Skin Cancer

The dangers of skin cancers and melanoma are well known but often ignored. Because 40 to 50 percent of Americans who live to age 65 will be diagnosed with a non-melanoma skin cancer at least once here are the facts.

This information is provided for a better understanding of the disease and does not replace the dialogue you should have with your physician regarding screening and treatment for skin cancer and melanoma.

What is the skin?

The skin is the largest organ of the body. It covers the internal organs and protects them from injury, serves as a barrier to germs such as bacteria, and helps prevent fluid loss. The skin helps control body temperature and gets rid of certain body wastes. Cells in the skin communicate with the brain and allow temperature, touch, and pain sensations.

How many people get skin cancer?

Skin cancer is the most common of all cancers. It accounts for nearly half of all cancers in the United States. More than 3.5 million cases of basal and squamous cell skin cancer are diagnosed in this country each year. Melanoma, the most serious type of skin cancer, will account for about 74,000 cases of skin cancer in 2015.

Adapted from Mayo Clinic.org, Cancer.org, SkinCancer.org, epa.gov/sunwise/statefacts.html, AimAtMelanoma.org and Melanoma.org

The following information is provided for a better understanding of the disease and does not replace the conversation you should have with your physician regarding screening and treatment for cancer.

Skin Cancer - Types

The two most common types of skin cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) can become disfiguring and even deadly if not diagnosed and treated promptly.

“Melanoma is the most talked about skin cancer because it’s the most deadly; however, basal and squamous cell carcinomas should be taken seriously as well,” says Perry Robins, MD, and President of The Skin Cancer Foundation. “Most non-melanoma skin cancers are preventable, if a complete sun protection regimen is followed. This is why protecting sun-exposed areas, such as the ears, nose and lips, and learning the warning signs of these common skin cancers, is so important.”

Basal Cell Carcinoma

Basal Cell Carcinoma is the most common form of skin cancer, with an estimated 2.8 million diagnosed annually in the US. BBC is caused by a combination of cumulative UV exposure and intense, occasional UV exposure, the kind one might experience when those of us living in the north visit sunny vacation spots. It can resemble noncancerous skin conditions such as psoriasis or eczema. Left untreated it may include an open sore, a reddish patch or irritated area, a shiny bump or nodule, a pink growth, and a scar-like area.

Squamous Cell Carcinoma

Squamous Cell Carcinoma is the second most common form of skin cancer, with an estimated 700,000 cases diagnosed in the US each year, resulting in approximately 2,500 deaths. It’s usually caused by cumulative UV exposure over the course of a lifetime. Find it on areas of the body frequently exposed to the sun, such as the rim of the ear, lower lip, face, bald scalp, neck, hands, arms and legs. A scaly red patch, an elevated growth, an open sore, or a wart-like growth, that may sometimes bleed is an indicator of SCC, squamous cell carcinoma.

Other types of skin cancer

There are a few rare types of skin cancer such as keratoacanthomas, Merkel cell carcinoma, skin lymphoma, Kaposi sarcoma, skin adnexal tumors, and sarcomas. These are all non-melanoma types. Find out more about these and other non-melanoma cancers here.

Adapted from Mayo Clinic.org, Cancer.org, The Skin Cancer Foundation at SkinCancer.org, epa.gov/sunwise/statefacts.html, AimAtMelanoma.org and Melanoma.org

Skin Cancer - Melanoma

Melanoma is a cancer that begins in the melanocytes – the cells that produce the skin coloring or pigment known as melanin. Melanin helps protect the deeper layers of the skin from the harmful effects of the sun.

Melanoma is almost always curable when it is found in its very early stages. Although melanoma accounts for only a small percentage of skin cancer, it’s far more dangerous than other skin cancers and causes most skin cancer deaths. Melanoma will account for more than 76,600 cases of invasive skin cancer in 2013. It accounts for more than 9,000 of the 12,000-plus skin cancer deaths each year.

Although researchers have found some things that can raise a person’s risk of melanoma, it’s not yet clear exactly how these factors cause melanoma. A risk factor is anything that affects your chance of getting a disease such as cancer. And risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And some people who get the disease may have few or no known risk factors.

Scientists have found several risk factors that could make a person more likely to develop melanoma.

