Skin Cancer

Summer is definitely here. Whether you’re in the city this summer, traveling abroad (Olympics anyone?!), upstate, out east, or at the shore, you’ll be exposed to sunlight. This brings lots of good things - boosts of serotonin and vitamin D, more time to exercise outdoors, and better sleep. Of course the sun also brings ultraviolet (UV) radiation exposure, so like all good things it must be enjoyed in moderation.

Skin cancers as a whole are THE MOST common cancer diagnosis in the world, affecting one in five people in the US by 70 years of age. It is frequently missed simply because we are not looking; this is especially true in people with dark skin, in whom skin cancer is frequently detected only in its late stages. Even more tragic is the fact that 90% of skin cancers are preventable with sun protection and tanning bed avoidance.

Basal cell carcinoma (BCC) is the most common skin cancer in the US. Christie Brinkley and Richard Simmons recently announced their diagnoses and subsequent treatment. So did my dad, with slightly less publicity. Fortunately he had a quick and beautiful Moh’s surgery and is doing just fine.

See? You don’t even know where it was!

Squamous cell carcinoma (SCC) is the second most common skin cancer in the US. It is often preceded by actinic keratoses (AKs), the rough scaly patches that can occur on sun-exposed skin as we age.

Merkel cell carcinoma is quite rare but garnered a lot of attention last year with Jimmy Buffett’s death following a four-year battle.

Melanoma is the deadliest of the skin cancers. It metastasizes relatively easily if not detected and treated early. Its incidence in young people is climbing, and it’s currently one of the top five most common cancer diagnoses in adolescents and young adults aged 15 to 39.

Fair skin is an obvious risk factor for skin cancer but not the only one. With melanoma specifically, having a first-degree relative (parent, sibling, child) with melanoma increases your risk of melanoma by 74%, BCC by 27%, and SCC by 22%. That said, 86% of melanoma cases are due to UV radiation exposure and thus preventable. The most haunting statistic I found was that the risk of melanoma doubles if you were sunburned more than five times in your life.

So how can you prevent these very preventable cancers?

1. Do monthly self exams as demonstrated in this YouTube video from the Skin Cancer Foundation. Be sure to check palms, soles, between fingers and toes, and under/around nails, as one type of melanoma has a predilection for these often overlooked areas.

There are a few ways to think about detection. Use the tool that is easiest for you to remember:

• New: especially after age 21

• Changing: in color, shape, size or texture

• Unusual: in outline; or continuously itch, hurt, crust or bleed for more than three weeks

• Asymmetry: One half of a mole or birthmark does not match the other half.

• Border: The border is irregular or notched.

• Color: A mole that has multiple colors or shades within it

• Diameter: The size of, or larger than, a pencil eraser

• Evolution: Any change in size, shape, or color of a spot on your skin

2. Have an annual total body skin examination with a board-certified dermatologist. They will use digital dermoscopy and take photos to look for changes year to year. They may also recommend treatment of AKs to help prevent progression to SCC.

3. Seek shade when outdoors, especially between 10 AM and 4 PM, when UV rays are the strongest. Even in shade though, rays pass through leaves and branches, hit your skin from the side, and reflect off water, sand, glass, and concrete. You can burn in the water, on cloudy days, and even through the windows of a car, bus, plane, or train (glass blocks UVB rays but not UVA.)

4. Wear long-sleeve shirts and pants as much as possible; all the better if the clothing is made from UV Protection Factor (UPF) rated fabrics. These protect against UVA and UVB radiation.

5. Wear sunglasses that block both UVA and UVB rays, plus a wide-brimmed hat to protect eyes, face, and scalp.

A+ for sun-smart yardwork attire

6. Of course, shade and clothing don’t cover everything. Sunscreen applied correctly can reduce your risk of developing melanoma by 50%. The keys are:

• Use broad spectrum sunscreen. 

• SPF 15 is fine for everyday use. SPF 30 or higher is recommended for extended outdoor activity (2 or more hours.)

• For perspective, the darkest skin tone is only SPF 13, so daily sunscreen use is important for everyone.

• A higher SPF does not mean you can apply less often.

• Choose a texture and smell that you like so you’ll actually reapply.

• Zinc oxide and titanium dioxide may be less likely to cause irritation for those with sensitive skin.

• Apply generously and evenly. One ounce (about a shot-glass) is needed to cover most bodies. Spray can be good for hard to reach areas (eg, back), but it’s difficult to gauge whether you’re using the right amount. If using spray, hold the nozzle an inch from your body and spray until your skin glistens. NB, “glisten” is a favorite summertime word for Southern women. We do not sweat, that is gross; we glisten.

• Apply EVERY TWO HOURS while in the sun. Also reapply after swimming, sweating (“glistening”), or toweling off. Be sure to reapply to your hands after washing them too. Water-resistant formulas only last 40-80 minutes, and you can burn in the water!

A note on children and adolescents - like everything we do as parents, the choices we make now can affect our children decades down the road. No pressure. Fortunately in the grand scheme of things, sun protection is really easy.

• Follow the guide above. You can begin slathering on sunscreen at 6 months old.

• They do what we do. Be a good example, and follow the advice above yourself. Make sure your children see you reapplying your own sunscreen, so they know the torture of pausing fun for reapplication isn’t reserved solely for them.

• State regulations vary, but regardless of age take a hard line NO on tanning beds. Long-term thinking is difficult for adolescent brains (and for most adult brains too), but appearance is everything to them. So instead of cancer warnings, focus on appearance. “It would be so sad if you looked like dear Grandma Betty one day, with wrinkly, leathery skin covered in brown spots. Yuck.”

Beach time = Breaks every two hours for sunscreen (and snack)

If you notice a spot that’s concerning, please call your physician. If you don’t have a physician, please give me a call to learn more about Dr. Dilling Internal Medicine & Pediatrics.

As with any cancer, ignoring skin cancer does not make it go away. We are fortunate to have some really excellent dermatologists and plastic surgeons here in the city who can get you back to your beautiful self, minus a cancer. Don’t wait!

Sources: American Academy of Dermatology and The Skin Cancer Foundation