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Are you at risk for UV ray exposure at work?

By: Heather P. Lampel, MD, MPH, FAAD, FACOEM

Typically, when we think of “occupational” or on the job skin cancer risk, we think of outdoor workers. It’s true, occupations like construction and agricultural workers have a higher risk because these workers are out in the sun for extended periods of time. Public servicemen and women and military workers, including police, firefighters and the armed forces, also have a higher risk. Anyone spending a majority of their workday outdoors needs to be more mindful of the dangers of UV exposure than others.

That said, through the course of the workday, everyone is exposed to UV to some degree. You – likely someone who is commuting on a regular basis – are at risk. Whether you’re driving in your own vehicle or riding in public transportation, protection from UV rays is inconsistent. Vehicle glass is often treated to help decrease UV rays, but this is variable depending on the vehicle and whether the glass is on the front, side or roof.

If you’re flying on a business trip, your exposure increases significantly. According to the American Medical Association, an hour of sun exposure on a plane is the equivalent of spending about 20 minutes in a tanning bed. As you climb in altitude, the thinner atmosphere filters less UV radiation. Sun protection becomes even more important.

The best thing anyone can do – whether they work inside or outside, in the air or on the ground – is to be aware of their exposure, and safeguard against it.

Tips for intermittent exposure indoors:

  1. Wear sunscreen daily (rain or shine!)
  2. Wear sun protective clothing when commuting. Keep gloves and sleeves to cover overexposed hands and arms, when driving, riding or flying
  3. Wear sunglasses during your commute to protect your eyes from exposure
  4. If you sit next to a window at work, apply a window film that blocks UVA and UVB rays
  5. If your “office” is your car, invest in a window film for the front, driver and passenger side windows

Tips for consistent exposure outside:

  1. Talk to your employer about your need and options for sun protection
  2. Wear sun-protective clothing that matches the demands of your job. Not all UPF 50+ fabrics perform the same way
  3. Always have a hat with a full brim to shield your face and neck
  4. Wear sunscreen daily (rain or shine!) for all exposed areas
  5. Wear sunglasses to protect your eyes from exposure

Additionally, take these tips home with you. Our workplace skin protective behaviors impact our home and leisure sun behaviors and visa versa.  We need to protect our skin both at work and at home since our skin goes with us everywhere!  For everyone, no matter where you work or spend your days, it’s important that you’re aware of your skin – its baseline color, markings and blemishes. If you or a friend note any skin changes, these should be checked by a professional.

Research has shown that patients, not doctors, are most likely to spot their melanoma, reinforcing the importance of thoroughly checking your skin each month.

Melanoma Research Foundation

Additionally, schedule an annual exam with a professional. No matter your background, age, race or gender – Melanoma and other skin cancers don’t discriminate so you ARE at risk. When melanoma isn’t recognized and treated early, it can spread to other parts of the body where it becomes hard to treat and can be fatal. The prevention and early detection of skin cancer can save lives!

About Dr. Heather Lampel:

Dr. Lampel is a board-certified dermatologist practicing in Raleigh, North Carolina. She is a Fellow of the American Academy of Dermatology and of the American College of Occupational and Environmental Medicine.  She has an interest in occupational skin disease including skin cancer and melanoma. 

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Live Wisely

Hawaii Bans Most Sunscreens. How Do I Cover Up?

It’s no secret that the coral reefs of the world are diminishing. From climate change to overfishing, one of Earth’s strongest ecosystems is being destroyed by countless factors. And just to make matters worse, a recently discovered threat may top the list – sunscreen.

For decades, research has proven the vitalness behind basic sunscreen usage. According to the Skin Cancer Foundation, one in five Americans will develop some form of skin cancer in their lifetime. With that statistic alone, there’s no denying the importance, but what environmental cost are we willing to pay?

Should I Not Use Sunscreen Anymore?

To clarify a bit, not all sunscreens are harmful. The two active ingredients in question, oxybenzone and octinoxate, are the main perpetrators and have been linked directly to increased bleaching, genetic damage to the reefs and it’s marine organisms and ultimately irreversible death to the coral. In fact, Hawaii, one of the world’s most popular tourist areas known for its coral reefs, signed the country’s first bill banning sunscreens containing the two destructive chemicals starting January 1st, 2021. The island’s ground-breaking decision even influenced the Western Pacific nation of Palau to take action and many others are expected to join the movement.

