Peter Young, MD
We've all heard the expression "a healthy tan." In fact, it was only one or two generations ago that people lived with the misunderstanding that sunbathing was indeed healthy. Sure, a golden tan is still considered attractive in today's society, but it is now well known that too much long-term sun exposure and bad sunburns cause the vast majority of skin cancers.
Skin cancer is the most common type of cancer in both men and women, and has reached epidemic proportions in the United States over the past several years. In fact, skin cancers represent fifty percent of all new cancers. Approximately one out of every five Americans will develop skin cancer in the course of his or her lifetime. There were over one million new cases of skin cancer detected in 1998. Alarmingly, the rate of melanoma, the most dangerous type of skin cancer, is doubling every eight to ten years. Rarely a day goes by in my own dermatology practice that I don't diagnose a patient with skin cancer.
Aside from overexposure to sunlight, other risk factors for skin cancer include light skin, light eyes (blue or green), and light hair (blond or red). Greater than ninety percent of all skin cancers develop on areas of the body exposed to the sun, including the face, ears, neck, hands, and forearms. However, skin cancer can develop on any area of your skin.
Prevention And Early Detection
There are several measures you can take to protect yourself from the sun without having to avoid it outright.
Stay out of the hot sun: Try to stay out of the midday sun (between the hours of 10 AM and 4 PM) when the sun's rays are at their strongest.
Cover up: Stay covered up as much as possible. This includes wearing long pants, a long-sleeve shirt, and a hat or visor with a wide brim to protect your face and neck. You should also wear sunglasses to protect your eyes.
Use sunscreen: Make sure to use a broad-spectrum sunscreen (UVA and UVB) every day, even during the winter months. I tell my patients to make sunscreen application a part of their daily morning routine, just like brushing their teeth. Use sunscreens with an SPF rating of at least 15. Remember to reapply your sunscreen every two hours while you are out in the sun, more frequently after swimming or sweating, even if it is waterproof. Don't forget to protect your lips as well. There are several commercially available lip balms that contain sunscreen.
Use sunscreen on your child: You should begin using sunscreen on your children when they reach the age of six months. Prior to this, they should be kept out of direct sunlight, in the shade. This can be accomplished by placing an umbrella over their stroller. The earlier you start practicing sun precautions, the better off you and your kids will be.
Avoid tanning parlors: Stay away from tanning parlors, tanning booths, and sunlamps. These artificial sources of ultraviolet light can be as dangerous, and sometimes even more dangerous, than the sun's rays.
Do self-examinations: Early detection of skin cancer is important, and may even be lifesaving. I recommend that you perform monthly skin self-examinations to check for any abnormal growths or moles. Your doctor can teach you the best way to do this. If you notice any new or changing skin lesions or moles, consult your doctor.
Pay particular attention to changes in size, shape, or color of your moles. Although these changes don't necessarily mean that you have skin cancer, a doctor should certainly check them out to be sure.
Get annual doctor-exams: I also advise that older, fair-skinned individuals have an annual skin examination by a doctor as part of their routine physical check-up. Keep in mind that expedient removal of an early melanoma/skin cancer is usually curative.
Basal Cell Carcinoma
Basal cell carcinoma is the most common type of skin cancer, representing about eighty percent of all skin cancers detected in this country. Fortunately, it is also the least aggressive form of skin cancer. Older people with fair skin, blond or red hair and blue or green eyes are at the highest risk of developing basal cell carcinoma.
Symptoms and medical outlook
These tumors of the skin usually appear as small, fleshy, shiny or pearly bumps or nodules, generally on sun-exposed areas of the body (face, ears, neck, arms, and hands). They commonly occur as sores on the skin that won't heal. Fortunately, basal cell carcinomas grow very slowly and almost never metastasize (spread to other vital organs). The cure rate is over 95 percent if detected and treated early. However, left untreated, they can cause considerable local damage and disfigurement.
There are several treatment options available for basal cell carcinoma, depending on the size and location of the cancer as well as the individual needs of the patient. These include surgery, freezing the cancer with a very cold substance known as liquid nitrogen, or a procedure called electrodesiccation and curettage (scraping the skin cancer with a curette device followed by burning the cancer with an electric needle). Your doctor will discuss these various treatment options with you.
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common form of skin cancer, accounting for sixteen percent of all skin cancers.
Symptoms and medical outlook
Like basal cell carcinoma, squamous cell carcinoma is found predominantly on sun-exposed regions of the body, again in people with light skin, light hair, and light eyes. These tumors may appear as red, scaly patches or as raised, crusty growths. The cure rate is over 95 percent with early diagnosis and treatment. Unfortunately, without proper treatment they can metastasize and even be deadly.
If detected early, the same treatment options are available for squamous cell carcinomas as previously mentioned for basal cell carcinomas. However, if the cancer has spread, radiation therapy or other more aggressive therapies may be necessary. Again, it is important to discuss all of the treatment options with your doctor first.
Also known as "malignant" melanoma, this is the least common, but most deadly type of skin cancer. The chances of developing a melanoma are about one in eighty. Although it represents only about four percent of all skin cancers, someone dies of melanoma about every hour in the United States. Fortunately, due to earlier detection, the death rate from melanoma is on the decline.
Similar to basal cell and squamous cell carcinomas, excessive sun exposure is a definite risk factor for melanoma, particularly among fair-skinned people. There is a strong association of melanoma with severe blistering childhood sunburns. People with a family history of melanoma also run an increased risk of getting melanoma, even if they haven't had an excessive amount of sun exposure. In addition, atypical moles, which may be hereditary, are often markers indicating an increased risk of melanoma either within these moles or on other areas of the skin. If you have a history of excessive sun exposure or severe sunburns, a family history of melanoma, or lots of unusual looking moles, make sure to have a complete skin check by your doctor every year.
The group at highest risk for developing melanoma is men over the age of fifty, but it can affect anyone of any age. The most commonly involved sites are the chest and abdomen in men, the lower legs in women, and the upper back in both genders. Persons of dark skin color, such as African Americans, Hispanics, and Asians, although less likely to get melanoma, are certainly not immune. Interestingly, when a black person develops melanoma, it often occurs on the palms, soles, or under the nails, all areas with very limited sun exposure.
Symptoms and medical outlook
A melanoma may spontaneously appear on previously normal skin or it may arise from a preexisting mole. It usually appears as an asymmetric dark brown or black mole-like growth with irregular edges. It may be multiple colors, including mixed shades of red, blue, tan, and white. Other warning signs include:
changes in the surface of a mole (raised areas, bleeding, or crusting).
pain or itching within a mole.
spread of pigment, or color, from the edge of a mole into neighboring skin.
If you notice any of these changes, it is important that you notify your doctor. Keep in mind that early detection and treatment of a melanoma is usually curative, but if a melanoma goes unnoticed, it can spread to other parts of the body and be deadly.
Melanomas are treated by excision (surgical removal). The earlier the cancer is detected the less invasive the surgery that will be required. If the cancer has already spread, additional treatments may be necessary, including radiation therapy or chemotherapy. Many studies involving new treatments as well as melanoma vaccines are currently underway, and offer hope for further advances in the prevention and treatment of this most aggressive form of skin cancer.
Skin cancer is the most common of all cancers, and has reached epidemic proportions. Excessive sun exposure is the single most important risk factor for developing skin cancer. Therefore, your best defense against skin cancer is to minimize contact with the sun during peak hours and through liberal use of sunscreen and other protective measures.