Skin Cancer Specialist
The reality is that up to 90% of all skin cancers are caused by exposure to the sun’s harmful UV rays, and the effect is cumulative. Fortunately, most skin cancers are visible and can be diagnosed and successfully treated before they spread (metastasize) to other body parts. Read below for information on types of skin cancers, tips for protection from the sun, and how we can help.
Sun & Skin Cancer
Have you noticed that deep, dark tans look decidedly out of place these days? In fact, they look like a holdover from the 1970s, when bronzed sun worshippers graced the covers of the leading fashion magazines. Luckily, those days are long gone: Lovely un-tanned skin is now chic. The reality is that up to 90% of all skin cancers are caused by exposure to the sun’s harmful UV rays, and the effect is cumulative. Each unprotected exposure increases one’s lifetime risk of developing skin cancer.
Fortunately, most skin cancers are visible and can be diagnosed and successfully treated before they spread (metastasize) to other parts of the body. In fact, many lesions can be detected and treated at a precancerous stage, at which their cells may be close to turning cancerous but have not yet.
Actinic keratosis (AK), also known as solar keratosis, is the most common type of precancerous skin lesion. The more time individuals spend in the sun over the years, the greater their odds of developing one or more AKs. An AK is evidence that sun damage has occurred and that the individual is at greater risk of developing skin cancer. AKs typically occur on the face, lips, ears, scalp, neck, back of the hands, shoulders, forearms, and back - the parts of the body most often exposed to the sun. Ranging in size from 1mm to 1 inch (most often about 2-4mm) in diameter, AKs usually appear as small crusty, scaly, or crumbly bumps or horns. The base can be dark or light skin-colored and may have additional colors such as tan, pink, and red.
Treated early, almost all AKs can be eliminated before becoming skin cancers. Based on the growth’s characteristics and the patient’s age and health, various treatments can be used effectively with little or no scarring.
If not treated early, AKs can develop into cancerous lesions requiring more in-depth treatments and surgeries.
Here’s a rundown on the three major types of skin cancer that can develop, what they look like and what you can do about them.
Basal Cell Carcinoma
Basal cell carcinoma is the most common form of skin cancer, accounting for 80% of all skin cancers diagnosed in this country. Last year, some 900,000 new cases were diagnosed. If caught early, the cure rate is better than 95%.
- What it looks like: Pearly nodule, sometimes with an area that won’t heal. It can be translucent, gradually grow, or look like a sore that won’t heal.
- Who gets it: People who have received chronic sun exposure.
- How it’s treated: Basal cell carcinomas can be removed by freezing or surgery.
Squamous Cell Carcinoma
Numbering 200,000 cases in 1998, squamous cell carcinoma is the second-most common form of the disease, representing 16% of all skin cancers. Like basal cell carcinoma, this disease is 95% curable if caught early. But squamous cell carcinoma can spread and is potentially lethal if left untreated.
- What it looks like: Crusty, scaly patch with a hard, callused surface.
- Who gets it: People who have had chronic sun exposure.
- How it’s treated: If caught early, squamous cell carcinomas can be removed by freezing or surgery.
Melanoma
Though melanoma is the least common form of the disease, it’s the most deadly. “The odds of getting melanoma are 1 in 79,” Dr. Rigel notes. In fact, adds Dr. Ceilley, “someone dies of melanoma every hour.” And if you have a family history of the disease, you’re at risk even if you’ve never been out in the sun, Dr. Ceilley explains.
- What it looks like: Usually a pigmented mole, sometimes with an uneven border. The color and diameter may change over time.
- Who gets it: People who have had several blistering sunburns in their youth or adolescence or those with a family history of the disease.
- How it’s treated: Removal of the tumor (excision). The amount of tissue that needs to be cut out depends on the tumor’s thickness, so early detection means less invasive surgery. The patient may need chemotherapy, radiation, or other treatments if the cancer has spread.
Prevention and Early Detection
If not completely preventable, skin cancer can be successfully treated if caught early. Here are some ways to protect yourself.
- Cover up - Wear long pants and shirts with sleeves. It can’t damage your skin if the sun can’t get to you.
- Wear a cap - Wear a hat with a 4-inch brim to protect your face and neck.
- Use a high-SPF sunscreen - If you are outside for any time, use sunscreen with an SPF of 15.
- Look for changes - growing, bleeding, crusting, or otherwise changing spots on your skin could indicate a problem.
- Make it routine - use a broad-spectrum sunscreen daily and start putting it on your kids at age six months.
- Reapply often - even waterproof sunscreens must be reapplied every 2 hours for maximum protection in the midday sun.
- Stay indoors - avoid the sun between 10 a.m. and 4 p.m., when its rays are strongest.
