Skin Cancer
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Skin cancer is the most prevalent of all types of cancers. It is estimated that more than one million Americans develop skin cancer every year.
Fair-skinned people who sunburn easily are at a particularly high risk for developing skin cancer. Other less important factors include repeated medical and industrial x-ray exposure, scarring from diseases or burns, occupational exposure to compounds such as coal tar and arsenic, and family history.
Actinic Keratoses (AK)
Actinic keratoses or solar keratoses are considered the earliest stage in the development of skin cancer. They are small, scaly spots most commonly found on the face, ears, neck, lower arms, and back of the hands in fair-skinned individuals who have had significant sun exposure. Actinic keratoses can be treated by cryotherapy (freezing), topical chemotherapy (applying a cream or lotion), chemical peeling, dermabrasion, laser surgery, curettage, photodynamic therapy (a chemical is applied to the skin prior to exposure to a light source), or other dermatologic surgical procedures. Some actinic keratoses may progress to advanced stages which require more extensive treatment. Proper use of sunscreens can help prevent actinic keratoses even after extensive sun damage has already occurred.
Basal Cell Carcinoma (BCC)
Basal cell carcinoma is the most common type of skin cancer and appears frequently on the head, neck, and hands as a small, fleshy bump, nodule, or red patch. Other parts of the body may be affected as well. Basal cell carcinomas are frequently found in fair-skinned people and rarely occur in dark skin. They usually do not grow quickly. It can take many months or years for one to grow to a diameter of one-half inch. Untreated, the cancer often will begin to bleed, crust over, heal, and repeat the cycle, and can extend below the skin to the bone and nerves, causing considerable local damage.
Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma is the second most common skin cancer; it is primarily found in fair-skinned people and rarely in dark-skinned individuals. Typically located on the rim of the ear, the face, lips, and mouth, this cancer may appear as a bump, or as a red, scaly patch. SCC can develop into large masses and become invasive. Unlike basal cell carcinoma, this form of cancer can metastasize (spread to other parts of the body); therefore, it is important to get early treatment.
When found early and treated properly, the cure rate for both basal cell and squamous cell carcinomas is over 95 percent.
Malignant Melanoma
Malignant Melanoma is the most deadly of all skin cancers. Every year, an estimated 8,000 Americans will die from melanoma; it is projected that greater than 108,000 Americans will develop melanoma annually. The death rate is declining because melanoma is usually curable when detected in its early stages and patients are seeking help sooner.
Melanoma begins in melanocytes, the skin cells that produce the dark protective pigment called melanin which makes the skin tan. Since melanoma cells usually continue to produce melanin, the cancer appears in mixed shades of tan, brown, and black; although, it can also be red or white. Melanoma can metastasize (spread), making treatment essential.
Melanoma may appear suddenly or begin in or near a mole, or another dark spot in the skin. It is important to know the location and appearance of the moles on the body to detect changes early. Any changing mole must be examined by a dermatologist. Early melanoma can be removed while still in the curable stage.
Excessive sun exposure, especially sunburn, is the most important preventable cause of melanoma. Light-skinned individuals are at particular risk. Heredity also plays a part. A person has an increased chance of developing melanoma if a relative or close family member has had melanoma. Atypical moles, which may run in families, and a large number of moles, can serve as markers for people at increased risk for developing melanoma.
Dark skin is not a guarantee against melanoma. People with skin of color can develop melanoma, especially on the palms, soles, under the nails, in the mouth, or on the genitalia.
The ABCDEs of Melanoma
Consult a dermatologist immediately if any of your moles or pigmented spots exhibit:
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A stands for ASYMMETRY; one half unlike the other half. |
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B stands for BORDER; irregular, scalloped or poorly defined border. |
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C stands for COLOR; varied from one area to another; shades of tan and brown, black; sometimes white, red or blue. |
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D stands for DIAMETER; while melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller.. |
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E stands for EVOLVING; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color. |
Warning signs of melanoma include:
- Changes in the surface of a mole.
- Scaliness, oozing, bleeding, or the appearance of a new bump.
- Spread of pigment from the border of a mole into surrounding skin.
- Change in sensation including itchiness, tenderness, or pain.
Treatment of Skin Cancer
If a skin biopsy reveals cancer, the dermatologist has an array of medical and surgical procedures as treatment, depending upon the type of cancer, its location, and the needs of the individual.
Dermatologic surgical treatments include: surgical excision; electrodessication and curettage (ED&C), which involves alternately scraping or burning the tumor in combination with low levels of electricity; cryosurgery (freezing using liquid nitrogen); and laser surgery. Mohs micrographic surgery is a special procedure used to remove the whole tumor while sparing as much normal skin as possible.
Other dermatologic treatments include radiation therapy and photodynamic therapy (a chemical is applied to the skin prior to exposure to a light source). Topical chemotherapy products may also be used.
Early Detection is the Surest Way to a Cure
Develop a regular routine to inspect your body for any skin changes. If a growth, mole, sore, or skin discoloration appears suddenly, or begins to change, see a dermatologist. It is wise to have an annual skin examination by a dermatologist, especially for adults with significant past sun exposure or a family history of skin cancer.
HOW TO PROTECT YOURSELF FROM ULTRAVIOLET LIGHT
Sun exposure is the most preventable risk factor for all skin cancers, including melanoma.[1],[2] You can have fun in the sun and decrease your risk of skin cancer. Here's how to Be Sun SmartSM:
- Generously apply a water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays to all exposed skin. Re-apply every two hours, even on cloudy days, and after swimming or sweating. Look for the AAD SEAL OF RECOGNITIONTM on products that meet these criteria.
- Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
- Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
- Protect children from sun exposure by playing in the shade, using protective clothing and applying sunscreen.
- Use extra caution near water, snow and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
- Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.[3]
- Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
- Check your birthday suit on your birthday. If you notice anything changing, growing or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
[1] American Cancer Society. 2008 Cancer Facts and Figures. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
[2} Robinson, JK. Sun Exposure, Sun Protection and Vitamin D. JAMA 2005; 294: 1541-43.
[3] Hemminki K, Dong C. Subsequent cancers after in situ and invasive squamous cell carcinoma of the skin. Arch Dermatol 2000;136:647-51.
PERIODIC SELF-EXAMINATION - Early detection and removal offer the best chance for a cure. Periodic self-examinations aid in recognition of any new or developing lesion. Get familiar with your skin and your own pattern of moles, freckles, and “beauty marks.” Make sure to look at the entire body every month or two. Watch for changes in the number, size, shape, and color of pigmented areas. Consult a dermatologist promptly if any changes are noticed. Individuals at high risk should be examined by a dermatologist on a regular basis. It is beneficial to get assistance from a partner in performing skin self exams.
1. Examine body front and back in mirror, then right and left sides, arms raised.
2. Bend elbows, look carefully at forearms, back of upper arms, and palms.
3. Next, look at backs of legs and feet, spaces between toes, and soles.
4. Examine back of neck and scalp with a hand mirror. Part hair to lift.
5. Finally, check back and buttocks with a hand mirror.
To learn more about skin cancer, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
Toll-free: (888) 462-DERM (3376)
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2007 American Academy of Dermatology
Revised 2001, 2003, 2005, 2007
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