Skin cancer is the most common type of cancer, probably making up more than half of all diagnosed cases of cancer, according to the American Cancer Society (ACS). The incidence of skin cancer is rising dramatically in the United States. More than three million cases of non-melanoma are diagnosed each year, leading to about 3,000 deaths.
And the ACS estimates that in 2012, there will be 76,250 new cases of melanoma and 9,180 deaths from the disease. In fact, between 40 percent and 50 percent of people in the United States over age 65 will develop non-melanoma skin cancer. This type of cancer is highly treatable when diagnosed in its early stages and is usually relatively easy to diagnose.
The majority of lifetime sun exposure occurs before age 20, and skin cancer can take 20 years or more to develop. In fact, very young children who experience as few as two to three severe sunburns are believed to have an increased risk of developing skin cancer later in life. That’s not to say you should ignore your risk of developing skin cancer. You need to be concerned about skin cancer, whether your sunbathing days are over or you still spend time pursuing the perfect tan.
What is skin cancer?
Skin cancer is a common and locally destructive cancerous (malignant) growth of the skin. It originates from the cells that line up along the membrane that separates the superficial layer of skin from the deeper layers. Unlike cutaneous malignant melanoma, the vast majority of these sorts of skin cancers have a limited potential to spread to other parts of the body (metastasize) and become life-threatening.
There are three major types of skin cancer:
(1) basal cell carcinoma (the most common)
(2) squamous cell carcinoma (the second most common), which originate from skin cells,
(3) melanoma, which originates from the pigment-producing skin cells (melanocytes) but is less common, though more dangerous, than the first two varieties.
The Structure of Skin
The skin is the largest organ in your body and is the body’s first defense against disease and infection. It also protects your internal organs from injuries. The skin regulates body temperature, prevents excess fluid loss and helps to remove excess water and salt from your body.
Skin is composed of two layers: the epidermis (the outermost layer of skin) and the dermis (the lower layer). The epidermis itself has four layers: the stratum corneum, the granular layer, the squamous cell layer and the basal cell layer. Keratin (dead, dense protein cells) makes up the stratum corneum or outer layer of the epidermis—the skin layer that can be seen and felt.
The granular layer moves the dead keratin cells to the surface of the epidermis. The squamous cell layer produces keratin for the stratum corneum and also transports water. The basal cell layer is the lowest layer of the epidermis. This is where squamous cells are produced and where the cells that produce melanin, or skin pigment, reside.
The dermis is the deeper layer of skin. It is a diverse combination of blood vessels, hair follicles and sebaceous glands or oil glands. The proteins collagen and elastinare found in the dermis. They provide support and elasticity to the skin. The sun’s rays eventually break down these proteins. With age, the skin naturally begins to wrinkle and sag.
The subcutaneous level, or subcutis, is a layer of fatty tissue that provides nourishment to the dermis and upper layers of skin. It also conserves body heat and cushions internal organs against trauma. Blood vessels, nerves, sweat glands and deeper hair follicles are found here.
Types of Skin Cancer
There are two main groups of skin cancer: non-melanoma skin cancer, the most common type of skin cancer, and melanoma (sometimes referred to as “malignant melanoma”) skin cancer.
According to the ACS, basal cell carcinoma makes up 80 percent of non-melanoma skin cancers, and squamous cell carcinomas account for about 20 percent. Together, these two types account for about 95 percent of all new cases of skin cancer. Over three million cases of non-melanoma skin cancer are diagnosed every year in the United States. Men have a higher risk than women of developing these skin cancers.
Melanoma is the least common, but most aggressive, of the three types of skin cancer. It originates in the skin’s melanocytes—the cells that produce pigment, or melanin.
In 2012, the ACS estimates that 76,250 new cases of melanoma will be diagnosed in the United States—about 4 percent of all diagnosed skin cancers. But melanoma accounts for about 75 percent of skin cancer deaths. One person dies of melanoma almost every hour (every 62 minutes).
Skin cancer is an abnormal growth of skin cells. It most often develops on areas of the skin exposed to the sun’s rays. Skin cancer affects people of all colors and races, although those with light skin who sunburn easily have a higher risk.
What does skin cancer look like?
1] Actinic Keratoses (AK)
These dry, scaly patches or spots are precancerous growths.
- People who get AKs usually have fair skin.
