has skin cancer -- the basal cell variety. She has two spots, both on her chest, each one scheduled to be surgically removed in a few weeks. If it were me with this new diagnosis, I'm sure I'd be freaking out, maybe because I've already had breast cancer and tend to panic about any cancer or maybe just because I'm a worrier by nature. But my sister is taking her cancer news in stride, and I am too -- because now that I've done a little research, it seems this type of cancer is pretty easy to beat.

Here's a little refresher lesson on the skin: The skin is the largest organ in the body, and is made of three layers -- the epidermis (top layer), dermis (middle layer), and subcutis (deepest layer). For the purpose of this post, let's focus on the epidermis.

The epidermis has three layers -- an upper, middle, and a bottom layer. This bottom layer is comprised of basal cells. This is where basal cell cancer begins.

The incidence of melanoma has steadily increased in the United States over the past several decades, according to Martin A. Weinstock, MD, PhD and professor of dermatology at Brown, in a speech to the American Academy of Dermatology's Summer Meeting.

From 1995 to 2004, melanoma, the most serious form of skin cancer, has increased by more than 1 percent per year while overall cancer rates have decreased by 0.6 percent.

According to Dr. Weinstock, the increase in melanoma rates from 1995 to 2004 was not specific to one age group, but there was an increase in the youngest group (15 to 30) and the 60-plus group.

For more information on the studies that went into this report and about the AAD's Be Sun Smart program, see here.

Summer is in full swing and there is no better time to have a reminder about checking yourself for skin cancer signs than now. In addition to ensuring those moles are benign, are there other things you can do to make sure you're safe from skin cancer? Some simple self checks are a great starting point.

Irregularly-shaped skin blemishes that are reddish-brown to brown in color should be checked out, and if those moles have any of the characteristics below, someone qualified like a regular physician, dermatologist or even oncologist may need to take a closer look.

• Bleeding
• Itching
• Rapid growth
• A sore or area that won't heal
• A scaly or crusty growth
• Rough patches that feel like sandpaper

How much do you know about protecting your skin? How often should you apply it? How much should you use to cover your whole body? What kind of rays does sunscreen protect against? UVA? UVB? Both? If these questions have left you scratching your head, check out this quiz from Fitsugar.

Here are some quick sunscreen facts:

• When you don't use enough sunscreen, the sunscreen you did apply is not nearly as effective.
  
• UVA Rays can pass through windows and contribute to aging of the skin. UVB rays cannot pass through windows and can cause skin cancer.
• SPF 15 blocks out 93% of harmful rays. Impressive, huh?

Finding an unusual mole can be scary, especially if you don't know the difference between 'normal' and 'abnormal'. I had one a few years ago on my back, and it turned out to be normal but it freaked me out a bit.

Here's a handy visual guide from Fitsugar on how to tell what's normal and what's not when it comes to moles. In a nutshell, look for:

• Uneven colouring
• Asymmetric shape
• Jagged (as opposed to smooth) border
• Diameter -- it should be no larger than a pencil eraser

If your mole has one of the following characteristics, don't panic. It could be nothing but the point is, you never know. Just see your doctor.

A recent sunscreen ad by Neutrogena Sunscreen features a young woman with the caption, 'My sister accidentally killed herself. She died of Skin Cancer'. The message is clear: Those who die of the disease only have themselves to blame.

But that statement is generating some controversy from Skin Cancer specialists for a number of reasons, according to this article. Firstly, despite everything we hear about covering up, it's not a proven fact that sunscreen prevents melanoma, but it is thought that it protects against less deadly forms of skin cancer. Secondly, tests show that people who've had more sun exposure have a better chance of survival against melanoma than those who stayed out of the sun. And while the ad is meant to evoke fear by claiming that skin cancer is the most common cancer, it doesn't mention that skin cancer only accounts for 2% of cancer deaths and almost all of these are from Melanoma.

Still, I think protecting yourself against the sun is ultimately important, and that message is clear from the ad.

I'm a little tired of reading and writing about sunscreen. Maybe it's not the actual reading and writing that has me worn out. Maybe it's the realization that I keep reading and writing about sunscreen yet the information is just not sinking in with the masses of sun-hungry people out there -- according to the EPA, there has been a staggering 1,800 percent increase in malignant melanoma cases since 1930. Recent figures show a shocking rise in skin cancers among those in their 20s and 30s.

The experts at Canyon Ranch are weighing in on sunscreen. So here I go again, with some more about this tiring topic.

• Sunscreen contains unique chemical components which absorb ultraviolet (UV) light. When applied to the skin, the chemical molecules form an invisible, protective layer that repels the penetrating UV rays. It also helps prevent premature aging and pre-cancerous growths.

