What is Skin Cancer
Skin cancer is the most common form of human cancer, affecting more than one million Americans every year. In America, about 3-4 million new skin cancers are diagnosed each year, which is close to the number of ALL other cancers of any type, combined. Skin cancers are generally curable if caught early. However, people who have had skin cancer are at a higher risk of developing a new skin cancer, which is why regular self-examination and doctor visits are imperative.
Skin Cancer Screening
First and foremost, if you see something overtly new or changing (size, shape, color, itching, not healing, unusual bleeding etc) on your skin, call the dermatologist for an evaluation, quickly. Don’t worry about whether you should call or not, whether it is a bother or not, or try to analyze it yourself. Simply go to the skin expert for an evaluation. Now, onward.
Did you know that each year there are just about the same number of skin cancers detected as all other cancers combined? By far and away, the major cause of these skin cancers is ultraviolet radiation (uvr). The two major sources of uvr in our world are the sun and tanning beds. Sun and tanning beds are essentially the same thing, a source of uvr. The more exposure you have to sunlight and tanning beds, the higher your risk of getting skin cancer. (We have designed a cartoon that visually demonstrates the dangers of tanning beds. You can see the cartoon here.) Unfortunately for most people, even if they hear/know this early in life, by the time it “sinks in”, and leads to behavioral changes on their part, (early to late 20′s it seems for most people) much damage to the skin has been done. Looking in the mirror at that point, little of the actual damage is very visible. However, even if uvr is conscientiously avoided from this age on, signs of the damage will continue to show up on the skin for the rest of their life, in the form of wrinkles, freckles, more moles, poor skin texture, and skin cancers. I am not saying once you reach your late 20′s, game over, don’t worry about ultraviolet radiation (uvr) exposure anymore, it won’t matter. It will. If you are not careful about protecting your skin from uvr after your 20′s, you will certainly do a lot more skin damage, and further increase your chance for skin cancer.
The three major types of skin cancer are basal cell skin cancer (bcc), squamous cell skin cancer (scc), and melanoma. They are distinct and separate skin cancers. They are not different stages of “skin cancer”, and they do not turn into one another. They each get their name from the different skin cells from which they develop. Bcc and scc are similar in many ways, and are often discussed together. They are both almost always caused by “too much” uvr, either from the sun or tanning beds. Therefore, they almost always appear in sun exposed skin. Over time, the uvr causes skin cells to become damaged. Some of these places become cancer. Since this damage accumulates over time, bcc and scc are usually seen in older people, though there are many instances where people in their 20′s and 30′s are affected.
As bcc and scc develop, they often become visible as pink/red spots, which often are scaly/crusty/pearly/sensitive/itchy/easy to bleed. When patients not familiar with bcc or scc first see/feel these lesions, it is not uncommon for them to think that it was an injury they experienced, or a “pimple” that is just not going away. Eventually, most people figure something is wrong and go to the doctor. Fortunately, the vast majority of bcc, and many scc, are fairly slow to become invasive. With prompt treatment, these patients do well. I do not want to trivialize bcc or scc. They are true cancers. Without appropriate treatment, bcc and especially scc will spread wider and deeper internally, eventually becoming very destructive, disfiguring, or even fatal. Any person that sees a new or changing (size, shape, color, itch, pain, not healing) skin spot should seek medical attention with a dermatologist.
Melanoma is different from bcc and scc in several ways. First, it does not necessarily require much uvr exposure (sun or tanning beds) in some cases. Of course, the more uvr to which you are exposed, the higher your risk for these skin cancers, including melanoma. Thus, melanoma can be found anywhere on the skin, including places that never have/never will be exposed to uvr. Your genetic makeup seems to play a prominent role in some melanomas. If you have a lot of moles (greater than about 50), “dysplastic” or atypical moles, or a close relative had melanoma, you are at a significant risk for getting melanoma. This genetic component is probably what accounts for melanoma occurring much earlier in life than bcc or scc in some cases, sometimes even the early to mid teen years.
Also, melanoma may not be very noticeable or give you many obvious symptoms when it is early and just in your skin. I think most of us have seen pictures on the web, in magazines, on TV etc, of melanoma. It has been my experience that what are usually shown are pictures depicting very striking lesions that are rather large, very dark, with many unusual colors and color patterns. These pictures clearly do represent melanomas and are good examples of what a person would want to seek care for should they be seen on their skin. However, while these do indeed represent a good portion of melanomas, I feel their appearance is not what a person should wait for a “mole” to look like, before seeking medical attention. Early melanomas that are still confined to the skin, and thus are curable, often do not look anywhere near as “bad” as many of these photos show. If a person waited for such striking features to develop in a mole before seeking medical attention, there is definitely a higher likelihood that the melanoma will have already spread internally, and be very difficult to treat or cure. To further assist us in helping to diagnose melanomas, we are one of the few dermatologists in the nation privileged to be using the Melafind device.
There are several measures you can take to minimize your risk of developing skin cancer. Avoid uvr exposure to the degree you can. The more uvr to which you are exposed, the higher your risk for these skin cancers. The peak hours of the day to especially avoid sun during the summer are 10am to 6pm. (other sources say 4pm, but here in Texas, on an average July day, when it gets to be even after 5pm, the sun is still pretty high in the sky). When you have to be outside during the day wear a protective hat. This means it has a solid top, and a good wide brim all the way around. A visor and a baseball hat do not qualify. To see why, the next time you are outside on a sunny day, watch someone who has a baseball cap or visor on. No matter what time of day, as they turn from side to side, you will notice that the sides of the forehead, sides of the face, the lower 2/3 of the face, both ears, and neck are pretty exposed, and not very shaded consistently by the these type of measures.
Wear long sleeves and long pants, as much as you can stand it. Sunscreen. I generally don’t recommend a particular brand since different sunscreens have different smells, textures, and difficulty of application, and personal preference as far as these features will go a long way in determining which sunscreen someone will be willing to use. I do recommend some basic criteria to look for. SPF of at least 30, higher is even better. It should block uva and uvb. Reapply every 2 or 3 hours, even if the bottle says it is waterproof, sweat proof, or lasts all day.
Now the issue of how much sun we need for adequate vitamin D levels, leading to proper bone health, and even proposed protection from other cancers and overall health is a hotbed of discussion and research. It is a topic not examined extensively recently. I am pleased this issue is being examined in detail. While it is being sorted out over the next several years, there will probably be many extreme and emotional proclamations made by the “no sun is best” and the “unprotected sun exposure is no problem” camps. Time will tell, but at least it is being investigated critically. We will probably find much valuable information about these issues, and be able to make more informed, rationale, specific, scientifically based recommendations in this regard, in the future. For now, we know that increasing exposure to uvr leads to increased risk for skin cancer, and that some level of uvr exposure is beneficial for some health issues.