June 01, 2020 8 min read

 

Skin Cancer – Causes, Signs and Solutions


Cancer can affect nearly every part of the human body, and with the skin being the largest external organ of the anatomy, it is the most susceptible to cancer. 


The most common type of cancer is skin cancer, with about 9,500 people in the U.S. diagnosed every day. There are different types of skin cancer, each with different causes, symptoms, risks and treatments. To protect yourself, is it important to understand that UV, or ultraviolet rays from the sun inflict damage on the skin which can lead to skin cancer. 

 

Who Is Vulnerable?

Normally, when someone goes outdoors and is exposed to UV rays, the skin produces melanin to protect itself. The tan that appears is a sign that your body is trying to shield you. However, fair-skinned people are most vulnerable to sun exposure as they don’t produce as much melanin as those with darker complexions. As their skin is innately unable to protect them, a sunburn results. Even one bad sunburn is enough to put someone at risk, which is why it is important to protect yourself from a very early age. Additionally, those who are prone to moles are also more inclined to develop skin cancer. It is important to understand that even those with dark complexions can develop skin cancer so everyone, regardless of skin tone, must remain cautious.


 

 

 

 

Symptoms and Types of Skin Cancer

While most types of skin cancer can be prevented and treated, some can be deadly, making vigilance against all forms of skin cancer paramount to living a long, healthy life.

 

Squamous Cell Carcinoma

When you feel a roughly textured bump with a lump beneath it, you may have a squamous cell carcinoma. It can also manifest as a tender volcano-like bump with a central crater, that is called a keratocanthoma. These usually don’t metastasize, but those on the central face, ears or lips can spread to the lymph glands if not addressed. If it stays on the top layer of the skin, it is Squamous Cell Carcinoma-In-Situ, or Bowen’s Disease.

 

Basa Cell Carcinoma

This is the most typical, curable form of cancers, with 1.5 million cases every year. It starts as small sores that fail to heal, or pearl-like bumps with small blood vessels. It can also appear as a small scar, rash or pimple that fails to go away. This often occurs on the ears, eyes, lips, nose or other body parts and while it doesn’t spread, can penetrate deeply and cause disfigurement.

 

 

Actinic Keratosis

These rough, surface patches appear on skin that has had sun exposure. While tending to be sensitive or tender, with a gritty texture, these are pre-malignant. Liquid nitrogen or topical prescription creams are used to eradicate these pre-cancerous sites. These are not to be ignored as some may turn into other skin cancers. 

 

 

Melanoma

Melanoma is the fifth most commonly seen type of cancer affecting people today. Getting early diagnosis and treatment of this form of skin cancer is crucial as it can spread to other organs (metastasize), making it potentially deadly. This form of skin cancer affects males and females equally, with about 10,000 people dying from it each year. This equates to one person every hour!


With every sunburn your risk of developing skin cancer increases, with five sunburns doubling the risk of developing melanoma.


The goal with regular checks is to catch skin cancers early, and remove them before they spread. Otherwise, treatment can be more extensive and require care from an oncologist and general surgeon. Often times the depth of the melanoma and the amount of skin that is removed leads many to seek help from plastic surgeons to reconstruct the damaged area.

 

 

 

 

 

 

Check It Out

An annual skin check by a dermatologist is recommended for everyone, regardless of skin color or risk factor, as no one is immune from skin cancer. But, if you are high risk for melanoma with fair skin and a history of more years in the sun than you can count, this annual visit needs to be a serious health priority on your calendar. Your life depends on it!


Here are some additional risk factors for melanoma:

  • Blue eyes
  • Sensitivity to the sun
  • Freckles
  • More than 50 moles, with a tendency to unusual moles
  • Family history of melanoma (this includes siblings, parents or children)
  • Two or more intense sunburns that blistered before the age of 16
  • Pronounced sun exposure for short durations such as vacations or weekends 

  • If the above applies to you, monthly self-checks are recommended. Many people mistakenly assume they can wait on starting annual checks, believing that only older people get melanoma. The fact is that 50% of melanoma cases appear in those under the age of 57, even children.


    When a melanoma is caught early, at the localized stage, the 5-year survival rate is 98%. So, if you suspect something is amiss, use these ABCDE’s before your annual skin check:

    • Asymmetry of outline
    • Border irregularity
    • Color irregularity
    • Diameter greater than 6 mm (larger than a pencil eraser)
    • Evolving (changing)

    If you see an asymmetrical mole, with an irregular border, color and size that appears to change, bleed, or feel itchy or tender, get it checked out immediately. Should something look suspicious, your doctor should do a biopsy for a pathologist to inspect.


    Hint: Benign moles tend to be symmetrical with an oval or circular shape and smaller size.


    Talk to your doctor or pharmacist about medication(s) you take as half of most medications can make you susceptible to sunburns.

     

     

     

     

     

     

    References:

    Livewell.org John Stoddard Cancer Center Des MoinesMay 2, 2019

    “25 Skin Cancer Facts that will Make You Never Forget to Wear Sunscreen Again”  

    https://www.aladerm.com/medical-dermatology/skin-cancer/

    Radiance By Web MD “Choosing Skin Care Products: Know Your Ingredients”

    AAD.org American Academy of Dermatology, “Skin Cancer”

    https://www.aad.org/media/stats-skin-cancer

     

    American Academy of Dermatology Article References:

    1Guy GP, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.

    2Guy GP, Machlin S, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002–2006 and 2007–2011. Am J Prev Med. 2015;48:183–7.

    3Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010 Mar;146(3):279-82.

    4Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.

    5Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population. JAMA Dermatol. Published online April 30, 2015.