So How Am I to Cover Up?

The bills don’t take effect for a couple years but transitioning now will greatly benefit the coral reefs. Although oxybenzone and octinoxate are two of the most common active ingredients found in sunscreens, there are other ingredients that are dermatologist recommended and considered environmentally safe by researchers.

Dr. Monica Scheel, a board-certified dermatologist in Kona, stated that, “Your best sun protection ingredients are zinc oxide and titanium dioxide.” Also, remember when searching to look for products that are “non-nano”, such as Badger, Coola and MDSolarSciences, because nanoparticles can be consumed by the corals and ultimately cause death.

Along with seeking shade whenever possible and limiting sun exposure, choosing UPF 50+ clothing is also a highly recommended move. Dr. Henry W. Lim, the president of the American Academy of Dermatology, considers UPF 50+ clothing just as effective as sunscreen.

For the environmental specialists, it’s simple. Craig Downs, the executive director of the Haereticus Environmental Laboratory that has studied the damage caused by sunscreen on the coral reefs, said, “For women in a bikini, 85% of her body will be covered in sunscreen. She can reduce that by 50% just by wearing a sun shirt.”

Obviously, sunscreen isn’t the only detrimental force attacking the coral reefs of the world, but it is one of the most controllable. That reasoning alone should be more than enough to encourage us all to reevaluate our approach to protecting ourselves in the sun. Together, we can protect the coral reefs.

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Together We Will

Together We Will… Educate Everyone and Anyone We Can Reach

Daniel Fine (Passed away October 10th, 1998 at the age of 26)

Written By: Stephen Fine Ph.D., Founder, President and Health Educator for the Melanoma Education Foundation

My oldest son Dan taught me about skin cancer. He’d never intended to give his family a hands-on, educational experience with the risks, treatments, and mortality rates of melanoma, but when he was 24 our education began.

In 1996, I noticed an ominously large mole on Dan’s lower back. It was brown, nearly half an inch wide, and thick. He had it removed and called me a week later from home, crying. He’d just learned that the mole was a high-risk melanoma and he would require further treatment. Not knowing what melanoma was, he’d searched the internet. As you can imagine, what he found was frightening.

If melanoma is not recognized and treated early it can advance and spread to other parts of the body where it becomes hard to treat and can be fatal.
– The Skin Cancer Foundation

Dan always had a dark complexion and tanned easily. He was also relatively sun safe, he wore sunscreen and covered up with a T-shirt when rowing with the University of Miami crew team. When his dermatologist told him that sun exposure was likely a factor in his diagnosis, we were all surprised. Throughout high school and even college, no one had shared with him the risks of sun exposure to ALL skin types. Even though he was an athlete who was constantly on the water in college, it never came up.

The signs were there though. About five months before he was diagnosed the mole had started bleeding slightly. He blamed it on the rough fabric of his new office chair and moved on. To make self-checking more difficult, the mole was on his back so any changes it had gone through from childhood to when it started to bleed went unnoticed. What started as a small mole when he was a kid, had grown into something deadly without him noticing.

After his diagnosis in June 1996, Dan underwent surgery to remove a large area of skin surrounding the mole, the removal of 29 lymph nodes in his right armpit – two of which tested positive for melanoma, and a year of Interferon treatment. In April 1998 it was discovered that the melanoma had spread to his liver and was inoperable. From then on, the disease progressed steadily until October 10, 1998 when he passed away at home.

After Dan passed away, like many families who’ve lost loved ones to cancer, we wanted to make a difference. Research was an obvious choice as everyone wants to find a cure. But our families story felt rooted in our lack of awareness. It became apparent to us that Dan’s death (like most melanoma deaths) could have been prevented by early detection. None of us had been educated about melanoma until it was too late. If that was the key to saving the lives of others, then education was what we needed to provide. We launched the Melanoma Education Foundation in 1999.

We identified middle schools and high schools as the ideal venue to educate youth about melanoma. They were old enough to request dermatology visits from their parents, and young enough to have any melanomas curable. When we started reaching out to schools in our area we discovered that most wellness teachers knew as little about melanoma as we had. As a result, it wasn’t included in most health classes at all.