- Most people see their first AKs after 40 years of age because AKs tend to develop after years of sun exposure.
- AKs usually form on the skin that gets lots of sun exposure, such as the head, neck, hands, and forearms.
- Because an AK can progress to a type of skin cancer called squamous cell carcinoma (SCC), treatment is important.
2] Basal cell carcinoma (BCC)
This is the most common type of skin cancer.
- BCCs frequently develop in people who have fair skin, yet they can occur in people with darker skin.
- BCCs look like a flesh-colored, pearl-like bump or a pinkish patch of skin.
- BCCs develop after years of frequent sun exposure or indoor tanning.
- BCC are common on the head, neck, and arms, yet can form anywhere on the body, including the chest, abdomen, and legs.
- Early diagnosis and treatment for BCC is important. BCC can invade the surrounding tissue and grow into the nerves and bones, causing damage and disfigurement.
3] Squamous cell carcinoma (SCC)
SCC is the second most common type of skin cancer.
- People who have light skin are most likely to develop SCC, yet they can develop in darker-skinned people.
- SCC often looks like a red firm bump, scaly patch, or a sore that heals and then re-opens.
- SCC tend to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, chest, and back. SCC can grow deep in the skin and cause damage and disfigurement. Early diagnosis and treatment can prevent this and stop SCC from spreading to other areas of the body.
Melanoma is the deadliest form of skin cancer
- Melanoma frequently develops in a mole or suddenly appears as a new dark spot on the skin.
- Early diagnosis and treatment are crucial.
- Knowing the ABCDE warning signs of melanoma can help you find an early melanoma.
It is important to remember the “ABCs” of melanoma. The AAD has developed an easy-to-use method to evaluate your skin for melanoma. Look for:
- Asymmetry: One half of the spot is not shaped like the other half.
- Border irregularity: Poorly defined, ragged, blurred, notched or “scalloped” border.
- Color: Shades of tan, brown, black, and sometimes red, white and blue, vary across the mole.
- Diameter: The spot is larger than six millimeters, about the diameter of a pencil eraser. However, in recent years, health care professionals are finding more melanomas between three and six millimeters.
- Evolving: The mole or skin lesion looks different from the rest or is changing in size, shape or color.
Excessive sun exposure causes the majority of melanoma. A family history of the disease is also a major risk factor. Individuals with a family history of melanoma, or who have had melanoma in the past, may need to see a dermatologist regularly in addition to performing self-examinations. Talk to your dermatologist about how often you should be professionally screened. To learn how to effectively perform a self-examination, visit The Skin Cancer Foundation.
Other types of skin cancer:
Less common types of skin cancer, which together make up only 1 percent of all cancers, include:
This form starts in the blood vessels of the dermis and subcutaneous layers and can affect internal organs. Prior to the middle 1980s, this skin cancer was very rare. But since it often afflicts people infected with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), it has become more common.
These are cancers that form in the cells of your connective tissues but occasionally they begin in the dermis. Angiosarcoma, a blood vessel cancer, is one example.
These skin cancers originate in the skin’s lymphocytes, which are immune system cells found in the bone marrow and blood. The most common cutaneous lymphoma is cutaneous T-cell lymphoma, also called mycosis fungoides.
These are typically benign tumors that originate in the hair follicles and sweat glands. Occasionally they can be malignant.
Merkel cell carcinoma.
This rare cancer begins in the skin’s neuroendocrine cells. It frequently returns after treatment and can spread to internal organs and lymph nodes.
What are the risk factors for skin cancer?
The most common risk factors for skin cancer are as follows.
- Ultraviolet light exposure, either from the sun or from tanning beds. Fair-skinned individuals, with hazel or blue eyes, and people with blond or red hair are particularly vulnerable. The problem is worse in areas of high elevation or near the equator where sunlight exposure is more intense.
- A chronically suppressed immune system (immunosuppression) from underlying diseases such as HIV/AIDS infection or cancer, or from some medications such as prednisone or chemotherapy
- Exposure to ionizing radiation (X-rays) or chemicals known to predispose to cancer such as arsenic
- Certain types of sexually acquired wart virus infections
- People who have a history of one skin cancer have a 20% chance of developing a second skin cancer in the next two years.
- Elderly patients have more skin cancers.
Is skin cancer hereditary?
