Skin Cancer Awareness Month: Prevention & Facts

May is Skin Cancer Awareness Month. With over 5 million cases of skin cancer diagnosed in the United States each year, skin cancer is found to be the most common type of cancer within the United States. Fortunately, skin cancer is also one of the most preventable forms of cancer. 

Approximately 90% of nonmelanoma skin cancers and 85% of melanoma cases are associated with exposure to ultraviolet radiation from the sun. By raising awareness of the dangers of unprotected exposure and encouraging sun-safe habits, behaviors can be changed and lives can be saved. 

With the incidence of this disease reaching epidemic levels, it's become imperative to talk about the facts of skin cancer, and how to prevent this far too common disease.

Skin Cancer: The Basics

How Does Cancer Occur?

Cancer occurs when normal cells undergo a transformation and grow and multiply without normal controls. As the cells multiply, they form a mass called a tumor. Tumors are only cancerous if they are malignant. This means that the tumors encroach on and invade neighboring tissues - especially lymph nodes - because of their uncontrolled growth. 

Tumors may also travel to remote organs via the bloodstream. This process of invading and spreading to other organs is called metastasis. Tumors overwhelm surrounding tissues by invading their space and by taking the nutrients they need to survive and function. 

There are 3 major types of skin cancers: 

• Basal Cell Carcinoma
• Squamous Cell Carcinoma
• Melanoma

The first 2 skin cancers are grouped together as non-melanoma skin cancers. Other unusual types of skin cancer include Merkel cell tumors and Dermatofibrosarcoma Protuberans. 

The vast majority of skin cancers are basal cell carcinomas and squamous cell carcinomas. While malignant, these are unlikely to spread to other parts of the body. They may be locally disfiguring if not treated early.

A small, but significant number of skin cancers are malignant melanomas. Malignant melanoma is a highly aggressive cancer that tends to spread to other parts of the body. These cancers may be fatal if not treated early.

Like many cancers, skin cancers begin as precancerous lesions. These precancerous lesions are changes in skin that are not cancer, but could become cancer over time. Doctors often refer to these changes as dysplasia. Some specific dysplastic changes that occur in the skin are:

• Actinic Keratosis: an area of red or brown, scaly, rough skin, which can develop into squamous cell carcinoma.
• Moles: are simply growths on the skin that rarely develop into cancer. Most people have 10 to 30 moles on their body that can be identified as flat or raised, smooth on the surface, round or oval in shape, pink, tan, brown or skin colored, and no larger than a quarter inch across. If a mole on your body looks different from others, ask your health care professional to look at it.
• Dysplastic Nevi: or abnormal moles. They aren't cancer, but can become cancer. People can sometimes have as many as 100 or more dysplastic nevi, which are usually irregular in shape, with notched or fading borders. Some may be flat or raised, and the surface may be smooth or rough. They are often large, at a quarter inch across or larger, and are typically of mixed color, including pink, red, tan, and brown.   

Recent studies have shown that the number of skin cancer cases in the United States is growing at an alarming rate. Fortunately, increased awareness on the part of Americans and their health care providers has resulted in earlier diagnosis and improved outcomes. 

The Causes of Skin Cancer

Ultraviolent light exposure, most commonly from sunlight, is overwhelmingly the most frequent cause of skin cancer. Other important causes of skin cancer include:

• Tanning beds/booths
• Immunosuppression, or impairment of the immune system, which protects the body from germs or substances that cause an allergic reaction.
• Exposure to unusually high levels of radiation, such as from X-rays.
• Contact with certain chemicals, such as arsenic and hydrocarbons in tar, oils, and soot. 

The following individuals are at the greatest risk of skin cancer: 

• People with fair skin, especially types that freckle, sunburn easily, or become painful in the sun. 
• People with light hair and blue or green eyes.
• Those with certain genetic disorders that deplete skin pigment, such as albinism and xeroderma pigmentosum.
• People who have already been treated for skin cancer.
• People with numerous moles, unusual moles, or large moles that were present at birth.
• People with close family members who have developed skin cancer.
• People who had at least 1 severe sunburn early in life.
• People with burns unrelated to sunburn. 
• People with indoor occupations and outdoor recreational habits.