Children will be more inclined to practice sun protection if they understand why it’s important, namely to prevent skin cancer and premature aging.
– The Skin Cancer Foundation

Our free course—which includes a detailed one-period lesson plan, separate videos for high schools and middle schools, student handouts, and a teacher video—received a Gold Triangle award from the American Academy of Dermatology. The reach of the program quickly spread. By 2015 our SkinCheck® class had been adopted by over 1,700 schools in 49 states. We’ve also spread our reach by offering community outreach sessions at regional wellness events, public libraries, colleges, city employee sites, post offices, and service organizations.

We do all of this thanks to support from our donors and special events we host throughout the year. Their financial support helps us in our efforts to provide every teacher we can connect with the tools they need to be most effective. We continue to expand our database of almost 20,000 schools and serve the 1,700 who are actively engaged with us. Beyond outreach, most of our funds go to revising and updating our teaching materials and methods. Thanks to donor contributions, we’ve even been able to provide schools with facial sun damage analyzer machines. For a lot of students, especially skeptical teenagers, seeing is believing. With every dollar we earn, we’re able to reach more communities, teachers and students, and we’re constantly getting better at it.

In a 2017 survey of 334 teachers after teaching the course:

• 49 reported that students found early melanoma

• 113 reported that students found precancerous moles

• 145 students reported that family members found suspicious moles

• 95% reported that students said they’d use more sun protection

• 81% reported that students said they’d stop using tanning beds

– The Melanoma Education Foundation

Nearly 20 years since we offered our first course, we continue to be devoted to saving lives from melanoma by expanding high school and middle school educational services, serving as a resource for health educators on the subject of skin cancer education, and promoting greater public awareness.

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Skin Diaries

Fighting Fires and Melanoma

I’m a firefighter. Someone once lovingly called us a group of “macho bastards”. We’re tough, self-sacrificing, and stubborn. The day my future disappeared, my macho demeanor suddenly changed to extremely vulnerable and fearful.

I was an active, healthy man and a fireman for Pete’s sake. It wasn’t until I became a father that my perception of the need for sun protection changed. Our family photographer, Tracy Callahan, launched the Polka Dot Mama Melanoma Foundation after being diagnosed with skin cancer. I recognized her efforts to raise awareness about the importance or early detection and prevention. She encouraged me to make an appointment with a dermatologist. I went out of support more than anything.

On May 20th, in a quick 15-minute appointment I had one mole on my back biopsied and was sent on my way as the doctor assured me that everything should be fine. Four days later a nurse called and things began to change quickly. The biopsy was malignant, and my doctor was scheduling an appointment at the University of North Carolina.

“Firefighters are diagnosed with melanoma at younger ages—an average of 42 compared with 64 for the U.S. population.”
– The Skin Cancer Foundation

While I was still recovering from this news, the phone range again. It was the oncology department advising me to come in as soon as possible. I was going to an oncologist. A doctor who treats cancer. As I sat in my appointment the next day listening to the doctor use words like “excision”, “margins”, “sentinel lymph nodes”, “out of work for weeks”, and last but not least “cancer”, the realization and shock that I was in trouble really started to sink in.

After spending the Memorial Day holiday with my family and five-year-old son, I went in for surgery on June 7, 2016 to have the cancer removed. It all happened in the course of a morning and I was sent home heavily bandaged with a drain tube in my side, an abdominal binder wrapped around me, and NO idea what was next.

All I could do was try to rest and recover while I waited for the doctor to call and let me know if they got all the cancer. For days I just prayed and between prayers, I would cry over the life I could lose and what my family’s future would look like without me. Yes, when faced with your own mortality, career firefighters cry. When I finally got word that I was in the clear I wanted to scream from the rooftops! I immediately shared the news with my friends, family and coworkers, all of whom had been so encouraging and supportive.

I owed my life to Tracy Callahan and Polka Dot Mama. She got me to get checked. She saved this stubborn fireman’s life. Literally. What shocked me was that she was the only source of the information I needed to survive. Tracy was the only one that made me aware of the dangers of skin cancer. I wanted to make sure my friends and family were safe. I wanted to protect my firefighting brothers and sisters from skin cancer.