Since most skin cancers are caused by ultraviolet light exposure, skin cancers are generally not considered to be inherited. But the fact that skin cancer is much more common among poorly pigmented individuals and that skin color is inherited does support the proposition that genetics are very important. There are some very rare genetic syndromes that result in an increased number of skin cancers in those affected.
What causes skin cancer?
It appears basal cell skin cancers arise from DNA mutations in the basaloid cells in the upper layer of the skin. Many of these early cancers seem to be controlled by natural immune surveillance, which when compromised may permit the development of masses of malignant cells that begin to grow into tumors.
In squamous cell cancers, the tumors arise from normal squamous cells in the higher layers of the skin of the epidermis. As with basal cell cancers, these cells are prevented from growing wildly by natural mutational repair mechanisms. When there is an alteration in these genes or the immune surveillance system that controls it, these skin cancers start to grow. In most instances, the genes are altered by ultraviolet exposure.
What are the signs and symptoms of skin cancer?
Most basal cell carcinomas have few if any symptoms. Squamous cell carcinomas may be painful. Both forms of skin cancer may appear as a sore that bleeds, oozes, crusts, or otherwise will not heal. They begin as a slowly growing bump on the skin that may bleed after minor trauma. Both kinds of skin cancers may have raised edges and a central ulceration.
Signs and symptoms of basal cell carcinomas include:
- Appearance of a shiny pink, red, pearly, or translucent bump
- Pink skin growths or lesions with raised borders that are crusted in the center
- Raised reddish patch of skin that may crust or itch, but is usually not painful
- A white, yellow, or waxy area with a poorly defined border that may resemble a scar
Signs and symptoms of squamous cell carcinomas include:
- Persistent, scaly red patches with irregular borders that may bleed easily
- Open sore that does not go away for weeks
- A raised growth with a rough surface that is indented in the middle
- A wart-like growth
Actinic keratoses (AK), also called solar keratoses, are scaly, crusty lesions caused by damage from ultraviolet light, often in the facial area, scalp, and backs of the hands. These are considered precancers because if untreated, up to 10% of actinic keratoses may develop into squamous cell carcinomas.
When is a mole dangerous or high-risk for becoming a skin cancer?
Moles are almost always harmless and only very rarely turn into skin cancer. If a mole becomes cancerous, it would be a melanoma. There is a precancerous stage, called a dysplastic nevus, which is somewhat more irregular than a normal mole. An early sign of melanoma is noticing a difference in a mole: asymmetry, irregular border, color changes, increasing diameter, or other evolving changes may signify a mole is melanoma. Moles never become squamous cell carcinomas or basal cell carcinomas.
What are the most common sites where skin cancer develops?
Skin cancers typically arise in areas of the skin exposed to the sun repeatedly over many years such as on the face and nose, ears, back of the neck, and the bald area of the scalp. Less commonly, these tumors may appear at sites with only limited sun exposure such as the back, chest, or the extremities. However, skin cancer may occur anywhere on the skin.
How do physicians diagnose skin cancer?
To determine if your skin abnormalities are skin cancer, your dermatologist may perform a biopsy: taking a sample of skin to examine under a microscope. After receiving a local anesthetic, you may feel some minor discomfort—a small needle stick, burning and pressure. There are four primary types of biopsies:
- Shave biopsy. The top layers of skin, the epidermis and a part of the dermis are shaved off in a thin slice.
- Punch biopsy. A deeper, cylindrical core sample of the skin layers and part of the fat layer is taken.
- Incisional biopsy and excisional biopsy. A wider, deeper sample of all your skin layers is taken, then the skin is sutured with stitches. Incisional biopsies remove a portion of the tumor and excisional biopsies remove the entire tumor.
- Biopsies of cancer that has spread. In some cases, biopsies of areas other than the skin may be necessary. To find out if—and where—a skin cancer has spread, your health care professional may use one or more of the following tests:
- Fine needle aspiration biopsy. Using a fine needle to remove very small tissue fragments, fine needle aspiration (FNA) biopsy may be used to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread.
- Surgical (excisional) lymph node biopsy. If a lymph node’s size suggests melanoma has spread but an FNA biopsy doesn’t find any melanoma cells, your health care professional may remove the enlarged node through a small skin incision to take a closer look.
