Skin Cancer

Skin cancer is the most common form of cancer in the U.S., with more than 3.5 million cases diagnosed each year—more than the incidence of breast, prostate, lung and colon combined. Statistics show that one in five Americans will develop skin cancer in the course of a lifetime. There are three main types of skin cancer.

  • Basal cell carcinoma is the most common form of skin cancer, with an estimated 2.8 million cases diagnosed each year. It occurs when cancer cells grow in the outer layer of the skin (the lower part of the epidermis). This cancer is rarely fatal, but it can be disfiguring if allowed to grow.
  • Squamous cell carcinoma is the second most common type of skin cancer, with an estimated 700,000 cases diagnosed in the U.S. each year. It occurs when cancer cells grow in the squamous cells—the flat cells that form the surface of the skin—and is also considered highly treatable.
  • Melanoma is the third most common skin cancer, but it’s also the most dangerous. It occurs when cancer forms in the melanocytes, the skin cells that make pigment. The overall five-year survival rate for patients with melanoma is about 98 percent when the cancer is detected early (before it has spread to regional lymph nodes or other organs). But it falls to 62 percent when the cancer reaches the lymph nodes and just 15 percent when distant organs are involved. Up to 90 percent of all melanomas are caused by exposure to ultraviolet light.
  • Actinic keratosis is a skin condition that looks like rough, red, pink or brown scaly patches that may be flat or raised. When it’s on the lip, it may seem cracked or peeling and using lip balm or petroleum jelly doesn’t relieve it. Actinic keratosis is not cancer but can sometimes change into squamous cell carcinoma. It usually occurs in areas that receive prolonged sun exposure, such as the face, back of the hands or lower lip.

5 Steps to Protect Your Skin

  1. Limit your sun exposure. The vast majority of skin cancer cases are caused by exposure to ultraviolet rays, the invisible radiation that comes from the sun. UVA and UVB are the most common rays, both of which can damage connective tissue and increase skin cancer risk. That means you need to be vigilant year round—not just on the beach on a warm, sunny day. UV rays can penetrate clouds and haze and reflect off surfaces like water, sand and snow. The rays are strongest between 10 a.m. and 4 p.m. Protect yourself by wearing clothing to minimize skin exposure, plus a wide-brim hat to shade the face, head, ears and neck and sunglasses that wrap around your face.
  2. Avoid the tanning salon. Indoor tanning, with a bed, booth or sunlamp, can greatly increase your skin cancer risk—people who use a tanning bed who start younger than age 35 have a 75 percent risk of developing melanoma than those who never try indoor tanning. A tan indicates damage to your skin, plain and simple, and in addition to skin cancer risk you’ll also boost your risk of wrinkles, eye damage and changes in skin texture.
  3. Get the right sunscreen. It’s difficult to avoid the sun altogether, but sunscreen can help you minimize sun damage. Use sunscreen with a sun protective factor (SPF) of 15 or higher, and one that provides protection from both UVA and UVB rays. Put on the sunscreen before you go outside, and reapply every two hours or so, or after you swim or exercise. Be sure to check the expiration date, since sunblock’s effectiveness can diminish over time.
  4. Know your risk factors. Although everyone is at risk for skin cancer, some people do carry a higher chance of developing the disease. In general, people with a lighter natural skin color (or skin that burns, freckles or reddens easily), a family or personal history of skin cancer, a history of sunburns early in life or a history of using tanning beds, those with a large number of moles, and people with blue or green eyes and/or blonde or red hair all carry a higher risk. The Center for Disease Control lists six skin types, based on how easily you burn or tan.
    They include:

    • Type I: Always burns, never tans, sensitive to UV exposure.
    • Type II: Burns easily, tans minimally.
    • Type III: Burns moderately, tans gradually to light brown.
    • Type IV: Burns minimally, always tans well to moderately brown.
    • Type V: Rarely burns, tans profusely to dark.
    • Type VI: Never burns, deeply pigmented, least sensitive.
  5. Be aware of the warning signs. Caught early, almost all skin cancers are considered curable. But if you let them go too long, they can lead to disfigurement, and even death. Do a monthly self-exam, becoming familiar with freckles, moles and any changes in your skin. Traditionally, cancer experts recommended looking for your “ABCDs” on any suspicious-looking growths or lesions. These include:
    • A-for asymmetry (one side should mirror the other)
    • B- for irregular border (a more jagged border is suspicious)
    • C- for color variation (the entire growth should be one color, not a variety of shades, except for a solid shade of black, which may be dangerous)
    • D- for a diameter of more than 6 millimeters (about the size of a pencil eraser)

    New research also indicates adding “E, F and G”:

    • E- evolving (the size, shape, color or elevation of the mole should stay the same)
    • F- for firm (firmer moles are considered suspicious)
    • G-the size of the mole should not grow
    • Talk to your doctor if you notice any suspicious changes in your skin.

Ask Your Doctor

Since it’s impossible to examine every inch of your own body, experts recommend that everyone get an annual skin exam from their health-care provider. Your doctor will be able to identify any suspicious growths. If an area does look abnormal, your doctor may perform a biopsy, removing as much of the suspicious tissue as possible. Most skin melanomas can be identified through a visual exam, and because melanoma is generally slow-growing in the top layer of the skin, it can be found relatively early before it spreads.

Treatment Options

How melanoma is treated depends on the type and how far it may have spread. Tests, including a CT scan, MRI or lymph node biopsy can help determine whether the cancer has spread within the skin or to other parts of the body. In the case of melanoma, PET scans (positron emission tomography scan, which offers a different view of tissues) or blood tests may also be done.

Depending on the cancer type and location, your doctor may advise doing a surgical procedure to remove the cancer. In some cases, radiation and chemotherapy may be prescribed to stop the growth of cancer cells.

Other treatments include photodynamic therapy, which uses laser light to kill cancer cells, and biologic therapy, which uses substances made by the body or in a laboratory to enhance the body’s natural defenses against cancer. For melanoma, targeted therapies (treatments that use drugs or other substances to identify and attack cancer cells without harming normal cells) may also be employed. Both basal cell carcinoma and squamous cell carcinoma have high recurrence rates, so talk to your doctor about how often you should have your skin checked for signs of cancer.

Find a cancer specialist at the North Shore-LIJ Cancer Institute.