    6American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.

    7Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; doi: 10.3322/caac.21551.

    8American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD.

    9Muzic, JG et al. Incidence and Trends of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma: A Population-Based Study in Olmstead County, Minnesota, 2000-2010. Mayo Clin Proc. Published Online May 15, 2017. http://dx.doi.org/10.1016/j.mayocp.2017.02.015

    10SEER Cancer Stat Facts: Melanoma of the Skin. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/melan.html

    11Little EG, Eide MJ. Update on the current state of melanoma incidence. Dermatol Clin. 2012:30(3):355-61.

    12Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.

    ​13Dawes SM et al. Racial disparities in melanoma survival. J Am Acad Dermatol. 2016 Nov; 75(5):983-991.

    14Surveillance, Epidemiology, and End Results (SEER) program 18 registries. Data run July 25, 2018.

    15Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

    16Reed KB et al. Increasing Incidence of Melanoma among Young Adults: An Epidemiological Study in Olmsted County, Minnesota. Mayo Clinic Proceedings, 2012; 87 (4): 328–334.

    17Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat Clin Pract Oncol 2007; 4(8):462-9.  

    18Gamba CS, Clarke CA, Keegan TM, et al. Melanoma Survival Disadvantage in Young, Non-Hispanic White Males Compared With Females. JAMA Dermatol. 2013;149(8):912-920. doi:10.1001/jamadermatol.2013.4408

    19Wehner MR et al. All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2018: 78 (4): 663 - 672.e3

    20Arnold M, Kvaskoff M, Thuret A, Guenel P, Bray F and Soerjomatarm I. Cutaneous melanoma in France in 2015 attributable to solar ultraviolet radiation and the use of sunbeds. J Eur Acad Dermatol Venereol. Published online April 16, 2018. https://doi.org/10.1111/jdv.15022​

    21Arnold M et al. Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012. Int J Cancer. 2018 April. https://doi.org/10.1002/ijc.31527.

    22Parkin DM, Mesher D and Sasieni P. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. British Journal of Cancer. 2011. 105 (S66–S69) doi: 10.1038/bjc.2011.486.

    23Lin JS, Eder M, Weinmann S. Behavioral counseling to prevent skin cancer: asystematic review for the U.S. Preventive Services Task Force. Ann Intern Med.2011 Feb 1;154(3):190-201. Review.

    24Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up J Clin Oncol Jan 20, 2011:257-263; published online on December 6, 2010.

    25Watts CG, Drummond M, Goumas C, et al. Sunscreen Use and Melanoma Risk Among Young Australian Adults. JAMA Dermatol. Published online July 18, 2018. doi:10.1001/jamadermatol.2018.1774

    26CDC. Sunburn and sun protective behaviors among adults aged 18–29 years—United States, 2000–2010. MMWR Morb Mortal Wkly Rep 2012;61:317–22.

    27Dennis, Leslie K. et al. “Sunburns and Risk of Cutaneous Melanoma, Does Age Matter: A Comprehensive MetaAnalysis.” Annals of epidemiology 18.8 (2008): 614–627.

    28Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev; 2014. 23(6); 1080-1089.

    29Ting W, Schultz K, Cac NN, Peterson M, Walling HW. Tanning bed exposure increases the risk of malignant melanoma. Int J Dermatol. 2007 Dec;46(12):1253-7.

    30Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014;70:847–57. 

    31Wehner M, Chren M-M, Nameth D, et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150(4):390-400. Doi: 10.1001/jamadermatol.2013.6896.

    32Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909. 

    33Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005 Jan;41(1):45-60.

    34Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol. 2010 Mar;146(3):265-72.

    35Song F, Qureshi AA, Giovannucci EL, et al. (2013) Risk of a Second Primary Cancer after Non-melanoma Skin Cancer in White Men and Women: A Prospective Cohort Study. PLoS Med 10(4): e1001433. doi:10.1371/journal.pmed.1001433

    36Cai ED, Swetter SM and Sarin KY. Association of multiple primary melanomas with malignancy risk: a population-based analysis of the Surveillance, Epidemiology, and End Results Program database from 1973-2014. Journal of the American Academy of Dermatology. Published online Oct. 1, 2018. https://doi.org/10.1016/j.jaad.2018.09.027

    37Avilés-Izquierdo JA, Molina-López I, Rodríguez-Lomba E, Marquez-Rodas I, Suarez-Fernandez R, Lazaro-Ochaita P. Who detects melanoma? Impact of detection patterns on characteristics and prognosis of patients with melanoma. J Am Acad Dermatol. 2016; 75(5):967-974.

    38Cheng MY, Moreau JF, McGuire ST, Ho J, Ferris LK. Melanoma depth in patients with an established dermatologist. Journal of the American Academy of Dermatology. 2014; 70(5):841-846.

    39Brady MS, Oliveria SA, Christos PJ, et al. Patterns of detection in patients with cutaneous melanoma. Cancer. 2000;89:342-347.

    40Epstein DS, Lange JR, Gruber SB, et al. Is Physician Detection Associated With Thinner Melanomas? JAMA. 1999;281(7):640-643.

    41Koh HK, Miller DR, Geller AC, et al. Who discovers melanoma? Patterns from a population-based survey. Journal of the American Academy of Dermatology. 1992;26:914-919.

    ​42Berg A. Screening for skin cancer. US Preventive Services Task Force, 2007.

    43Guy GP, Berkowitz Z and Watson M. Estimated Cost of Sunburn-Associated Visits to US Hospital Emergency Departments. JAMA Dermatology. 2017. 153 (1): 90-92.  

     

     



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