Understanding Skin Cancer

Skin cancer is the most common of all cancers diagnosed in the United States, with one in five Americans expected to develop cancer in their lifetimes. 

“Knowing how skin cancer occurs, how to spot any changes to your skin, and keeping up with annual skin exams can reduce your risk of developing skin cancer,” said Joy Curran, DO, Catholic Health Family Medicine Physician. “Early detection of skin cancer increases the likelihood of successful treatment and prevention of further advancement and spread of the cancer.”

What are the types of skin cancer?

Skin, the body’s largest organ, has two main layers: the upper layer or epidermis and the lower layer or dermis. Skin cancer is an abnormal and uncontrolled growth of skin cells typically caused by overexposure to the sun’s ultraviolet (UV) rays. You can be exposed to UV rays from the sun, sunlamps or tanning beds.

There are three main forms of skin cancer:

Basal cell cancer affects the bottom layer of the epidermis, where skin cells are routinely exposed to direct sunlight or other UV rays. It is the most common type of skin cancer. If left untreated, it can grow deeper in the skin and cause disfiguration.

Melanoma affects the cells that produce the pigment that determines the color of your skin, called melanin. It typically causes dark brown spots on the skin. A family history of melanoma is a high-risk factor for developing this type of cancer. It is the most serious form of skin cancer because it tends to grow quickly and spread to other areas of your body.

Squamous cell cancer affects the top layer of the skin. It typically appears on sun-exposed areas such as the arms, hands, neck, ears or face.
 

Who is at risk for developing skin cancer?

Anyone exposed to UV rays, regardless of skin color, can get skin cancer. Certain factors increase risk, including:

• Family history of skin cancer
• Previous personal history of skin cancer
• Age (typically older adults)
• Gender (higher in women before age 50; higher in men after age 50)
• Skin type (fairer, lighter skin color)
• Hair color (blonde or red)
• Eye color (blue or green)
• Spending a lot of time in the sun (work, hobbies)
• Living in sunny climates or at high elevations when sunlight is strongest
• Easily sunburned or have a history of sunburns
• Tanning, either in a tanning bed or outdoors
• Atypical moles (can be large, irregularly shaped or multicolored)
• Precancerous skin lesions (also known as actinic keratosis)

How is skin cancer diagnosed?

“Diagnosis of skin cancer typically begins with examining the skin,” said Dr. Curran. “Your primary care physician can begin an annual skin exam but may refer you to a dermatologist for further evaluation. If you have a high risk of developing skin cancer, your PCP may recommend when you should begin scheduling an annual skin exam with a dermatologist.” 

She explained that in between exams, you should do self-exams and learn the “ABCDEs” that help identify skin abnormalities. 

Remember your ABCDEs

Knowing what to look for is as easy as reciting your ABCs—especially when identifying melanoma. Always have your doctor check any changes in your skin, such as new growths, changes to old growths or sores that do not heal.

• Asymmetrical. A spot or mole that has an irregular shape with two parts that look different from each other.
• Border. The area has jagged, hazy or irregular edges.
• Color. Uneven or splotchy or multi-colored area or mole.
• Diameter. Larger than the size of a pencil head eraser (> 1/4 inch or 6mm) or any growth in size.
• Evolving. A spot or mole that continues to change in size or appearance over a few weeks or months. 

If your skin has any of the ABCDEs, you should visit your doctor for further evaluation. Your doctor will take a biopsy of suspicious skin to determine if it is cancerous.

How is skin cancer treated?

Treatment for skin cancer depends on the type of cancer. Typically, excisional skin biopsy removes the entire growth of small skin cancers. Mohs surgery may be recommended for larger or recurring cancers that are more difficult to remove. A Mohs procedure removes cancerous cells without also removing an excessive amount of healthy skin.

Your doctor will explore other treatment options that are best for your skin cancer type and stage. For advanced skin cancer, they will refer you to a plastic surgeon or an oncologist.

Can I prevent skin cancer?

Protecting yourself from exposure to UV rays also protects you from skin cancer. Get started with these tips.

• Use a broad-spectrum sunscreen with an SPF of 30 or higher, even on cloudy days. Sunscreen should be used year-round, not only in the summer. 
• Reapply sunscreen when outside for long durations (every 90 minutes), especially after being in the water or sweating.
• Wear protective or SPF clothing, including pants, shirts, hats and sunglasses, that limits skin exposure to UV rays.
• Wear dark clothes (dark blue is the best) that absorb the UV rays, which will decrease the chance of UV rays from reaching the skin.
• Protect yourself from sun exposure from reflective surfaces (water, snow or sand) and car, house or airplane windows. 
• Seek shady areas outdoors or avoid outdoor activities from 10 a.m. to 4 p.m., when UV rays are strongest.
• Remember your “ABCDEs” and check your skin at least once a month. Call your PCP if you notice any abnormalities or changes. 
• Schedule your annual skin exam.

“Being in the sun makes us feel good and has health benefits like Vitamin D,” said Dr. Curran. “But if we do not take the right precautions, sun exposure can be harmful and increase the risk of developing skin cancer, especially if you already have certain risk factors. Protect yourself and make time for yourself to do self-exams and annual exams.”