“Men are more likely to die of melanoma than women. This is true at any age.”
– American Academy of Dermatology

Cancer is not a new word around the firehouse, we are exposed to some of the most toxic carcinogens known to man. Firefighters experience cancer-related deaths at a 14 percent higher rate than the U.S. general public. We often focus on our lungs, or prostate, but our largest organ is our skin, and it absorbs everything. As fellow firefighter Mark Rine discovered when he was diagnosed with terminal stage 4 melanoma, occupational cancer is real.

Organizations like the Firefighter Cancer Support Network are working to remind firefighters of the importance of taking steps to protect themselves on and off the job. I’m doing my best to help spread the word wherever I can. I now bear the scars to show what not being sun safe can do to your body. I’m certain that the people around me, especially my colleagues, are sick of hearing me get on them about being sun safe and wearing protective clothing AND sunscreen. But you know what? If I save just one life, just one, it will have been completely worth it.

Story originally shared by Polka Dot Mama on June 23, 2016.

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Live Wisely What's Hot

2018 Coolibar Guide to Showing Someone You Care
“One in five Americans will develop skin cancer in the course of a lifetime.”
– Skin Cancer Foundation

The need for sun protection is universal. Whether you live in a hot or cold climate or have fair or dark skin, we all need to be mindful of our exposure to UV rays. Coolibar recommends gifting UPF 50+ protection to the people you love most as a way to help them live a sun-safe lifestyle while enjoying the outdoor adventures they love most.

For tiny cuties who already love the water:

“Because babies have thinner skin, sunscreen is not recommended for infants under 6 months of age.”
– Skin Cancer Foundation

For the “big kiddos” you love to the sun and back:

“Even one blistering sunburn during childhood or adolescence can nearly double a person’s chance of developing melanoma.”
– Skin Cancer Foundation

For the sun protection-resistant men in your life:

“By age 50 men are more likely than women to develop melanoma. This number jumps by age 65 making men two times more likely as women of the same age to get melanoma.”
– American Academy of Dermatology

For global-trotting sun seekers:

Travel destinations like Hawaii are starting to ban sunscreens containing chemicals harmful to coral reefs.

For adventures in and on the water:

“Many surfaces reflect UV radiation and add to the overall UV levels you experience. Water reflects 10%; sea foam reflects 25% and sand reflects 15% UV rays.”
– World Health Organization

For the garden party goddess that craves a touch of glamour:

“About 90% of visible skin changes such as aging, wrinkles, brown spots or leathery skin are caused by the sun’s ultraviolet rays and can be minimized by sun protective clothing.”
– Skin Cancer Foundation

For someone who needs a little extra support:

“Melanoma is not just a skin cancer. It can develop anywhere on the body – eyes, scalp, nails, feet, mouth, etc.”
– Melanoma Research Foundation

For EVERYONE spending time in the sun

“For every inch of brim you wear, you reduce your lifetime risk of skin cancer by 10%. So a 6” brim means 60% risk reduction.”
– Skin Cancer Foundation

 

2018 Holiday Gift Guide

 

 

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Experts Say Live Wisely

How Do You Pick a Dermatologist?

Dr. Cynthia Bailey, Dermatologist practicing at Advanced Skin Care and Dermatology Physicians, provided guidelines to unlock the mystery of selecting the right dermatologist.  After a summer of being outside, fall is a great time for scheduling your annual skin exam.

Way to go! You’ve decided to get your skin checked and now you’re about to embark on the first step in the process: picking a dermatologist. For some it’s a daunting task, for others, it’s simple. But everyone could use some general guidelines to get the most out of your visit and skin exam.

With these suggestions, go forth and choose a dermatologist that fits your needs and leaves you feeling confident in your decision.

  • Focus

Each dermatologist has their own specialty or focus. Keep this in mind while you start your search. If you are someone who only needs a skin exam to screen your skin for skin cancer choose a dermatologist who focuses on what you need.

Many dermatologists have diversified their practice to include cosmetic procedures. Along with cosmetic dermatology, it’s important to remember dermatologists diagnose and treat more than 3,000 diseases of the skin, hair, and nails.  Look for a board-certified dermatologist who specializes in melanoma and skin cancer for your full-body skin exam, also known as the Total Body Skin Exam (TBSE).  Reference the American Academy of Dermatology Skin Exam Module for a comprehensive overview of what to expect during your skin exam (TBSE). If you are not interested in certain types of specialties or procedures make sure you factor that in when you are looking for a dermatologist.