Basal cell carcinomas and squamous cell carcinomas are more common in older people. Melanomas are one of the most common cancers in younger people, especially in those ages 25 to 29. The risk of melanoma increases with age. 

Skin Cancer Symptoms

Skin cancer symptoms depend on the type of skin cancer that has developed. A basal cell carcinoma usually looks like a raised, smooth, pearly bump on the sun exposed skin of the head, neck, or shoulders. Other signs include:

• Small blood vessels may be visible within the tumor.
• A central depression with crusting and bleeding frequently develops.
• A basal cell carcinoma often appears as a sore that doesn't heal.

A squamous cell carcinoma is commonly a well defined, red, scaling, thickened bump on sun exposed skin. It may ulcerate and bleed, and left untreated, it may develop into a large mass. 

The majority of malignant or cancerous melanomas are brown to black pigmented lesions. Other signs of a cancerous melanoma are:

• A change in size, shape, color, or elevation of a mole. 
• The appearance of a new mole during adulthood, or new pain, itching, ulceration, or bleeding of an existing mole.

The following is an easy to remember guideline "ABCDE", and is useful for identifying malignant melanoma. 

• Asymmetry: 1 side of the lesion doesn't look like the other.
• Border Irregularity: Margins may be notched or irregular.
• Color: Melanomas are often a mixture of black, brown, blue, red, or white.
• Diameter: Cancerous lesions can be larger than 6 mm across, typically the size of a pencil eraser. With early detection, they will not reach this size. 
• Evolution: Has the mole changed over time?

Many people, especially those who have fair coloring or have had extensive sun exposure, periodically should check their bodies for suspicious moles and lesions. Have your primary health care doctor, or a dermatologist check any moles or spots that concern you. See your doctor if you notice any changes in the size, shape, color, or texture of pigmented areas. 

Exams & Tests for Skin Cancer

If you think that a mole or other skin lesion has turned into skin cancer, your primary care doctor will most likely refer you to a dermatologist. The dermatologist will examine any moles in question, as well as the entire skin surface. Any lesions that are difficult to identify, or are thought to be skin cancer may then be checked. Tests for skin cancer include:

• The doctor may use a dermatoscope to scan the lesion. Another handheld device, MalaFind, scans the lesion, then a computer program evaluates images of the lesion to indicate if it's cancerous.  
• A biopsy of the skin will be taken so that the suspicious area can be examined under a microscope.
• If a biopsy shows that you have malignant melanoma, you may undergo further testing to determine the extent of the spread of the disease, if any. This may involve blood tests, a chest x-ray, and other tests as needed. This is only required if the melanoma is of a certain size. 

Treatment for Skin Cancer

Surgical removal of the lesion is usually adequate for basal cell carcinoma and squamous cell carcinoma. Malignant Melanoma, however, may require several treatment methods - depending on the size of the tumor. Treatment for malignant melanoma include: surgery, radiation therapy, immunotherapy, and chemotherapy. Due to the complexity of treatment decisions, people with malignant melanoma may benefit from the combined expertise of the dermatologist, a cancer surgeon, and an oncologist. 

Most skin cancer is cured surgically in the dermatologist's office. Of skin cancers that do recur, most do so within 3 years. Therefore, follow up with your dermatologist as recommended. 

If you have advanced malignant melanoma, your oncologist may want to see you every few months. These visits may include total body skin exams, regional lymph node checks, and periodic x-rays and body scans. 

Skin Cancer Prevention

You can reduce your risk of getting skin cancer by following these guidelines:

• Limit sun exposure. Attempt to avoid the sun's intense rays between 10am and 4pm.
• Apply sunscreen every day. Use a sunscreen with sun protection factor (SPF) of at least 30, both before and every 60 to 80 minutes during outdoor exposure. Select products that filter both UVA and UVB light.
• If you are likely to sunburn, wear a long sleeved shirt, pants and a wide brimmed hat.
• Avoid artificial tanning booths.
• Conduct monthly self exams. The best time to do these is right after a shower or bath, using a full length mirror and a hand held mirror in a bright room.   

PLEASE CONSULT A QUALIFIED HEALTH CARE PROFESSIONAL BEFORE BEGINNING ANY MEDICATION, TAKING ANY SUPPLEMENTS, OR BEGINNING A NEW HEALTH REGIMEN.