It’s May! During this month we celebrate holidays such as Cinco De Mayo, Mother’s Day, and Memorial Day to name a few. It marks the end of the school year and is the official start of the summer season. . .
…but did you know that it is also Skin Cancer Awareness Month?
I can’t think of a better month to raise awareness about this preventable form of cancer than the month of May, especially since this is when many of us begin to spend more time outdoors.
The Skin Cancer Foundation reports that skin cancer is the most common form of cancer in the United States, with over five million new cases diagnosed each year. A vast majority of these cases can be linked directly from exposure to ultraviolet radiation (UV) from the sun.
My goal for this article is to help familiarize you with the common forms of skin cancer that are seen in our office and provide you tips on how to prevent them, as well as recognize early warning signs as a flag to take action and have them evaluated. . .
...sooner rather than later!
And to help us out with this endeavor is our own Laura Collins, APRN.
About Laura Collins, APRN, DCNP
Laura received her Bachelor of Science degree in nursing from Northern Illinois University (NIU) in 2000. She completed the Nurse Practitioner Program and earned her Master’s Degree from NIU in December of 2004. She is board certified as an Adult Nurse Practitioner and is also a Dermatology Certified Nurse Practitioner by the Dermatology Nurses Association.
Ms. Collins is a member of the Illinois Society for Advanced Practice Nurses, the Dermatology Nurses Association Nurse Practitioner Society, and the Society of Dermatology Physician Assistants.
She has practiced in the field of dermatology for over twelve years. Her medical interests include general dermatology, skin cancer screening and prevention, patient education, acne, eczema, and psoriasis. Ms. Collins believes in providing comprehensive patient care and strives to give friendly and courteous service.
She enjoys helping patients understand their condition and educating them on the best possible treatment options.
What causes skin cancer?
While there are a number of factors contributing to skin cancer, sun exposure is among the most common.
The sun emits two main forms of UV rays, UVA and UVB. Both of these types of rays are capable of penetrating the skin to cause permanent damage to the cells below.
UVA penetrates more deeply than UVB and can cause genetic damage as well as photo aging (a.k.a. wrinkles, discoloration, etc.) and immune-suppression.
UVB rays penetrate into the epidermis, the top layer of the skin, and are more responsible for sunburn, which places an individual at a greater risk for skin cancer, especially melanoma. UV rays can also contribute to eye damage.
Another important point to note is that we can also sustain exposure to UV rays from sources other than the sun, such as in tanning beds.
Over time, if the body cannot repair the damage sustained to the cells, they can begin to divide and grow in an uncontrolled way which may have the potential to eventually form a tumor. These tumors can be cancerous—and therefore, deadly.
The Most Common Forms of Skin Cancer
As I mentioned before, skin cancer can be preventable. Oftentimes, we can see pre-cancerous lesions on the skin in individuals who have had lots of UV exposure over time.
These lesions are called Actinic Keratoses (AKs) and are predominantly found on fair skinned individuals in sun-exposed areas such as the head, face, neck, and backs of the hands or forearms.
AKs concern us because they have the potential to evolve into a form of skin cancer known as squamous cell carcinoma (more on that one later).
What you are looking for here initially is a poorly defined area of redness with or without small visible blood vessels. Over time, these spots may evolve and develop a thin transparent, white, or yellow scale.
They can usually be felt by your fingertips and are often mistaken for dry skin. The hallmark is that they do not go away, even with moisturizers. If these lesions are not treated, eventually they may progress to forming a thicker scale and can become raised, and sometimes sore or painful.
It is estimated that 10% of untreated actinic keratoses progress to squamous cell carcinoma.
We recommend that if you notice any red, dry, scaly spots that are persistent or worsening over time to come in for an evaluation. We have many ways to treat these lesions and prevent them from transitioning into skin cancer.
The most common form of skin cancer is called Basal Cell Carcinoma (BCC). This cancer derives from the basal layer of keratinocytes, the predominant cell type of the epidermis (the top layer of the skin).
Basal Cell Carcinoma
Like AKs, basal cell carcinomais also more likely to be found in people with fair skin in sun-exposed areas. It is most common after age 40, however, it may appear at any age. The most common risk factor is cumulative sun exposure over time.
BCC has many variants, some more aggressive than others.
What does basal cell carcinoma look like?