  • Referral

 

Get a little help from your friends. Rather than rely on a Google search, ask members of your community. Find out who they see for their TBSE and ask them to share their experience with you. They might be a helpful resource if you can tell them what you are looking for in your skin exam and future needs.

If one name does not bubble up as a frequent recommendation in your area, use this find a dermatologist resource from the American Academy of Dermatology as a starting point for a skin cancer specialist in your neighborhood. In the search line of this site, enter “skin cancer” for a list of physicians who treat skin cancer near you.  This physician listing will also indicate the doctor’s accepted insurance, as well as hospital affiliations and patient reviews/star ratings if any have been entered.

  • Clarity

When you call to schedule your TBSE, be precise about what you are looking to accomplish during your appointment and that an appropriate visit type and amount of time has been scheduled. Be very clear with the scheduler and ask the right questions to insure you make the most of your exam visit. When you are clear about what you want to get out of a visit it helps the dermatologist focus.  I liken this analogy to that of a chef.  “Dermatologists treat thousands of diseases and generally specialize in just a few.”  When someone is coming in for a TBSE, I know what we are doing during the appointment. If it is vague, your dermatologist may not know what to expect out of the visit.

Here are some key questions to ask:

  1. What types of conditions does the doctor frequently treat?

(You are looking for an expert in finding and treating skin cancers. An emphasis on acne, rashes or esthetics may be considered for a future appointment but keep your skin check appointment focused on early skin cancer detection. Save the rest of your concerns for a return appointment because your time is limited.)

  1. How long will the appointment take?

(The more moles you have the longer the exam may take. The average full body, head-to-toe exam should take about 10 minutes.)

  1. How does the doctor document suspicious “spots,” freckles or moles for their patients? (Some doctors take a photograph or measure the suspicious “spot” and take inventory of any findings in the patient record as baseline reference. This is a good practice to confirm for your visit.)

 

  • Advocacy

 

You are your own best health advocate. Be assertive and make the most of your 10-minute exam because early detection is key.  If you feel the dermatologist is missing the reason for your visit, remind them that you are there for a skin check.

Use these suggestions to schedule your next skin exam. When we think of melanoma prevention, we often think of the usual: using sunscreen, covering up, not burning, avoiding tanning beds, etc. But did you know that finding a suspicious mole or spot and having it checked out by a professional is considered one of the most important steps to preventing melanoma? Detecting melanoma, when it’s early enough to treat, could mean the difference between life and a life-threatening illness.

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SunAWARE

Three More States Ban Tanning Beds for Minors

Because skin cancer rates continue to rise among young adults – a group previously unlikely to be diagnosed – states are acting on convincing evidence that indoor tanning is a significant factor.  In 2013, following a number of other states, Illinois, Nevada, and Texas enacted legislation to block access to indoor tanning for minors. This is a trend we hope will eventually be rolled out across all states.

In June, Texas and Nevada became the fourth and fifth U.S. states to pass laws prohibiting anyone under 18 from indoor tanning; in August, Illinois became the sixth.

These new laws take effect as significant scientific evidence links indoor tanning with melanoma and other skin cancers. According to figures compiled by the Skin Cancer Foundation, of melanoma cases among 18-to-29-year-olds who had tanned indoors, 76 percent were attributable to tanning bed use. And more than 170,000 cases of non-melanoma skin cancer in the U.S. each year are associated with indoor tanning.

Along with the three states to entirely ban indoor tanning among minors in 2013, three others passed legislation regulating the use of indoor tanning equipment. In Oregon, anyone under 18 is prohibited from indoor tanning without a prescription, and in Connecticut and New Jersey indoor tanning is prohibited for anyone under age 17,  This is in addition to other states that require parental consent, or prohibit indoor tanning for those under 14.

The American Academy of Dermatology cites studies showing nearly 28 million Americans – including 2.3 million teens—use indoor tanning beds each year. However, six states have now banned indoor tanning for minors since the beginning of 2012, and some 29 additional states have at least one legislative bill under consideration regarding the regulation or prohibition of indoor tanning for minors in 2014. And the U.S. Food and Drug Administration has proposed that the classification for sunlamps and tanning beds be raised to a Class II level, which institutes stricter regulations to protect public health.

Make your voice heard.