- Sentinal lymph node biopsy. Sentinal node biopsy is typically performed for melanomas beyond Stage 0. Dye is injected into the skin at the site of the tumor to identify the one or several “sentinel” lymph nodes in the region that “cleanse” that area of the skin. These few lymph nodes are then removed and carefully examined for evidence of cancer. If positive, a full lymph node dissection is usually performed.
To determine how widespread a melanoma is, your health care professional uses a system to describe its size and pervasiveness.
The most common system is called the “TNM” system in which:
- T stands for the “tumor”—noting the size and how far it has spread within the layers of the skin and nearby tissue.
- N denotes tumor that has spread to lymph nodes.
- M stands for metastasize, in which the cancer has spread to distant organs.
Using this system, melanomas are grouped according to stage. The stages are:
- Stage 0. The melanoma only involves the epidermis. Also called melanoma in situ.
- Stage I. This stage tumor is between 1.0 and 2.0 mm and may or not be ulcerated. It appears to affect only the skin and has not been found in lymph nodes or distant organs. This stage has a five-year survival rate of 86 percent to 95 percent.
- Stage II. A tumor with any thickness greater than a stage I tumor that appears to affect only the skin and has not been found in lymph nodes or distant organs. This stage has a five-year survival rate of about 40 percent to 67 percent.
- Stage III. A melanoma that has spread to lymph nodes near the skin where it originally began. This stage has a five-year survival rate of about 24 percent to 68 percent.
- Stage IV. A melanoma that has spread well beyond the originally affected skin and the nearby lymph nodes. It has metastasized to vital organs or to distant areas of the skin or distant lymph nodes. This stage has a five-year survival rate of 15 to 20 percent.
A skin examination by a dermatologist is the way to get a definitive diagnosis of skin cancer. In many cases, the appearance alone is sufficient to make the diagnosis.
A skin biopsy is usually used to confirm a suspicion of skin cancer. This is performed by numbing the area under the tumor with a local anesthetic such as lidocaine. A small portion of the tumor is sliced away and sent for examination by a pathologist, who looks at the tissue under a microscope and renders a diagnosis based on the characteristics of the tumor.
What is the treatment for skin cancer?
There are several treatments your dermatologist may prescribe for actinic keratoses (precancerous lesions) or skin cancer:
For precancerous lesions:
- Topical chemotherapy, which uses drugs like fluorouracil (5-FU) to kill precancerous cells
- Cryotherapy, which involves freezing precancers with liquid nitrogen
- Scraping (curettage), which involves scraping off damaged cells
- Chemical peeling, during which one or more chemical solutions are applied to the area
- Photodynamic therapy, which involves applying a chemical that makes the skin more sensitive to light and then using an intense laser to destroy damaged skin cells
- Laser therapy, which uses a special laser to remove the actinic keratoses and affected skin
- Dermabrasion, a procedure that removes affected skin with a rapidly moving brush
For non-melanoma skin cancers:
- Topical chemotherapy, which uses drugs like fluorouracil (5-FU) to kill precancerous cells
- Cryosurgery, which involves freezing precancers with liquid nitrogen
- Photodynamic therapy, which involves applying a chemical that makes the skin more sensitive to light and then using an intense laser to destroy damaged skin cells
- Immune response modifiers, or drugs that boost the immune response against the cancer, causing it to shrink and disappear
- Curettage and electrodessication. A sharp instrument resembling a vegetable peeler called a curette is used to scrape away the cancer, and an electric current or needle burns the borders of the site where the tissue was removed.
- Simple excision. The cancer is cut from the skin along with some of the healthy tissue around it. This may scar your skin, so sometimes skin is taken from another part of your body and grafted over the area where the cancer was removed.
- Mohs micrographic surgery. This surgical technique has a high five-year cure rate, which approaches 98 percent. The procedure, which is usually performed in the surgeon’s office on an outpatient basis, removes the cancer and as little normal tissue as possible. The surgeon then uses a microscope to examine the borders of the removed tissue to ensure no cancer cells remain.
- Laser surgery. A relatively new technique, laser surgery uses a beam of light to vaporize cancer cells in squamous cell carcinoma in situ, which involves only the epidermis, and very superficial basal cell carcinomas. This treatment is currently not widely used.
- Lymph node surgery. If the lymph nodes near a non-melanoma skin cancer are growing larger, those nodes may be biopsied or removed and examined under a microscope for signs of cancer. This procedure is more involved than skin surgeries and usually requires general anesthesia.
