Andy Tullis / The BulletinShanRae Hawkins, a melanoma survivor, stands outside her home in Tumalo last week. After letting her doctor know of a new mole, it was discovered Hawkins had skin cancer. Because of the early detection, the cancer did not spread.

Before going in for her annual checkup four years ago, ShanRae Hawkins hadn’t planned to mention any moles to her doctor. But one of the first questions her doctor asked the fair-skinned, blond, then-35-year-old was whether anything on her skin had changed.

Come to think of it, there was this strange mole on the back of her right shin. She wasn’t sure whether it was new, but it was darker than her other moles and had become raised, so that sometimes when she shaved, she’d nick it, causing it to bleed a bit.

“I always thought I was doing a bad job shaving,” she said.

The doctor had that and two other moles removed. Hawkins, who did not know at that point what melanoma was, had a bad feeling.

The bad news came when she was in Salem for work. Her doctor called her and told her she had to get in as soon as possible for surgery to learn whether the cancer had spread. Hawkins did what most people would do: She called her husband, then her parents. Then she went to her next meeting.

“I was like, ‘I’m over here, I have this meeting to go to,’ so I went to it,” she said.

Luckily for Hawkins, who lives in Tumalo, the cancer was caught early and had not spread. But the experience has made the active Central Oregonian far more diligent than ever before about limiting her sun exposure, including wearing long sleeves outside and slathering on lots of sunscreen. She also sees a dermatologist every three months, who typically removes a couple of moles each visit.

Now, she said, she’s passionate about encouraging others to think about melanoma. She even started the region’s first melanoma support group in 2011.

“I just want people to be aware, and then it’s a choice just like anything,” Hawkins said.

It’s a worthwhile message here in Oregon, the state that saw the fifth-highest melanoma diagnoses between 2007 and 2011, and the most of any state among women during that time, according to the North American Association of Central Cancer Registries. No one knows exactly why that is, but there are quite a few theories, each of which could be a part of the answer.

“As cloudy as it is, you wouldn’t expect it,” said Dr. Sancy Leachman, director of the Melanoma Research Program in Oregon Health & Science University’s Knight Cancer Institute. (She was speaking, of course, of the Northwest portion of the state, not Central Oregon, which, by contrast, tends to get a lot of sun.)

Leachman recently launched a massive project called the War on Melanoma with the ultimate goal of cutting the number of melanoma deaths in Oregon in half in five years. The clock on that five years hasn’t actually begun yet, as the project is still in its fundraising phase. So far, more than 3,300 melanoma survivors, family members and friends have agreed to become part of a registry researchers will use to find study subjects — which can be difficult to find for any type of clinical trial — and blood donors when samples are needed for certain melanoma studies.

On a more basic level, the War is simply designed to get people thinking about melanoma and protecting themselves from the harms associated with sun exposure. The project will include teaching people to teach others about melanoma, Leachman said.

Research has shown the causes of melanoma are 55 percent genetic and 45 percent environmental, Leachman said.

“It’s almost 50-50,” she said. “That’s different than a lot of cancers, which are primary genetic or primarily environmental.”

Skin cancer specialists say it could just be Oregon’s population, which is heavily Caucasian and fair-skinned, with lots of light hair and eyes — people who are most susceptible to skin cancer.

For people living in the Willamette Valley, which is cloudy and rainy much of the time, it could be that people don’t expect to need sun protection, so they don’t wear sunscreen or long sleeves. Clouds tend to block a wavelength of light called UVB, but not UVA, which is thought to play a larger role in melanoma. People living in that region also tend to have “sun-seeking behaviors,” such as soaking up every ounce when it’s out or going on beach vacations or using tanning beds, Leachman said.

Central Oregon, which is known for getting plenty of sun and is at a high altitude, is likely a different story. Here, people are active and tend to spend a lot of time outdoors. Hawkins, for example, said she has always been very active — whether hiking, biking, running and riding horses.

Dr. Oliver Wisco, a dermatologist at Bend Memorial Clinic, can’t really say why Oregon has such a high rate of melanoma.

“Why Oregon? I don’t know that answer,” he said, “but the registry is a great place to start.”