The Ultraviolet (UV) Light Exposure Connection

Ultraviolet (UV) radiation is a major risk factor for most melanomas. Sunlight is the main source of UV rays. Tanning lamps and beds are also sources of UV rays. People who get a lot of exposure to light from these sources are at greater risk for skin cancer, including melanoma. Ultraviolet radiation is divided into 3 wavelength ranges:

  • UVA rays cause cells to age and can cause some damage to cells' DNA. They are linked to long-term skin damage such as wrinkles, but are also thought to play a role in some skin cancers.
  • UVB rays can cause direct damage to the DNA, and are the main rays that cause sunburns. They are also thought to cause most skin cancers.
  • UVC rays don’t get through our atmosphere and therefore are not present in sunlight. They do not normally cause skin cancer.

While UVA and UVB rays make up only a very small portion of the sun’s rays, they are the main cause of the damaging effects of the sun on the skin. Based on what is known today, there are no safe UV rays. The amount of UV exposure a person gets depends on the strength of the rays, the length of time the skin is exposed, and whether the skin is protected with clothing or sunscreen.

The nature of UV exposure may play a role in melanoma development. Many studies have linked the development of melanoma on the trunk (chest and back) and legs to frequent sunburns (especially in childhood). The fact that these areas are not constantly exposed to UV light may also be important. Some experts think that melanomas in these areas are different from those on the face and neck, where the sun exposure is more constant. And different from either of these are melanomas that develop on the palms of the hands, soles of the feet, under the nails, or on internal surfaces such as the mouth and vagina, where there has been little or no sun exposure.

Other Causes

Moles - Some moles appear during our lifetime, some are present at birth. Sometimes a mole will develop cancer. Called Nevus, most moles never become cancerous. People with a close relative that have developed melanoma and who have a large number of moles, are more likely to develop melanoma. People with these two factors should have regular consultations with their dermatologist.

Predisposition: Those with Fair Skin, Freckling, and Light Hair - The risk of melanoma is more than 10 times higher for Caucasians than for African Americans. People of European descent with red or blond hair, blue or green eyes, or fair skin that freckles or burns easily are at increased risk.

Family History - Your risk is greater if one or more parent, brother, sister, or child has had melanoma. About 10% of all people with melanoma have a family history of the disease. Shared family lifestyle of frequent sun exposure, a family tendency to have fair skin, or a combination of factors may be responsible in part. It may also be due to gene changes (mutations) that run in a family. Gene mutations have been found in anywhere from about 10% to 40% of families with a high rate of melanoma.

Personal History - If you’ve had melanoma before, you’re more likely to have it again.

Immune Suppression - People who have been treated with medicines that severely suppress the immune system, such as organ transplant patients, have an increased risk of melanoma.

Xeroderma pigmentosum - XP is a rare, inherited condition resulting from a defect in an enzyme that normally repairs damage to DNA leading to development of cancers on sun-exposed areas of their skin.

Adapted from Mayo Clinic.org, Cancer.org, The Skin Cancer Foundation at SkinCancer.org, epa.gov/sunwise/statefacts.html, AimAtMelanoma.org and Melanoma.org

Skin Cancer - Treating Melanoma

Treatment is varied depending upon the stage of the disease. Treatment may include excision, drug treatments such as interferon, chemotherapy, radiation therapy, immunotherapy, biochemotherapy.

Awareness

Avoid exposing unprotected skin to sources of UV light. The sun, tanning beds, and sun lamps damage skin.

The skin burns on hazy or cloudy days. As much as 90 percent of UV rays pass through clouds. UV rays can also reflect off snow, ice, sand, water and other reflective surfaces, burning skin as severely as direct sunlight.

Non-steroidal anti-inflammatories (NSAIDs) like Ibuprofen (Advil and Motrin) and Naproxen (Aleve) make one extra sensitive to the sun. If such medications are used, extra vigilance about protecting skin is recommended.

Adapted from Mayo Clinic.org, Cancer.org, The Skin Cancer Foundation at SkinCancer.org, epa.gov/sunwise/statefacts.html, AimAtMelanoma.org and Melanoma.org

Skin Cancer - Protection

  • Seek the shade, especially between 10 AM and 4 PM.
  • Do not burn.
  • Avoid tanning and UV tanning booths.
  • Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
  • Examine your skin head-to-toe every month.

Follow the Slip! Slop! Slap!® and Wrap! Rules:

Slip on a shirt: Cover up with protective clothing to guard as much skin as possible when you are out in the sun. Choose comfortable clothes made of tightly woven or treated fabrics that you cannot see through when held up to a light.

Slop on sunscreen: Use sunscreen and lip balm with broad spectrum protection and a sun protection factor (SPF) of 30 or higher. Apply a generous amount of sunscreen (about a palmful or 2 tablespoons) to unprotected skin at least 30 minutes before outdoor activities. Reapply every 2 hours and after swimming, toweling dry, or sweating. Use sunscreen even on hazy or overcast days.

