Credit: American Academy of Dermatology Association
One in every five adult Americans — that’s more than 14 million people — will develop skin cancer in their lifetimes. Basal cell and squamous cell skin cancers, slow-growing and rarely fatal, are the most common malignancies in the United States, five times more common than the next four cancers combined (breast, prostate, lung and colon). Melanomas rank sixth; 1% of all skin cancers. Sometimes life-threatening, melanomas kill an estimated 8,300 Americans annually.
Excessive exposure to sunlight is the main cause: The damage to skin DNA from the sun’s ultraviolet (UV) radiation is cumulative. Don’t be fooled into thinking that winter clouds protect you, either. Even on gray days, UV rays damage uncovered body parts and the reflective properties of snow can double the amount of radiation. Exposed areas — ears, face, and bald heads — are the most frequent spots for cancer. Darker-skinned people tend to develop lesions on their palms and soles, too.
Skin cancer is most common in non-Hispanic white people, especially those with freckles or red hair. Sun worshipers and tanning fanatics are at higher risk, too. Studies have shown that using a tanning bed even once before the age of 35 increases the chances of melanoma by 75%. Those taking Immunosuppressive medications like chemotherapy drugs are more likely to get skin cancer, as are people over the age of 60.
The majority of skin cancers are basal cell carcinomas, appearing as flesh-colored pearly or waxy bumps, or as scar-like lesions. Known to dermatologists as “the sore that doesn’t heal,” a basal cell tumor often bleeds, scabs over then recurs. Squamous cell cancers are second-most frequent and appear as firm red nodules or scaly flat patches. Though not life-threatening, the cancer destroys nearby healthy tissue as it grows, making surgical excision extensive and disfiguring.
Timely treatments for basal and squamous cell cancers are relatively simple: scraping, freezing, or topical chemo cream, which kills abnormal surface-level cells. Mohs surgery, in which cancer cells are shaved away layer by layer to minimize scarring, is another option.
Melanomas are dangerous and spread quickly, metastasizing in as little as six weeks after they first appear. They have five frequent features, described by the mnemonic “ABCDE“: asymmetry (its shape usually isn’t round); border (its edges are often irregular); color (although usually dark brown, multiple shades of color are also a warning sign); diameter (moles larger than 6 millimeters — the size of a pencil eraser — are often abnormal); and evolving (the lesion starts bleeding, or changes size or shape).
Suspected melanomas are removed by excisional biopsy. If abnormal cells are deeper than one millimeter — the thickness of a credit card — lymph node biopsies and imaging studies (CT, MRI, or PET scan) are done to rule out distant spread. Death rates have significantly declined over the last decade thanks to new immunotherapy treatments (medicines that enhance the immune system’s ability to identify and kill cancer cells). Even in cases of advanced inoperable melanoma, immunotherapy increases the patient’s lifespan from six months to nearly six years.
Credit: cancer.org.au
The good news is that skin cancer can be prevented. Just remember the Five S’s: Slip on a shirt, slop on some sunscreen, slap on a hat, seek some shade and slide on wraparound sunglasses. Clothing made of synthetic fiber, such as polyester or Lycra, is elastic and dense, helping to block UV rays. Darker colors are more protective, too, because they absorb UV light. Dermatologists recommend water-resistant sunscreen with a minimum SPF of 30. Squeeze out enough lotion to cover two fingers, and cover all areas of exposed skin. Reapply every two hours. Avoid the sun from 10 a.m. to 2 p.m. when UV rays are strongest.
A monthly self-exam is a great way to monitor for early skin cancer and is easy to do just after a bath or shower. Stand in front of a mirror and look at your skin, from the top of your head to your toes. Don’t forget your underarms and the soles of your feet. Use a mirror to look at your back. You can quickly become an expert at knowing what’s normal for you and at detecting changes.
Annual skin exams by a medical professional have become controversial, due to the high numbers of skin biopsies performed by overly cautious doctors, (there are 10 million done annually in the U.S. and 44% are positive for cancer). Most experts now recommend skin checks by a dermatologist every two to three years, with annual exams reserved for those at high risk. Talk to your primary provider to find out what is best for you. Visit the American Academy of Dermatology Association’s Skin Cancer Resource Center for more information.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York State.