Zita Farelly died of skin cancer, at the too-young age of 29 -- only a few years older than me. A mother of two, Zita didn't damage her skin through excess sun exposure. No, she preferred artificial sun, and got that orangey, leathery sun glow by tanning twice a day from the age of 14 to 21. Twice a day! I would say using a sunbed twice a week is too much, let alone 14 times a week.

To her credit, Zita stopped tanning once she learned of the negative effects on her skin. But it was too late -- soon after she quit the tanning, she found a mole on her leg -- melanoma.

As Zita's family struggles to carry on, they've come out with a powerful message: Tanning beds are so dangerous. I hope all the tanners out there begin to listen.

Last Tuesday night, I watched Greta Van Susteren of Fox News' On The Record as she interviewed Brittany Lietz, Miss Maryland 2006. Greta asked Brittany what her Miss Maryland job entails. Brittany told Greta her full-time job is to represent her platform -- skin cancer.

Brittany didn't choose just any topic for her platform. She chose one that is entirely personal.

Skin cancer has left more than 20 scars on Brittany's body. One, on her back, marks the site where a stage two melanoma was removed when she was just 19 years old. It presented as a mole, a little smaller than a nickel, she says. In all likelihood, the cancer was caused by two years of tanning bed use. Brittany says she probably tanned every day for two years. Her pursuit of bronzed skin began when she was 17 and wanted a tan for her prom. It ended after doctors told her she had cancer.

When I slather sunscreen on the shoulders of my fair haired toddler, I trust that the claims on the bottle are accurate. I believe that by frequently covering is pale skin in cream, his epidermis will be safe, healthy and cancer free. It turns out this might not be the case.

A recent study by the Environmental Working Group (EWG), a Washington-based nonprofit, found that many of the most popular sunscreens do not provide any protection against harmful ultraviolet (UV) rays and break down too fast in the sun. Most consumers rely on the SPF number when buying a sunscreen, the higher the number the better the protection. But what continues to slip through the cracks is the sun block's ability to protect from UVA rays. The UVA rays damage skin without leaving a burn and are the main cause of skin cancer.

There is hope on the horizon. The FDA is addressing the UVA issues and is hoping to have some standards in place by the end of the summer. This is good news to those of us who heavily rely on sunblock as a protective effort to sun damage.

A new website assesses the effectiveness and safety of almost 800 sunscreens. The suncreen screening site was put together by the Environmental Working Group and gives detailed information about many sunscreen products. It also groups them by the types of harmful rays they're meant to protect against.

SPF numbers on sunscreens only cover UVB, the type of rays most responsible for burns. UVA is far less responsible for burning, but still can raise skin cancer risk. Only one sunscreen in five has effective UVA protection. There are ingredients that protect well against UVA, but sunlight can break down and make them ineffective if they are not formulated well.

Watch out for the commonly misleading claims -- all day protection, waterproof or chemical free products. You can check the website for sunscreens that are recommended and ones to be avoided.

A little while ago, Jacki wrote about Sarah, a young woman with Melanoma who died not long ago. In one of her last blog entries, Sarah lamented the loss of her friend Heather, calling Heather her inspiration. She urged readers to visit Heather's blog, claiming they would never be so uplifted and inspired. So I visited Heather's blog and it was bittersweet. From her last entry, after receiving good news from her doctor:

"I jumped. And the fall was endless, and I had no idea if anyone would be there to catch me, but I held on tight anyway. I kept the faith, held onto the hope, even though the odds looked so hopeless just a couple of short months ago. The fall was infinite.

"People don't often understand how a tiny skin blemish can kill," wrote Sarah Toller in her July 2, 2006 blog entry. Yet it call kill. And it killed Sarah on Tuesday, June 12, 2007.

On June 10, I wrote about Sarah. I wrote about how melanoma was claiming this young woman, how her husband was writing the final chapters of his wife's life on the blog she began just more than one year ago.

I visited Sarah's blog yesterday and read a closing statement written by her beloved. It was simple, to the point, and terrifyingly sad.

I keep writing about skin cancer, specifically melanoma, because I'm a little obsessed about it. I guess the seriousness of the disease is finally sinking in and making me think.

I want you to think about it too. I want you to stay out of the sun, cover up, dress yourself in sunscreen, report for annual skin cancer screenings, and arm yourself with knowledge.

If you are not convinced by my words alone, please watch this video about how melanoma spreads -- how it breaks away from its original location and metastasizes throughout the bloodstream and lymphatic system, landing in other parts of the body. Melanoma is the deadliest from of skin cancer. This video proves it.