- Skin grafting and reconstructive surgery. If a surgically removed non-melanoma skin cancer was large, the nearby skin may not stretch far enough to close the wound. In a case like this, healthy skin may be taken from another part of the body and grafted over the wound to help with healing.
- Surgery. Most melanomas are surgically removed with a layer of healthy surrounding skin, the size of which is based on the thickness of the melanoma tumor under the microscope (determined during the biopsy). A specific type of surgery called Mohs surgery is sometimes used to treat ill-defined shallow melanoma tumors in the head and neck area.
- Lymph node dissection. During this procedure, the surgeon removes all of the lymph nodes in the region of the melanoma. Once a diagnosis of melanoma is made, the physician will examine the lymph nodes closest to the melanoma, either by physical examination or imaging tests. If the nearby lymph nodes feel abnormal and a fine needle aspiration or excisional biopsy reveals the melanoma has spread, a lymph node dissection will most likely be done.
- Immunotherapy. Immunotherapy uses substances produced by the body or similar substances produced in a laboratory to stimulate the immune system to help the body fight cancer. This treatment is typically used for melanomas that are very thick or when lymph nodes are involved. Specific therapies include ipilimumab (Yervoy), interferon and interleukin-2 (IL-2). Side effects of these treatments include headache, chills, fever, fatigue and muscle aches.
- Oral or injected chemotherapy. Chemotherapy is the use of medicines to slow or stop the growth of cancer cells. In the case of melanoma, chemotherapy is typically used for metastatic disease to shrink tumors. The most common chemotherapy drug used for melanoma is dacarbazine (DTIC).
- The drug temozolomide (Temodar), an oral pill, may also be given. It acts similarly to DTIC. Physicians give chemotherapy in cycles, with a period of treatment followed by a period of rest to allow the body to recover. Each cycle typically lasts for a few weeks. Side effects of these drugs include nausea and vomiting.
In severe cases of melanoma that are confined to an arm or leg, a type of chemotherapy called isolated limb perfusion may be done. During this surgical procedure, blood flow to the arm or leg is separated from the rest of the body, and a high dose of chemotherapy is injected into the limb for a short period of time.
About 90 percent of all skin cancers could be prevented by protecting yourself from the harmful rays of the sun, especially from 10 a.m. to 4 p.m.
Sunlight consists of two types of ultraviolet (UV) rays that damage skin—UVA and UVB rays. UVC rays, another spectrum in sunlight, are also potentially harmful, but the ozone layer blocks most of them from reaching the earth. UVA and UVB rays are present all year and are hazardous, whether they are direct or reflected. When the sun’s ultraviolet radiation reaches the surface of the skin, the skin reacts by producing melanin—otherwise known as a tan—to protect itself.
UVB rays are the main cause of sunburn and skin cancer. This type of sunlight intensifies during the summer and damages skin more quickly than UVA rays. The epidermis absorbs most of the intensity of UVB rays.
UVA rays are milder than UVB rays, but because their wavelengths are longer, they penetrate deeper through the skin’s layers. UVA rays also penetrate through glass and are present on cloudy days and all year round, even early and late in the day. UVA rays contribute to wrinkling of the skin and immunosuppression, as well as the development of skin cancer.
UVA rays also are used in tanning booths. There, they not only inflict the same type of skin and eye damage as the sun, they may be as much as 12 times stronger than natural sunlight, depending on the bed. UVA rays also can pass through window glass, unlike UVB rays.
To screen for skin cancer, ask your health care professional to examine your skin carefully as part of a routine cancer-related checkup. You should also examine your own skin for abnormalities, preferably once a month. If you find anything suspicious, make an appointment with your health care professional.
Minimize Total Sun Exposure
For the best protection from the sun’s harmful rays:
- Stay in the shade whenever you can.
- Limit the time you spend in the sun.
- Avoid the sun between 10 a.m. and 4 p.m., when its rays are strongest.
- Be aware that the sun’s ultraviolet (UV) rays can reflect off water, sand, concrete and snow, and can reach below the water’s surface, as well as burn on an overcast day.
- Wear a large-brimmed hat and sunglasses to protect your scalp and eyes.
- Wear a cool, long-sleeved shirt and long pants with a tight weave (or made of material especially designed for sun protection) whenever possible.