Wisco has some ideas, though. Living here is a double-edged sword: It’s beautiful, and almost everyone is an outdoor enthusiast, he said. But it’s also about 3,200 feet above sea level and receives sun almost 300 days per year.

So how can Central Oregonians protect themselves?

“The key is not to stop living,” Wisco said. “The key is to not get the sun you absolutely don’t need.”

Some of his tips are ones people may not want to hear, but he says it’s about striking a balance between enjoying life and being safe. In a perfect world, people would minimize their sun exposure in every way possible — meaning if you don’t need to be outside, don’t be, Wisco said. Since no one is going to do that, he said, protection becomes the goal. That means covering the skin from direct sunlight with long-sleeved shirts and wide-brimmed hats (baseball caps and trucker hats don’t work because they leave the neck and some of the face exposed — and no mesh, because the sun goes right through that).

Several active-clothing manufacturers have special sun-protectant clothing labeled with ultraviolet light protection factors, Wisco said. The idea is to get a very tight weave, such as jeans (without holes, obviously). If you can see your skin from the outside of the shirt, chances are it’s not offering very good sun protection, he said.

Sunscreen is another area people tend to screw up, mostly because they’re not using nearly enough, Wisco said. After applying sunscreen, skin should have a slightly white appearance, he said.

“You shouldn’t be Casper-white; you should just have a very faint white,” Wisco said.

Since most people won’t do that, Wisco and other dermatologists recommend buying sunscreen with sun protection factors of at least 50. That way, even a thin layer will at least provide the protection of an SPF 30, he said.

When it comes to detection, many people have heard of the A, B, C, D and Es of things to look out for when it comes to melanoma: asymmetry, irregular border, more than one color, a diameter larger than 6 millimeters and a mole that’s evolving, or changing in size, shape or color.

What many people don’t know is those criteria are relative to the other moles on each person’s body. Every person develops an average of 2.8 different types of moles, Wisco said. The changes associated with the A, B, C, D and E rule are actually more subtle than people would expect, he said. The most significant factor people should look for in their own moles is whether they’ve evolved, Wisco said.

“We don’t need you to make a diagnosis; we simply need you to say, ‘This does not look like it did a month or two months ago,’” he said.

The best way to do that, he said, is just to take a photo of it.

Wisco often hears people say, “I just feel better in the sun.” No arguments there. The statement he does take issue with, however, is, “I look better when I have a tan.”

“No tan is a good tan unless you’re born that way,” he said.

Society has arbitrarily within the past 50 to 60 years upheld being tan as attractive, Wisco said. Almost 80 years ago, it was the opposite: light skin was deemed more attractive and dark skin was the mark of the poorer, working-class population. The big flip happened when famous fashion designer Coco Chanel took a vacation to South America in the 1920s and came back tan.

“That became the new trend,” Wisco said.

In reality, a tan is just the mark of skin damage: the pigment adjusts to protect itself. In that case and especially when skin burns, the DNA itself is altered. Certain genes are activated and deactivated, causing excessive cell turnover, Wisco said.

Jen Maxwell, who lives in Bend but grew up in Portland and lived there until her late 20s, has been diligent about sunscreen since she was a young kid. Imagine her surprise then, when in 2011, at the age of 38, she was diagnosed with melanoma and basal cell carcinoma, another form of skin cancer that’s more common but less deadly.

Then in October 2014, her dermatologist found two more moles with melanoma just a week after she had been diagnosed with breast cancer. Her doctors have told her it must be genetic, since it’s coming back so frequently. Maxwell, who has joined Hawkins’ support group, now worries about her 7-year-old daughter, who she said is at high risk of getting the disease one day.

Maxwell now goes back to the doctor every six months, and each time, they cut off a couple more moles. That’s been hard.

“Once you get a melanoma, they just really start cutting on me more and more and more,” she said. “I constantly had biopsies and stitches and biopsies and stitches for years. That became overwhelming.”

Maxwell has heard from plenty of people who are hesitant to see a doctor about suspicious-looking moles. They’re afraid the scar would look bad, she said. She always urges them to get things checked out sooner. The bigger a mole gets, the bigger the scar will be.

“I always say trust your gut,” she said. “If you see something that’s changed, don’t let it go. The peace of mind is worth every penny.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com