Keeping Skin Cancer at Bay
When John Richardson's* wife first noticed a "funny" patch of skin on his scalp, he and his wife didn't think much of it. But after seeing photos of skin cancer in a women's magazine, she took another look.
"She handed me the phone and forced me to call the doctor right then," recalls Richardson, 45. It's a good thing she was so insistent. That "funny" patch turned out to be basal cell carcinoma, a rarely fatal, but very common type of skin cancer.
According to the American Academy of Dermatology (AAD), approximately 1.3 million new cases of skin cancer will be diagnosed in the United States each year, making it the most prevalent form of cancer. And this year, almost 8,000 people will die of skin cancer, most from
How Aging Influences Skin Cancer Risk
Skin cancer is a particular concern for older adults, who often live in sunny areas and experience more sun exposure. Retired people also have more leisure time to spend on outdoor activities such as golf, gardening, or boating.
Men are also more likely to develop skin cancer because they are more likely to have worked and played outside than their female counterparts. The skin cancers we see today are due to the sun exposure of many years ago. Perhaps as women are more and more outdoors, they will start to match the incidence of male skin cancers 20–50 years from now.
Some researchers estimate that all Americans, if they live into their 80s, will develop some form of skin cancer (almost always squamous cell or basal cell, the two most common types). Because skin cancer, like all cancers, takes a long time to develop from the single mutated cell to the full-blown visible change we can actually see, skin cancer is a disease most often seen in older adults. Skin cancer seen in children is particularly worrisome because it may indicate that a genetic defect predisposes them to all types of cancers.
Basal and squamous cell cancer tend to result from years of prolonged exposure to the sun. Melanoma, on the other hand, can be found in both sun-exposed and non-exposed tissues. In some cases, melanoma can first appear inside the body (intestines or brain), where no sun exposure occurred. Eighty percent of all basal cell carcinoma occurs on the face, and these lesions spread very rarely. Squamous cell carcinoma can spread if left untreated for a long period, and melanoma can double in size in just a few months.
After being diagnosed by a qualified physician, patients are typically referred to a dermatologist who will excise, or remove, the lesion, send it to a lab for testing, and recommend a future treatment plan.
During his initial visit, Richardson's dermatologist examined his whole body, surgically removed the patch on his head using local anesthesia, and used liquid nitrogen to treat several other pre-cancerous areas on his scalp, face, and chest.
A cream called 5-fluorouracil/epinephrine (5-FU) may also be used to help treat precancerous areas.
After the lab biopsy confirmed that Richardson had basal cell carcinoma and that the entire lesion had been removed, his dermatologist gave him a stern lecture on the use of sunscreen and hats, and instructed him to come back every six months.
"He said that since I'm prone to skin cancer, I need to be really careful," Richardson says.
Surgical excision is the common approach for skin cancer, and it's most often handled on an outpatient basis by a dermatologist. But larger lesions or those found to be melanoma may require additional treatment. If a melanoma is more than approximately a millimeter deep, a patient may be referred to an oncologist to explore other options, such as
Skin cancers around particularly sensitive structures—the fold of the nose, the eyelid, the corner of the mouth, and the lining of the ear—can lead to a poor cosmetic outcome if removed by surgery. Radiation therapy, in experienced hands, can be as successful as surgery in preventing the tumor from returning while sparing the removal of tissue and the inevitable scarring that occurs.
Although skin cancer is rarely fatal, even the nonfatal forms can result in pain and scarring. They also often occur on the face, the last place on the body you want to have a large—or small—area of skin removed. That's why it's so important to practice preventive measures.
The AAD recommends the following:
- Use a waterproof sunscreen with a sun protection factor (SPF) of at least 15 anytime you're outside.
- Avoid outdoor activities between 10:00 am and 4:00 pm, when the sun is strongest.
- Wear a hat and sunglasses.
In addition to these common sense steps, research also suggests that what you eat can help protect your skin.
It is plausible that antioxidants can help reduce the risk of skin cancer caused by free radicals. Some researchers suggest that
Examine Your Skin Regularly
Beyond staying out of the sun and eating your tomatoes, the best move you can make to prevent skin cancer is to regularly examine your skin for any changes. Cancers usually present as lumps or areas of skin with changed color, but precancerous conditions needing treatment often feel rough like sandpaper.
If you do have skin cancer, it's likely to be a non-aggressive carcinoma, rather than a deadly melanoma. But a layperson might not be able to distinguish between the two, making any delay in treatment a potentially deadly one. If you experience any unusual or new growth on your skin, make an appointment with your primary care doctor or a dermatologist.
* Not his real name.
American Academy of Dermatology
The Skin Cancer Foundation
BC Cancer Agency
Canadian Cancer Society
Last reviewed December 2008 by
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