There is a true epidemic of skin cancer in America. One million cases of skin cancer will occur this year in America. Lifelong sun exposure is increasing for Americans as we spend more time outdoors and the sun’s rays are becoming more intense with our loss of ozone. The use of tanning booths is a new way to further damage our skin and raise our risk for skin cancers. There are three common forms of skin cancer and we are seeing dramatic annual increases in the number of these skin cancers. Melanoma, which is the most aggressive form of skin cancer, is now the most common cause of cancer deaths in American women under forty years old.
Basal Cell Carcinoma The most common and least aggressive form of skin cancer is basal cell carcinoma. This is the most common cancer in America and happily it causes nearly no fatalities. This cancer is most common on light skinned people and thirty percent of Caucasian people in America are expected to have a basal cell in their lifetime. The great majority of basal cell carcinomas will occur on the head and neck. Though this form of cancer almost never enters the bloodstream or the lymph system, it may be locally invasive. Basal cells do grow by local extension and over time can erode and invade not just skin, but other important areas down to muscle or bone. There are more aggressive forms of basal cell carcinoma that will infiltrate and extend below the surface more than above the surface. These tumors are especially dangerous for the surrounding tissue. Basal cell tumors often appear as pale or translucent patches or raised bumps on the skin with fine blood vessels in them. They may grow for months or years without detection. The often ulcerate and bleed as they grow, but otherwise have no symptoms like itching or pain. The tendency towards growing basal cells is inherited and many patients report at least one family member with a history of basal cell. Patients will often have more than one basal cell in their lifetime and I have seen patients who have had dozens of them. Darker skin tends to get fewer basal cells but one of the first lesions I had in my new practice was an African-American women with a basal cell on the leg. She is fine and nearly everyone who has this is fine. With early detection and removal this should simply be a speed bump on the road of life. I have seen already seen hundreds of basal cells in my young practice. I have seen a woman from Fort Mill and a man from Ballantyne who both grow basal cells like I grow tomatoes. They are both fine and happy that their lesions were not anything worse than basal cells.
Squamous Cell Carcinoma The second most common form of skin cancer is squamous cell carcinoma. There are far fewer of these than basal cell carcinomas, and these do have a higher rate of spreading internally. Though some squamous cell carcinomas of the skin potentially may metastasize, they are far less dangerous than melanomas. These tumors often start as scaly, red plaques on chronically sun exposed skin like the face, ears, shins, arms, and hands. There is a form of squamous cell that grows rapidly, sometimes even in days, and looks like a cyst. This is called a keratoacanthoma and is a non-aggressive tumor. The biggest risk factors for these to become metastatic is an immunocompromised patient, a tumor growing on certain areas like the lip or ears, and a long delay in treatment. I had a recent patient from Waxhaw with three keratoacanthomas in less than one month. Her lesions all “popped up” over a few days and were easily treated.
Melanoma The malignant tumor that arises from our mole cells is called melanoma. There are over 160,000 case of melanoma each year in America and nearly 8,000 deaths. The rates of this cancer are increasing at an alarming rate. Increased ultraviolet radiation from the sun and indoor tanning are the clear cause for this increase. This summer the World Health Organization rated the use of tanning beds to be in the same cancer risk category as “mustard gas” and “arsenic”. With the rise of tanning booth use we have seen a parallel rise in the number of cases of melanoma, especially in younger patients. Outdoor tanning is also a major risk not just for all three of these skin cancers, but for wrinkles and sun spots.
The key to surviving a melanoma is early detection. The earlier we find and remove a melanoma the more likely that person will survive. These tumors will thicken with time and the thicker they grow the more likely they will spread throughout the body. Once a melanoma has spread it can be impossible to stop.
Melanoma is nearly always a dark and irregular lesion. It can occur anywhere on the skin but is most commonly on the trunk in men, with more leg lesions occurring in women. We talk about the ABCD’s of melanoma when looking for it: A is for asymmetric lesions, B is for irregular borders, C is for color variation and especially darker colors, and D is for diameter larger than a pencil eraser. The darker a lesion, the scarier the lesion.
There are definite risk factors for melanoma. Besides tanning booths, a family history can multiply your lifetime risk for melanoma. There are families with atypical or “dysplastic” moles; these are considered precancerous lesions that are associated with a greatly increased risk for melanoma. A history of even one severe sunburn will also raise your risk. Even spending one summer as a lifeguard has been correlated with increased odds of having a melanoma.
The most important lesson of melanoma and all skin cancers is to be diligent in checking yourself and preventing the sun damage that leads to skin cancer. Sunscreen, sun avoidance, protective clothing, and checking your skin are all things that may save your life. Melanoma is often called the most preventable form of cancer death. Know what to look for and look often. I recommended monthly skin self-examinations and an annually skin cancer screening with your dermatologist.
David B. Schulman M.D., F.A.A.D.
South Charlotte Dermatology
Board Certified Dermatologist