About 10 years ago, lactation expert and blogger Leigh Anne O’Connor had a pearly looking, slightly raised area on her chest. Concerned, she asked a client of hers—who happened to be a dermatologist—what she thought about it. “She thought it was suspicious and suggested I see my dermatologist,” O’Connor says. It turned out that the raised area was squamous cell carcinoma, a cancer that occurs in one of the upper layers of the epidermis, so she had it removed. Since then, O’Connor has had other cancers removed. She’s had surgery to remove a cancer on her face, and she’s currently waiting for the results of a biopsy on her nose. “I was glad to know that I picked up on something I knew was not right. I was not surprised, as my parents and my older brother have all had skin cancers removed,” she says. According to the American Cancer Society, skin cancer is the most commonly diagnosed cancer in the United States. An estimated 5.4 million cases of non-melanoma skin cancer were diagnosed among 3.3 million people in 2012 alone. Research also indicates that most of these cases can be prevented by avoiding excessive exposure to the sun. With summer just around the corner, it’s imperative that we all learn about detecting and preventing skin cancer so that we can keep ourselves and our loved ones safe.
What are the different types of skin cancer?
According to the National Cancer Institute, the three most common kinds of skin cancer are squamous cell carcinoma, basal cell carcinoma, and melanoma. The epidermis is the outermost layer of skin and consists of many layers of cells. Squamous cells are closer to the skin’s surface, followed by the basal cells. In the deepest part of the epidermis are melanocytes, cells that make melanin, which is responsible for the pigments of our skin. Cancer can occur in any three of these skin cells. The most common kinds of skin cancer are squamous cell carcinoma and basal cell carcinoma. These forms of skin cancer are also called non-melanoma cancers. Melanoma spreads faster than squamous or basal cell carcinoma. Because the melanocytes are deeper, melanoma can easily spread to other tissues and cause cancer in other parts of the body. Another form of skin cancer is Merkel cell carcinoma, which is a rare, fast-spreading, aggressive form of skin cancer. Merkel cell carcinoma is often linked to immune suppression and to excessive exposure to ultraviolet (UV) light; it occurs more frequently in people with conditions like HIV or leukemia and people over age 50 or who have had organ transplants.
What are the early signs of skin cancer?
The most obvious sign of skin cancer is a strange-looking spot or mole on your skin. “If you find something suspicious on your skin—growing, bleeding, not healing, tender, scabbed, or crusted—see a dermatologist right away. If you have skin cancer, the best thing to do is to diagnose and treat it as early as possible,” says Caroline A. Chang, MD, FAAD, clinical assistant professor of dermatology at Alpert Medical School of Brown University. Frequently checking your own skin for strange marks is a great way to detect skin cancer at an early stage. But how can you perform a self-check? We spoke to Keira Barr, MD, a dual board-certified dermatologist, founder of the Resilient Health Institute, and author of The Skin Whisperer. Although you’re most likely to get skin cancer on the places that are frequently exposed to the sun, like your face, neck, arms, and trunk, you should still check absolutely everywhere—even in your private areas, says Barr. “My best advice is to get naked!” she says. “The only way to examine your skin is to see it. All of it. Don’t be modest; have fun with it.” She suggests checking your skin once a month from top to toe. “Look in all your nooks and crannies: mouth, armpits, belly button, nails, and between your fingers, toes and bottoms of your feet. Recruit help for places you can’t easily see like your scalp, eyelids, and oral cavity. Ask a trusted friend, hairdresser, doctor, or dentist,” she says. Not sure what to look out for? Barr recommends using the “ABCDE” method for assessing spots, moles, and sores:
A is for asymmetry.
Harmless spots are typically symmetrical. If one half of your spot doesn’t match the other half, this could be a red flag.
B is for border.
“You are looking for spots that have a poorly defined border,” says Barr. If your spot has a jagged, blurry, or irregular border, make a note of it and show a dermatologist.
C is for color.
If the color of the spot isn’t the same all over, it should be seen by a dermatologist.
D is for diameter.
If a spot is larger than 5 mm in diameter, it might be cause for concern. Barr says this is a soft call, however. “If your spot meets any of the above criteria, ignore the size and get it checked out,” she advises.
E is for evolving.
If a spot changes over time, get it checked out. “This logic also applies for sores that aren’t healing in a time frame typical for your body and/or a sore or red, scaly spot that recurs in the same spot time and time again,” Barr adds. Of course, if your spot fits any of the above criteria, it doesn’t necessarily mean it’s skin cancer, but it’s still crucial that you see a dermatologist. If you find something strange, O’Connor encourages you to seek help as soon as possible. “Do not be afraid. A small area cut off early will likely not scar much if at all. The longer you wait the larger the cancer can grow,” she says. Fortunately, skin cancer can be treated effectively.
What are the treatment options for skin cancer?