Safe-Sun Tips for Young and Old
Here are some sun-savvy tips from Steven E. Hodgkin, M.D., Medical Director, Aesthetic Skin & Laser Medical Center.
- Avoid reflective surfaces, such as sand or water, which can reflect up to 85 percent of the sun’s damaging rays.
- Make applying a broad-spectrum sunscreen with a minimum SPF of 15 as much a part of your year-round daily routine as brushing your teeth.
- Make sure there’s a tube of sunscreen in your car, golf bag, or backpack for last-minute sun activities.
- Reapply sunscreen every two hours after you’ve been in the sun or water - even if it claims to be “waterproof.”
- Check the UV Index in the morning paper, TV, or radio before you go out. Then take the necessary steps to stay sun-safe.
- If you’re in the sun and there’s shade nearby, stand under it. If there’s no shade, bring your own (i.e., a hat with a 4-inch brim).
- Wear sunglasses and tightly-woven protective clothing. Dark colors give more protection.
- Let the sunscreen dry on your skin for 20 to 30 minutes before going outside. It takes that long for the chemicals to start working; this also helps ensure that it stays on your skin where it belongs. And try to avoid being in the sun between 10 a.m. and 4 p.m.
- Put your sunscreen on yourself when you slather it on your kids. Not only will you also be protected, but you’ll be a good role model, too.
- Spread the word about sunscreens and the dangers of skin cancer to friends and family members. You could save a life!
- Sunscreens and other skin-care products (such as moisturizers) are real time-savers. Ensure that the product’s sunscreen has an SPF of at least 15.
Moles & Melanoma
Generally, an individual’s risk for developing melanoma depends on two groups of factors: intrinsic and environmental. Intrinsic factors are generally an individual’s family history and inherited genotype, while sun exposure is the most relevant environmental factor. Learn how to check for the warning signs of a potential melanoma and how they differ from normal moles.
It is one of the rarer types of skin cancer but causes most skin cancer-related deaths. Malignant melanoma is a severe type of skin cancer. It is due to the uncontrolled growth of pigment cells called melanocytes. Around 160,000 new cases of melanoma are diagnosed worldwide each year, and it is more frequent in males and Caucasians. It is more common in caucasian populations living in sunny climates than in other groups.
Generally, an individual’s risk for developing melanoma depends on two groups of factors: intrinsic and environmental. “Intrinsic” factors are generally an individual’s family history and inherited genotype, while sun exposure is the most relevant environmental factor. Epidemiologic studies suggest that exposure to ultraviolet radiation (UVA and UVB) is one of the major contributors to the development of melanoma. UV radiation causes damage to the DNA of cells, typically thymine dimerization, which when unrepaired can create mutations in the cell’s genes.
To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCDE” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.
A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:
Asymmetrical skin lesion.
Border of the lesion is irregular.
Color: melanomas usually have multiple colors.
Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
Evolving: any change -in size, shape, color, elevation, or any new symptom such as bleeding, itching, or crusting - points to danger.
Benign Malignant
Symmetrical Asymmetrical
Borders are even Borders are uneven
One shade, Two or more shades
Smaller than 1/4 inch Larger than 1/4
Skin Cancer Foundation (www.skincancer.org)
Minimizing exposure to sources of ultraviolet radiation (the sun and sunbeds), following sun protection measures, and wearing sun-protective clothing(long-sleeved shirts, long trousers, and broad-brimmed hats) can offer protection. In the past, it was recommended to use sunscreens with an SPF rating of 30 or higher on exposed areas as older sunscreen more effectively blocked UVA with higher SPF. New sunscreen ingredients (avobenzone, zinc, and titanium) effectively block both UVA and UVB, even at lower SPFs.
Moles that are irregular in color or shape are suspicious of a malignant or a premalignant melanoma. Following a visual examination and a dermatoscopic exam used routinely by one in 4 dermatologists in the United States or an examination using other in vivo diagnostic tools, such as a confocal microscope, the doctor may biopsy the suspicious mole. If it is malignant, the mole and an area around it need excision.
The diagnosis of melanoma requires experience, as the early stages may look identical to harmless moles or not have any color at all. A skin biopsy performed under local anesthesia is often required to assist in making or confirming the diagnosis and in defining the severity of the melanoma. Amelanotic melanomas and melanomas arising in fair-skinned individuals are very difficult to detect as they fail to show many of the characteristics in the ABCDE rule. These melanomas are often light brown or pink in color - and very hard to distinguish from acne scarring, insect bites, dermatofibromas, or lentigines. There is no blood test for detecting melanomas.
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here https://www.openpaymentsdata.cms.gov. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.