Precautions and vigilance are the first defense against America’s most common cancer
THE SPECIALIST: Dr. Angela Lamb
WHO’S AT RISK
Common almost to the point of ubiquity, skin cancer will affect one in five Americans over the course of their lifetime, making it the single most common cancer diagnosis in the country. “Skin cancers originate in the skin, when normal cells mutate and start overproducing, which causes a tumor to form,” says Lamb. “Protecting your skin from the sun and the early detection of tumors are the best defense against skin cancer.”
There are three main categories of skin cancer, which vary in severity. “The two most common and least aggressive types are basal cell carcinoma and squamous cell carcinoma,” says Lamb. “Melanoma is the most serious type of skin cancer, and also the least common.”
Men and women of all skin types are susceptible, but fair-skinned people are 10 times more likely to develop any skin cancer, and 20 times more likely to develop melanoma. “The people at highest risk have light hair and light eyes; they can’t even tan,” says Lamb. “People with dark eyes, dark hair and dark skin are at much lower risk, though they should still keep an eye out for suspicious moles or lesions that are fast growing.”
Sun exposure is the other driving risk factor. “It’s a question of what your skin looks like and what you’ve done to that skin,” says Lamb. “A history of blistering sunburns and cumulative sun exposure increases your risk of skin cancer. And tanning beds in particular have a horrible track record of causing melanoma.”
People of all ages can develop skin cancer, though the risk does goes up with age. “Because the skin damage caused by sun exposure has a cumulative effect, aging is accompanied by an increased risk,” says Lamb. “What that also means is that it’s never too late to start protecting yourself from the sun. Even if you’re 40 or 50, you can decrease your risk by starting to take precautions for the first time.”
SIGNS AND SYMPTOMS
The three types of skin cancer all look slightly different, though they have some features in common. “A good rule of thumb is to have a dermatologist check out any new lesions, bumps or moles that are painful or growing fast,” says Lamb. “The blemishes you really need to look out for are ones that change quickly or are symptomatic. They can start to itch or bleed or burn.”
The red flag of basal cell carcinoma is a sore that won’t heal. “Sometimes patients call it a pimple — usually it’s a little red patch, sometimes it looks like a cut, and often they’ll start to bleed,” says Lamb. “Squamous cell carcinomas look like painful scaly sores that don’t heal, often on the face.”
Melanomas usually look like a mole that doesn’t fit in with your other moles. “A quick and dirty rule is that what you really need to look out for is something that is growing or changing quickly,” says Lamb. “Another mnemonic device is ABCDE: Look out for moles characterized by Asymmetry, Borders that are irregular, Color that is different from your other moles, a Diameter bigger than an eraser head, and that are Evolving.”
One of the best things you can do for your overall health is take precautions against excessive sun exposure. “Protect yourself from the sun and stay out of tanning booths at all costs,” says Lamb. “These are common-sense and fairly inexpensive steps you can take: Wear a good sunscreen and a hat.”
At the beach, people who are extremely fair should also wear rash guards or swim shirts, the stretchy athletic swimwear that blocks sun while allowing for activity.
Many dermatologists recommend that patients do a monthly mole check, so you can get any new moles or changing ones checked out. “When the dermatologist does find a suspicious lesion, the first thing we always do is biopsy — we take a sample and send it to the pathologist,” says Lamb. “The pathology report determines what kind of tumor it is, which is essential for determining treatment.”
Basal and squamous cell carcinomas have three main treatment options. “We can excise the tumor with margins, we can do a burning and scraping procedure, or we can do Mohs micrographic surgery, which has the additional benefit of ensuring that the tumor margins are clear during the procedure,” says Lamb. “Mohs is particularly important for skin cancers on the face or very large tumors.”
Melanoma is the most difficult skin cancer to treat, because it can metastasize, which is what makes it potentially dangerous. “There are stages of melanoma, based on how deep it extends down into the layers of the skin,” says Lamb. “The standard of care is wide local excision, with margins depending on size.” A sentinel node biopsy, chemotherapy and radiation may also be necessary for cancers that have spread.
Researchers are continually improving the drugs that treat skin cancer. “One thing we’re just discovering is that NSAIDs like aspirin can have some protective role. We’re still trying to determine how to apply these findings,” says Lamb. “And in just the past two to three years, we’ve had some great breakthroughs in metastatic melanoma medications — they’re just much better than they used to be.”
QUESTIONS FOR YOUR DOCTOR
Because skin cancer is definitely a case where an ounce of prevention is worth a pound of cure, ask, “Can you recommend a sunscreen?” And if you’re fair: “What kind of hat should I be wearing?” Perhaps most importantly, be sure to voice any concerns by asking, “Could you examine this mole or lesion?”
“Never hold back on having something looked at,” says Lamb. “The dermatologist’s eye has seen many, many moles and blemishes, so they can tell if something doesn’t quite look right. And early detection is crucial for getting the best treatment results.”
WHAT YOU CAN DO
Get informed. There are plentiful online resources for skin cancer, including the American Cancer Society (cancer.org), which is extraordinarily up-to-date, the American Academy of Dermatology (aad.org) and the Skin Cancer Foundation (skincancer.org).
Take precautions. Wear a broad-spectrum sunscreen.
Know your family history. If you have a first-degree relative who’s had melanoma, then you need to be extra-vigilant. “If there’s a family history, I recommend yearly skin checks, regardless of age,” says Lamb.
See the dermatologist regularly. For people with no family history of skin cancer and no personal history of sunburns, Lamb recommends getting checked in your 20s and then starting to go every two years or so.
No tanning beds. No amount of tanning bed use is safe. They dramatically increase the risk of melanoma. “The only safe tan is one that comes out of a bottle,” says Lamb.