“There are many options for skin cancer, including surgical and non-surgical options,” says Barry Goldman, MD, a dermatologist and a clinical instructor at Cornell NY Presbyterian Hospital. “Most skin cancers are typically removed under local anesthesia in the doctor’s office,” Goldman says. An example of this is Mohs surgery, which O’Connor had on a facial cancer. This procedure is commonly used to remove non-melanoma skin cancers, and it typically scars very little. Mohs surgery is often used for cancers on the face or for cancers that are large, rapidly growing, or recurring. Although doctors have seen promising results using Mohs surgery for some melanomas, depending on the nature (size, depth, etc.) of the melanoma, more extensive surgery is often necessary. When it comes to small skin cancers, Goldman says that certain topical creams can be prescribed to halt the carcinoma. This could include topical chemotherapy. Other potential treatment options include photodynamic therapy, which uses lasers; cryotherapy, which uses liquid nitrogen to freeze off the cancer; and electrodessication and curettage, in which the cancer is physically removed using special equipment. “Radiation therapy is another option, particularly for an elderly patient who may have a hard time with surgery,” Goldman adds. The course of treatment will be decided by your dermatologist, who will take into consideration your general health, the type of cancer you have, the size of the cancer, and whether it has spread. Most of the time, a basal or squamous cell skin cancer won’t come back after it’s been removed, but a small percentage of people with skin cancer have recurring cancers. This is why people who have had skin cancer are advised to frequently check their skin, visit their dermatologist for regular exams, and avoid excessive exposure to the sun. Other than experiencing the physical, tangible symptoms of skin cancer, a skin cancer survivor and their loved ones might also experience psychological distress. This is totally normal, and it’s advisable to attend skin cancer support groups or speak to a therapist to help you through this stressful time. Online forums and cancer support hotlines could be another avenue for finding support.
How can skin cancer be prevented?
We know that limiting your time in the sun is imperative when it comes to skin cancer prevention, but what else can you do to keep yourselves and your loved ones from getting skin cancer? To reduce your risk, you want to minimize your exposure to UV rays. Primarily found in sunlight, UV rays can damage your skin cells’ DNA directly. This can cause sunburn as well as skin cancer. Research tells us that UV rays are stronger between 10 a.m. and 4 p.m., during spring and summer, and when you’re situated closer to the equator. If you’ve had skin cancer before, or if you have a family history of skin cancer, it’s even more important to protect yourself from the sun because those are risk factors. If you have to be in the sun, wear sunscreen, try to stay in a shady spot, and wear protective clothing and sunglasses. Chang suggests reapplying sunscreen every one to two hours. Although sunscreen can’t block out all of the UV rays, it can filter it. Chang also suggests wearing sun-protective clothing, which usually has a built-in UPF (UV protection factor) of 50. Since children tend to spend more time outdoors, especially during the summer, it’s essential that you teach the little ones in your life about protecting themselves from the sun. When they’re very young, try to limit their time in the sun. And when they are outdoors, apply sunscreen regularly—especially if they are swimming or sweating. As they grow older, remind them to apply sunscreen themselves, wear protective clothing, and reduce their sun exposure during peak hours.Although fair-skinned people are more likely to get skin cancer, anybody can get it. The American Cancer Society points out that the pigment melanin, which helps protect the skin from UV rays, is also involved in the tanning process. When you suntan, it’s melanin that turns your skin darker. So people with more melanin will have darker skin, and they’ll be better protected from UV rays. But Chang says that this doesn’t mean that people with dark skin or people who tan easily are immune from getting skin cancer. It’s imperative that everyone uses caution when exposed to the sun’s UV rays. When it comes to vitamin D, a little sun every so often is enough to give your body the vitamin D it needs, says Goldman: “20 minutes of sun on your arms is typically all a person needs to get vitamin D production going. As a dermatologist, I would rather get a little every day than compress sun exposure into multiple hours in one day. A lot of dermatologists feel that a few bad sunburns is a bigger risk factor for melanoma than mild chronic exposure,” he explains. It can also be helpful to take topical and/or oral antioxidants such as vitamin C–enriched lotion or the oral supplement Heliocare, Chang says. “The effects of UV light have been shown to continue to damage your DNA even hours after sun exposure, so using an antioxidant lotion or taking antioxidant pills can be helpful in blocking the UV damage,” she notes. Goldman personally does not recommend dietary changes to prevent skin cancer, although some dermatologists do. “With regards to dietary changes, the available medical studies tend to be small and conflicting,” he says. “Since UV light causes skin cancer in part by oxidation, some dermatologists recommend a diet high in vitamins C, E, and A; zinc; selenium; beta carotene (carotenoids); omega-3 fatty acids; lycopene; and polyphenols. However, when taken in isolation, these antioxidants have not been shown to prevent skin cancer, and high doses can be toxic,” Goldman explains. Chang says that it’s also important to avoid tanning beds. The American Cancer Society points out that tanning beds and tanning lamps give off large amounts of potentially cancer-causing UV rays. Although skin cancer is serious, most forms are easy to treat, especially if they’re detected early. While you’re soaking up the sun this summer, be sure to protect yourself from harmful UV rays and keep an eye on your skin for potentially worrying spots.