If you believe indoor tanning devices should receive the maximum amount of regulation, which more closely matches the health risks of these harmful devices, write a letter of support to your state elected officials urging the FDA to regulate tanning beds and ban those under 18 from using them. You can also email The Skin Cancer Foundation at advocacy@skincancer.org. The Foundation will compile all emails of support and send them to the FDA Commissioner Margaret Hamburg’s office.

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SunAWARE Wear Sun Protection

Promote Skin Cancer Prevention with SPOT

Have you ever been at a party or event where a conversation ignited over something you were wearing? Maybe it was your interesting hat, your scarf (which you bought while touring Italy) or your T-Shirt with a clever message. All these items make for great conversation starters, but if you want to steer the chitchat towards something more meaningful, a UPF 50+ SPOT Skin Cancer™ T-Shirt could be just the thing you’re looking for.

Last spring we partnered with The American Academy of Dermatology (AAD) SPOT Skin Cancer™ initiative to help raise awareness on skin cancer prevention. Since our UPF 50+ SPOT T’s were revealed at the Academy’s 71st Annual Meeting in Miami, hundreds of you are showing off your SPOT and talking about skin cancer prevention. Here’s what people are saying.

Comfortable UV Awareness
“I hope the Spot is noticeable enough to lead to questions. It might be an excellent shirt to wear to ‘meet the legislators’ events.”

So cool
“I prefer this t-shirt over the other simple white mainly because of the logo. The fabric is as always, comfortable and lightweight and has this ‘cool vibe.’ Paired with skinny dark jeans and flats it’s a match made in heaven.”

We’ve got UPF 50+ SPOT T-Shirts for men and women and Gigi the Giraffe™ for children. Coolibar will donate $10 from every SPOT Skin Cancer™ T-Shirt sale to the initiative.

Talking about skin cancer is the first step in prevention and SPOT can start the conversation. Together, we can all work toward preventing skin cancers.

Current estimates are that one in five Americans will develop skin cancer.

 

 

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Inside Coolibar

Coolibar Employees Visit AAD’s Camp Discovery

Coolibar had the pleasure of meeting the youth and staff at the American Academy of Dermatology’s Camp Discovery on July 10, 2013. Camp Discovery offers youth with skin conditions the opportunity to spend a week among young people who have similar skin conditions — free of charge — with a dermatologist referral.

Coolibar employees arranged a scavenger hunt for the teens and counselors, which eventually led to the beach front where volunteers were giving away Coolibar sun hats and UPF 50+ swim shirts. Many campers immediately put on their new shirts (a huge compliment from teenagers) and dived right into the water.

Camp Big Trout, located at Camp Knutson in Crosslake, Minnesota is one of six AAD Camp Discovery locations. Each year Coolibar also donates sun protective hats to all Camp Discovery locations, providing sun hats to 350 kids.

Check out our album below from Coolibar’s road trip to Camp Discovery.

[nggallery id=35]

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Avoid UV & Seek Shade

FDA works to increase awareness of tanning bed risks

Tanning Bed

Monday, the U.S. Food and Drug Administration issued a proposed order that, if finalized, would reclassify sunlamp products and require labeling to include a recommendation designed to warn young people not to use these devices.

According to the American Academy of Dermatology, there is a 75 percent increase in the risk of melanoma, the deadliest type of skin cancer, in those who have been exposed to ultraviolet radiation from indoor tanning, and the risk increases with each use. The proposed order does not prohibit the use of sunlamp products by those under the age of 18, but it provides a warning on the consequences.

The order would reclassify sunlamp products from a low risk device (class I) to a moderate risk device (class II).

“Using indoor tanning beds can damage your skin and increase your risk of developing skin cancer,” said FDA Commissioner Margaret A. Hamburg, M.D. “The FDA’s proposed changes will help address some of the risks associated with sunlamp products and provide consumers with clear and consistent information.”

If the order is finalized, manufacturers would have to submit a pre-market notification (510(k)) to the FDA for these devices, which are currently exempt from any pre-market review. Manufacturers would have to show that their products have met certain performance testing requirements, address certain product design characteristics and provide comprehensive labeling that presents consumers with clear information on the risks of use. The order proposes to include a contraindication against use on people under 18 years old, and the labeling would have to include a warning that frequent users of sunlamp products should be regularly screened for skin cancer.

Resource: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm350864.htm

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