Look for any flat or raised pink or translucent spots. These tumors grow slowly and enlarge over time, sometimes developing tiny superficial blood vessels or rolled raised borders.
BCCs may also bleed with minor trauma such as shaving or rubbing with a towel, but the warning sign is that it is a lesion that does not heal or go away.
Although these tumors rarely metastasize, they will enlarge and locally invade the surrounding skin if left untreated.
This can be very concerning if they are located on an eyelid, lip, nose or the ears. A biopsy is usually performed to confirm the diagnosis to determine the type of BCC that is present. We have many treatment options for BCC, however, the type, size, and location are taken into consideration when recommending treatment.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is the second most common form of skin cancer that we see. SCC is more invasive than BCC. It also arises from the keratinocytes of the skin and is most common in the sun-exposed areas of the body in elderly patients after years of cumulative UV exposure.
Caucasian people with fair skin are at the greatest risk.
Unlike BCC, which is primarily due to sun exposure, SCC can also be caused by other factors such as tobacco, chronic infections and inflammation, burns, and the human papillomavirus infection.
People who are immunocompromised are at an even greater risk. Our main concern with SCC is that if left untreated, it does have the potential to metastasize through the lymphatic system to the local lymph nodes and beyond.
What does squamous cell carcinoma look like?
These lesions are usually pink to a dull red color with firm, poorly defined raised bump with yellowish scale. As the lesions progress, they may become more raised with a crusted center. Skin biopsies are recommended for all suspected squamous cell carcinomas and as with BCC, the treatment needed may vary depending upon the type, size, and location of the tumor.
Our third most common skin cancer is Malignant Melanoma (MM). MM is a cancer of the melanocytes, the pigment-producing cells of the skin.
Of the three skin cancers described in this article, MM is the most serious.
It is potentially curable with early detection and treatment, however, if it is left untreated, may carry a poor prognosis.
The risk factors include having fair skin, the presence of atypical moles in both sun-exposed areas as well as sun-protected skin, a personal and/or family history of MM, a history of blistering sunburns, and a history of pigmented birthmarks (congenital nevi).
Earlier detection and treatment are the key to a more favorable prognosis as the cancer can grow rapidly and spread through the lymphatic system to other areas of the body. Normal moles do not have any symptoms, however, if a mole is sore, itchy, bleeds, or demonstrates any other symptoms, have it evaluated by a dermatology provider.
Other Criteria to look for would be to evaluate your moles for the ABCDEs of skin cancer:
A = Asymmetry. Check your moles to see if it is symmetrical; meaning that one half matches the other. If not, the mole is asymmetrical and should be evaluated.
B = Border Irregularity. Normal moles should have smooth, even border. A mole should be evaluated if the borders appear to be scalloped, jagged, or seem to fade out.
C = Color Variegation. Moles should demonstrate an even color scheme. If you see new colors, colors that are changing, or there are multiple colors it is time for a check.
D = Diameter > 6mm. If your mole is larger than the size of a pencil eraser, and/or growing, an evaluation is recommended.
E = Evolution. Monitor your moles with each monthly Self Skin Examination. If your moles appear to change or grow (evolve) over time, it is best to have them evaluated.
What does malignant melanoma look like?
MM can be tricky to diagnose. While they primarily arise from existing moles, this is not always the case. MMs are not always brown or black in color. A form of melanoma called Amelanotic Melanoma can simply appear as a colorless, pink or red spot.
They can be easy to miss, delaying their diagnosis which can potentially affect overall prognosis. For this reason, we highly recommend that you perform a monthly Self Skin Exam on yourself and have an annual evaluation with a dermatology provider, especially if you are over 40 years old.
Make sure to report any lesion that is new and changing or does not heal. The Skin Cancer Foundation has step by step instructions on how to perform this examination on yourself. For more information please visit SkinCancer.org.
Skin Cancer Prevention
The number one way to prevent skin cancer is to protect your skin. We recommend that during any season you apply a broad spectrum (UVA/UVB) sunscreen containing Zinc Oxide and/or Titanium dioxide of at least a sun protection factor (SPF) of 15-30 at least every two hours to any exposed areas when outside.
Be sure to use about one ounce of the product (about the amount in a shot glass) to ensure adequate coverage. It is also a good idea to use a facial moisturizer containing sunscreen to your face, ears, and neck daily before you leave the house.