Slap on a hat: Cover your head with a wide-brimmed hat, shading your face, ears, and neck. If you choose a baseball cap, remember to protect your ears and neck with sunscreen.

Wrap on sunglasses: Wear sunglasses with 100% UVA and UVB absorption to provide optimal protection for the eyes and the surrounding skin.

Sunscreen doesn’t protect from all UV rays, so don’t use sunscreen as a way to stay out in the sun longer.
Follow these practices to protect your skin even on cloudy or overcast days. UV rays travel through clouds.
The Foundation recommends every individual see their physician every year for a professional skin exam.
Play it Safe in the Sun. The Skin Cancer Foundation asked athletes who are uniquely qualified to advise readers - they're also dermatologists. Here is their advice for those who want to get the most out of the sporting life, without risking sun damage and skin cancer.

Golf

Steven M. Rotter, MD, is an avid golfer. A particular sun hazard for golfers, he said, is added ultraviolet (UV) radiation intensity due to reflection from ponds and sand traps (which can bounce back 80 percent or more of the sun's UV rays so that they hit golfers' skin twice). On the links, Rotter uses a sport sunscreen formula that doesn't run and irritate his eyes, and reapplies it every "nine holes, or every two hours." He also noted that, while hats are important to shield the face (one of the most common sites for non-melanoma skin cancers), they are not a substitute for sunscreen, and not all headgear is created equal: "You need a broad-brimmed hat. Baseball hats don't protect the back of your neck or shoulders." A hat with a 3-inch brim all around protects not just the face and top of the head, but also the neck, shoulders, and ears. Rotter was especially adamant about the latter: "Put sunscreen on your ears. People always forget that!"

Running

"It's important to realize that the sun's damaging rays are present year-round," said Elizabeth K. Hale, MD, who has completed the New York City Marathon - twice. Up to about 80 percent of the sun's ultraviolet radiation can penetrate clouds and fog, so protection is necessary even when it's overcast, she noted.
For Hale, "Protective clothing and hats are the most important first step, since with heavy perspiration, sunscreen products can rub off and lose their effectiveness." Hale looks for clothing with a UPF (ultraviolet protection factor) label, which indicates how much of the sun's ultraviolet radiation will be absorbed by the fabric. A shirt with a UPF of 30, for instance, allows just 1/30th of the sun's UV radiation to reach your skin. (The Skin Cancer Foundation recommends clothes with a UPF of 30 or higher.) Hale is a fan of Coolibar's line of sun-protective clothing, which offers UPFs of up to 50+. She also looks for breathable fabrics that help runners avoid overheating and likes Nike's DriFIT technology.
Additionally, said Hale, "It's important to pick a sunscreen that offers UVA and UVB protection. Runners should look for a sunscreen that is sweat-resistant and won't sting if it gets into the eyes - I like Coppertone Sport, for example, which has been tested on athletes."

Sailing

Andrew A. Hendricks, MD, says sailors face particular danger from extra UV exposure due to reflection off the water. "Sailors are encouraged to apply liberal amounts of sunscreen and to repeat application during the day, since medical care (for serious sunburn) is limited on the open water," said Hendricks. "We prefer the newer sunscreens that use micronized particles (for example, Vanicream). In these products (considered 'physical' sunscreens because they block or reflect rather than chemically absorb UV), zinc oxide and titanium dioxide - two of the best UVA-UVB physical sunscreen ingredients - offer better sun protection." Hendricks recommends supplies of extra sunscreen, since "sudden rain storms will wash off sunscreen, so repeat application is necessary. We encourage the crew to wear hooded sweatshirts and rain gear." These protect against not just the rain but also the sun.

Tennis

Amy Amonette Huber, MD, has been playing tennis for years and recommends physical sunscreens: "Zinc oxide tends to stay on better despite sweat or rubbing. I use zinc oxide (Vanicream 30 or 60 SPF) on my face and then I use one of the SPF 30 or 50 spray preparations (Coppertone Sport, for example) on other exposed areas: It's convenient and less messy to put on. It's also very important to protect the lips." Huber chooses a lip balm with an SPF of at least 30.

Adapted from Mayo Clinic.org, Cancer.org, The Skin Cancer Foundation at SkinCancer.org, epa.gov/sunwise/statefacts.html, AimAtMelanoma.org and Melanoma.org