When it comes to skin cancer, most of us know what it is, but we really don’t know much else about it. Skin cancer affects over 5 million Americans every year, and it is considered the most common cancer in the United States. More people are diagnosed with skin cancer every year than all cancers combined. The good news is that skin cancer is one of the most preventable cancers. Knowing the facts goes a long way toward prevention, as with so many other health issues. Joseph Cvancara, M.D. discusses key components of skin cancer, including early detection, prevention, types, and diagnosis.
What Causes Skin Cancer?
Skin cancer is caused by unrepaired DNA damage on skin cells in the epidermis, the outermost skin layer. These mutations cause skin cells to multiply out of control, forming malignant tumors.
There are various reasons this can occur. The most important cause is sunlight, particularly ultraviolet B radiation (UVB). UV radiation causes multiple genetic changes in the skin cells leading to cancer. Skin cancers on the head and neck are significantly more likely to occur in people with high levels of total sun exposure. The Skin Cancer Foundation mentions that having five or more sunburns doubles your risk for melanoma. Artificial UV light, such as found in indoor tanning beds, has the same effect on your skin cells as sunlight.
Here are some other risk factors that you need to be aware of:
- Complexion – Caucasian complexions with blonde / red hair and blue eyes are at higher risk of getting skin cancer. However, anybody can get skin cancer, so protecting yourself against UV rays is always essential.
- Genetics – if you have family members who have had skin cancer, you are at a higher risk of getting skin cancer.
- History of Skin Cancer – once you have been diagnosed with skin cancer, you are at a higher risk of developing additional skin cancers.
- Health Issues – Having an autoimmune disorder, such as lupus, or if you have had an organ transplant, puts you at a higher risk of developing skin cancer. Certain medications, such as immunosuppressants, can also increase this risk, especially if taken long-term.
Most Common Types of Skin Cancer
Of the three most common skin cancers, malignant melanoma is the most severe form of skin cancer. Melanoma is a cancer of the pigment cells (melanocytes) in the skin. It is the fifth most common cancer in the United States, following breast, lung, prostate, and colorectal cancer. What makes melanoma more serious than other skin cancers is that it is more likely to spread to other parts of the body, such as the lungs if it is not detected early. According to the American Cancer Society, melanoma accounts for only about 1% of skin cancers but causes the most skin cancer deaths.
Basal Cell Carcinoma (BCC) is the most common skin cancer, and the disease starts in the basal epithelial cells located in the lower layer of the epidermis. It is commonly found in areas exposed to the sun, such as your face and neck. The prognosis is excellent if treated early. If delayed, it can cause significant morbidity (pain, disfigurement, loss of function.)
Squamous Cell Carcinoma (SCC) is the second leading type of cancer, and it starts in superficial cells located in the upper layer of the epidermis. Likewise, SCC cancers can cause morbidity and death if not detected early.
How is Skin Cancer Diagnosed?
Skin cancers are diagnosed by taking a small sampling of the suspicious skin called a skin biopsy. There are different methods for achieving this, but usually, your Dermatologist will numb the area before taking a sample. Enough of the suspect area will be removed to make an accurate diagnosis. The skin biopsy is then examined to determine if it is skin cancer and what type of skin cancer. Further tests can be run to determine what stage the cancer is at. Roman numerals I through IV are used, with Stage I indicating the tumor is small and limited to the area it is located at. Stage IV indicates advanced cancer that has spread to other parts of the body.
This type of information helps determine what the best treatment options are. Some of the treatments available include:
- Freezing or Cryosurgery – some small, early cancers can be handled by using liquid nitrogen to freeze the area. The dead skin cells then slough off.
- Excisional Surgery – this type of surgery can be used for different kinds of cancers. It involves cutting (excising) out the cancerous tissue and a margin of the healthy skin as well.
- Mohs Surgery is a more delicate and precise procedure. It can be used on larger cancers, recurring cancers, and especially when necessary to preserve as much healthy tissue as possible, such as the face, neck, or nose. The tissue will be removed layer by layer, with the Fellowship-Trained Mohs Surgeon looking at the tissue under the microscope until only healthy tissue remains.
- Immunotherapy – this type of therapy uses the body’s immune system to fight off cancer.
- Chemotherapy – for skin cancers limited to the top layers of the skin, this may involve a cream or lotion containing anti-cancer agents to kill the cancerous cells. Treating cancers that have invaded other parts of the body will involve a more systemic chemotherapy.
- Radiation Therapy – This is useful in larger areas, harder-to-reach areas, or areas where you cannot altogether remove the cancer with surgery. A high-powered beam of energy, such as X-rays, is used to kill the cancer cells.
How Can We Help in the Early Detection of Skin Cancer?
Know your skin – learn about the early signs of skin cancer and what to look for. By examining your own body every month, you will be able to tell if there is something suspicious on your skin. If there is something that doesn’t look quite right, get it checked out by a Dermatologist. If you notice a new growth that has not gone away in 2 months, this is suspicious for skin cancer. Normal, benign lesions like a stye, pimple, or mosquito bite will resolve before two months.
Consider getting an annual skin exam by Board-Certified Dermatologist if you are at high risk of getting skin cancer.
Preventing Skin Cancer
Some things are beyond our control when it comes to risk factors. We cannot change our skin and eye color, genetic predisposition, or if we are immunocompromised due to leukemia, transplant surgery, etc. Even so, the best habit for everybody is to protect their skin from the sun using sunscreen, clothing, and brimmed hats.
The sunscreen you use should have a sun protection factor (SPF) of at least 30 and should be applied at least 30 minutes before you go outside. Make sure you reapply as needed.
As for clothing, long sleeves and slacks can protect you from harmful rays. A wide-brimmed hat will protect your face, and don’t forget to protect your eyes by wearing appropriate sunglasses.
How Early Do We Need to Start Being Proactive About Prevention?
Children need to be protected and taught about sun protection early on. Australians are ahead of the USA on this – they mandate brimmed hats be used on children at recess. Adults need to take ownership of their skin and be smart about protecting their skin for life to avoid developing skin cancers. Skin cancer is cumulative total sun exposure, so people in their later 1/3 of life develop many more skin cancers than younger generations.
At Advanced Dermatology & Skin Surgery, we have a dedicated, experienced team of Providers passionate about preventing, diagnosing, and treating skin cancer. If you have any questions about skin cancer or need to see one of our Board-Certified Dermatologists, please schedule a consultation today. You can book an appointment online at any of our four locations.
About the Provider
Joseph Cvancara, MD, FAAD, FACMS – Dr. Cvancara is a Fellowship-Trained Mohs Surgeon and a
Board-Certified Dermatologist who practices at our Spokane, WA and Coeur d’Alene, ID offices, focusing on medical dermatology and skin cancers. As a Fellowship-Trained Mohs Surgeon, he has treated and repaired over 18,000 complex skin cancer cases.