- Select a broad-spectrum sunscreen, which protects against both UVA and UVB rays. Apply sunscreen with an SPF of 30 or higher 15 to 30 minutes before sun exposure, with careful attention to sun-exposed areas such as the face, hands and arms.
- Apply lip balm with an SPF of 15 or higher to protect sun-sensitive lips.
- Reapply about an ounce (the size of a shot glass) of sunscreen at least every two hours, more frequently if you’ve been swimming or sweating.
- Be particularly cautious if you’re taking an antibiotic or other medication that can make your skin more sensitive to the sun.
Don’t forsake the sun altogether. Instead, follow these steps to greatly reduce your risk of developing skin cancer.
Nothing is as effective at reducing your risk of skin cancer as avoiding the sun or using physical “screens” such as umbrellas, broad-brimmed hats and long-sleeved shirts. However, sunscreens should also be an important part of your skin health routine whenever skin will be exposed to the sun because they absorb ultraviolet (UV) rays.
The Food and Drug Administration (FDA) put new sunscreen labeling rules into effect in 2012 to help you choose your sunscreen wisely. Here’s what to look for:
The regulations establish a standard test for over-the-counter sunscreen products to determine which may be labeled “broad spectrum.” Products that pass the test will protect against both UVB and UVA radiation. Although UVB primarily causes sunburn, both forms of UV rays can cause sunburn, skin damage and skin cancer.
Sunscreen products that pass the FDA test must provide a sun protection factor (SPF) of 15 or higher. The higher the SPF, the greater level of overall protection. A product rated SPF 30 is designed to provide approximately 30 times more protection than nothing. Wearing sunscreen with SPF 30 allows you to be in the sun 30 times longer without burning than if you had no protection, but no sunscreen can completely prevent burning.
A sunscreen with SPF 30 or greater should be used all year for all skin types. The FDA has proposed a regulation that limits the upper end of SPF labeling to “SPF 50+” because there is not adequate data to prove that products with SPF values higher than 50 provide additional protection over those with SPF 50.
Claims on the sunscreen’s front label must tell how much time you can expect to get the declared SPF level of protection while swimming or sweating, based on standard testing. Two times will be permitted on labels: 40 minutes or 80 minutes. Manufacturers will not be allowed to claim that sunscreens are “waterproof” or “sweatproof” and may not identify their products as “sunblocks.”
Sunscreens cannot claim “instant protection” (or any similar term that implies you are protected as soon as you put the sunscreen on your skin) or protection for more than two hours without reapplication, unless the manufacturer submits data and gets approval from the FDA.
The new regulations apply to sunscreens in the form of oils, creams, lotions, gels, butters, pastes, ointments, sticks and sprays. The FDA is continuing to study spray products to establish levels of effectiveness and to see if there’s any danger from accidental inhalation. Until that information is available, if you (or your kids) prefer the spray sunscreens, be sure to use a lotion on and near your face and apply the spray generously to the other parts of your body.
Remember, any sunscreen not labeled as “broad spectrum” or that has an SPF value between 2 and 14 may only help protect against sunburn (and even there, your protection is minimal). These products must carry a “Skin Cancer/Skin Aging Alert” to remind you that you are not protected against skin cancer or early skin aging.
If you develop a rash or other type of allergic response to a sunscreen, try a different brand or form (lotion vs. oil, for example) to see if you can better tolerate it. Sunscreens containing higher levels of SPF tend to stay on the skin longer. Gels wash off more easily and need to be reapplied more frequently, but may be preferable if you are acne-prone or have sensitive skin.
Facts to Know
- The most serious consequence of sun exposure is skin cancer.
- Skin cancer is the most common type of cancer.
- Skin cancer can take 20 years or more to develop.
- Anyone can develop skin cancer and precancerous conditions, although people with fair complexions tend to be more susceptible than people with darker skin tones.
- Although African Americans are diagnosed with melanoma less often than whites, they have a higher death rate from the disease. According to the Skin Cancer Foundation, the overall survival rate for African Americans is 77 percent, compared to 91 percent in whites.
- The earliest warning sign of severe skin damage is the development of actinic keratoses—rough, crusty bumps on sun-exposed areas that may itch or feel tender when exposed to sunlight. Actinic keratoses affect more than 10 million people in the United States and are becoming more common.
