Skin Cancer is the number one cancer in the United States, with 1 in 5 people diagnosed with skin cancer by the age of 70. It is one of the most preventable and treatable cancers, but many of us still have a lot of questions about it. This is a great time to bring the topic into the limelight, so we can provide some good information while getting the conversation going.
Types of Skin Cancers and the Different Risk Factors
The three main types of skin cancers are Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma:
Basal Cell Carcinoma (BCC) is the most common skin cancer. It forms in the lower part of the epidermis called the basal cell layer.
Risk factors for BCC include intermittent intense sun exposure, such as sunburns, radiation therapy, a family history of skin cancer, immunosuppression, a fair complexion (burns easily in the sun), and blistering sunburns in childhood. Indoor tanning is also a significant risk factor for early-onset BCC, and according to the Skin Cancer Foundation, a history of indoor tanning use can increase one’s risk of getting BCC by 40 to 69 percent.
Squamous Cell Carcinoma is the second most common skin cancer. This cancer forms in the upper part of the epidermis in the squamous cells.
Risk factors for SCC – Most cases of SCC are caused by ultraviolet radiation (UVR), so chronic and long-term exposure to the sun is a major risk factor. Other risk factors include immunosuppression, aging, and high-risk genital HPV (Human Papillomavirus). HPV can lead to SCC of the genitalia, which is why vaccination against HPV is so important.
Melanoma is less common than BCC or SCC, but of the three, it is the most serious form of skin cancer, as it is the deadliest. The lifetime risk of melanoma for persons in North America is 1 out of 60 persons.
Melanoma develops in the pigment-making cells of our skin, called melanocytes, and if not detected early, it can spread to the lymph nodes and other parts of the body. Melanoma can start anywhere on the skin, with about 30% of melanomas forming in pre-existing moles and the rest forming in normal-appearing skin.
Risk factors include UV light exposure (sunlight and tanning beds), having fair skin, a history of sunburns in childhood, family history of melanoma, weakened immune system, aging, specific gene mutations, and a skin condition called xeroderma pimentosum. Other risk factors include having many moles, atypical moles, large congenital moles, and a family history of atypical moles called Familial Atypical Multiple Mole and Melanoma Syndrome or FAMMM.
What are the ABCDEs used to recognize early signs of melanoma?
Finding a melanoma at an early stage is critical for a successful outcome. The Skin Cancer Foundation statistics show that the 5-year survival rate for patients whose melanoma gets diagnosed early is 99%. That number drops to 68% if the cancer reaches the lymph nodes and 30% if it spreads to distant organs. Using the first five letters of the alphabet to recognize signs of melanoma is an excellent way of remembering what to look for. The ABCDEs of melanoma stand for:
Asymmetry – an asymmetric spot in the body means that one half of the spot doesn’t match the other half.
Border – the border of the spot is irregular.
Color – the spot has two or more colors to it.
Diameter – the diameter of the spot is larger than the end of a pencil eraser.
Evolving – an existing spot that starts to change or evolve.
Areas of the Body Most People Forget to Check
One of the things we highly recommend is a skin self-examination every month. You are the best person to recognize any changes to your skin that might be a problem. Being proactive in early diagnosis can save lives. The American Dermatology Association has some great guidelines for doing a body examination. Now, when they recommend you check your body from head to toe, don’t forget to check your scalp, behind the ears, between the toes, soles of the feet, nail beds, and genitalia. It is also essential to check our mouths, so it’s important to get dental checkups, and our eyes – retinal exams screen for lesions on the retina.
If you find something concerning, make sure to contact your Dermatologist.
How Does the Sun Cause Skin Cancer?
The sun produces ultraviolet radiation (UVR), and this radiation from the sun damages the DNA in the skin cells. These abnormal skin cells then multiply out of control and grow malignant tumors. Having a sunburn, even once every two years, can triple the risk of getting melanoma. Having sunburns as a child can potentially increase a person’s risk of getting any type of skin cancer, and just one blistering sunburn in childhood or adolescence can double a person’s chance of getting melanoma later in life.
This brings us to the use of indoor tanning beds. Tanning beds produce ultraviolet radiation, which we have already ascertained is one of the major causes of skin cancer. Indoor tanning devices have been shown to have UV radiation 10 to 15 times higher than the sun at its peak intensity.
Importance of Early Detection
Early detection is important for any cancer, not just skin cancer, because when cancer is identified in its early stages, successful treatment and a cure are far more likely. This makes it extremely important to keep up with all our preventative health screening exams. One thing that makes skin cancer unique is that it is something that we can see, making it easier for us to help in early diagnosis.
Skin cancers are diagnosed by taking a small sampling of the suspicious skin called a skin biopsy. There are different methods for achieving this, but usually, your Dermatologist will numb the area before taking a sample. Enough of the suspect area will be removed to make an accurate diagnosis. The skin biopsy is then examined to determine if it is skin cancer and what type of skin cancer. Further tests can be run to determine what stage the cancer is at. Roman numerals I through IV are used, with Stage I indicating the tumor is small and limited to the area it is located at. Stage IV indicates advanced cancer that has spread to other parts of the body.
Treatments Available for Skin Cancer
Treatment depends on the type of skin cancer you have, how big and deep it is, where the skin cancer is located, and if it has spread to other parts of the body. Your Dermatologist will take all the factors into account when formulating the best treatment options. Some of the approaches to skin cancer treatment are:
- Freezing or Cryosurgery – Some small, early cancers can be handled by using liquid nitrogen to freeze the area. The dead skin cells then slough off.
- Excisional Surgery—This type of surgery can be used for different kinds of cancers. It involves cutting (excising) out the cancerous tissue and a margin of the healthy skin as well.
- Mohs Surgery is a more delicate and precise procedure. It can be used on larger cancers and recurring cancers, especially when necessary to preserve as much healthy tissue as possible, such as the face, neck, or nose. The tissue will be removed layer by layer, with the Mohs Surgeon looking at it under the microscope until only healthy tissue remains.
- Immunotherapy – this type of therapy uses the body’s immune system to fight off cancer.
- Chemotherapy—For skin cancers limited to the top layers of the skin, this may involve a cream or lotion containing anti-cancer agents to kill the cancerous cells. Treating cancers that have invaded other parts of the body will involve more systemic chemotherapy.
- Radiation Therapy – This is useful in larger areas, harder-to-reach areas, or areas where you cannot altogether remove the cancer with surgery. A high-powered beam of energy, such as X-rays, is used to kill the cancer cells.
Top Tips to Avoid Skin Cancer
The best way to prevent skin cancer is to avoid the sun. However, this is not always practical. We all enjoy spending time outside or doing outdoor activities. UV protective clothing and hats are a good option, as is seeking shade when possible. Sunscreens with UVA and UVB protection of 30 SPF or higher are essential to apply every day, no matter the weather.
Resources Available
We realize the importance of obtaining reliable information and support for patients, families, and their caregivers. Two of our favorite resources are the American Academy of Dermatology and the American Cancer Society.
We can also answer any of your questions or concerns at any of our three convenient locations. If you would like more information on preventing, diagnosing, or treating skin cancer, schedule an appointment to see one of our Dermatology Providers.