- There are two main forms of skin cancer: non-melanoma and melanoma—often referred to as “malignant melanoma.” Several other very rare types of skin cancer exist but account for less than one percent of all skin cancer cases.
- Basal cell carcinoma and squamous cell carcinoma are the most common types of non-melanoma skin cancer, comprising about 95 percent of all skin cancer cases—approximately one million each year, according to the ACS. These cancers are slow growing and rarely spread to other parts of the body.
- Melanoma is the least common, but most aggressive, of the three main types of skin cancer. The American Cancer Society predicts that there will be about 76,250 cases of melanoma diagnosed in 2012. Melanoma accounts for about 4 percent of all diagnosed skin cancers—but it accounts for about 75 percent of skin cancer deaths.
- The sun’s UVA rays contribute to wrinkling and burning of the skin, as well as to the development of skin cancer. UVA rays are also used in tanning booths where they may be up to 12 times stronger than natural sunlight, depending on the bed.
1. Are tanning beds safer than the sun?No.
Tanning beds use UVA rays. They may not only inflict the same type of skin and eye damage as the sun, but may also be as much as 12 times stronger than natural sunlight. Although UVA rays are milder than UVB rays—the main cause of sunburn and sun cancer—UVA wavelengths are longer and they penetrate deeper through the skin’s layers. UVA rays contribute to wrinkling the skin, as well as to the development of skin cancer.
2. If someone in my family has had skin cancer, does this increase my risk for developing the disease?
Yes. Although sun exposure is responsible for most cases of melanoma, a family history of the disease can also be a risk factor. You are especially at risk if other members of your immediate family have had melanoma. People with atypical moles (nevi) are also at higher risk for developing melanoma. Individuals with a family history of melanoma, or who have had melanoma in the past, may need to see a dermatologist regularly in addition to performing self-examinations. Talk to your dermatologist about how often you should be professionally screened.
3. Are dark-skinned people immune to skin cancer?
No. Anyone can develop skin cancer, although people with fair complexions tend to be more susceptible to skin cancer and precancerous conditions than people with darker skin tones. In addition to fair skin and light hair, risk factors for skin cancer include: a tendency to freckle or burn easily; lots of sun exposure throughout your life; sunburns as a child or adolescent; family history of the disease; history of radiation therapy; chronic scarring from diseases or burns; and exposure to toxic materials such as arsenic.
4. What type of SPF should I look for in a sunscreen?
Many groups, including the American Academy of Dermatology, recommend using broad-spectrum products with a sun protection factor (SPF) of 30 or more.
5. Should I avoid the sun altogether?
No. Sunlight is our primary source of vitamin D, important for building strong bone and other health-related issues. Sunlight isn’t entirely bad, but tanning (and long-term exposure) is. Learn how to protect your skin whenever you’re outside.
6. Does sunscreen prevent sunburn?
While sunscreen helps minimize damaging sunburns, it doesn’t completely prevent burning. The best prevention is still to minimize the total amount of sun exposure your skin receives. This includes avoiding the sun between 10 a.m. and 4 p.m., when its rays are strongest; wearing a large-brimmed hat and sunglasses to protect your scalp and eyes; covering other sun-exposed parts of your body; staying in the shade when possible; and limiting the time you spend in the sun.
7. My skin is sensitive and acne-prone, and sunscreen irritates it. What can I do?
If you’re prone to rashes, try different brands and types of sunscreen until you find one that doesn’t cause a rash. Gels wash off more easily and need to be reapplied more frequently than sunscreen lotions or creams, but they may be preferable if you are acne-prone. Discuss you skin reactions with your health care professional, perhaps a dermatologist, for other suggestions.
8. It’s been years since I’ve tanned my skin. Do I still need to worry enough about skin cancer to do self-exams?
It’s important to remember that your average lifetime sun exposure risk occurs before age 20, and that skin cancer can take 20 years or more to develop. In fact, very young children who experience as few as two to three severe sunburns are believed to have an increased risk of developing skin cancer later in life. So examine your skin once a month for anything unusual.
9. I’ve never had moles before, but I just noticed a brown spot on my skin. Should I be worried?
Although melanoma typically begins in or around an existing mole, it can also appear without warning on clear skin. You should bring your condition to the attention of your dermatologist for further evaluation and an accurate diagnosis.
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