Skin cancer

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VOL 107 / NO 7 / JUNE 2000 / POSTGRADUATE MEDICINE

Skin cancer is a major risk for sun worshippers and is definitely on the rise in the United States. In fact, one of every five Americans will have skin cancer at some time during his or her life. The good news is that this type of cancer can almost always be cured--provided it is found early. Unfortunately, the incidence of melanoma, the most deadly type of skin cancer, is increasing faster than that of any other cancer.

Types of skin cancer
The three major types of skin cancers are called basal cell carcinoma, squamous cell carcinoma, and melanoma. The basal cell and squamous cell types most often occur on areas of the skin that are regularly exposed to the sun, such as the face, the back of the hands, and the ears. People who spend many hours in the sun, such as landscape workers, farmers, and construction or highway crews, tend to be at the greatest risk for these cancers.

Melanoma, on the other hand, tends to occur on areas of the body not exposed to the sun on a regular basis. This type of cancer is more common in people who work indoors and have limited but sometimes intense exposure to the sun on weekends or during vacations. Children whose unprotected skin is exposed to the sun a lot during the first 15 years of their lives are also at increased risk of melanoma as adults.

What are the signs?
The American Academy of Dermatology recommends that we all examine our skin regularly. This means looking over your entire body, including back, scalp, soles of your feet, the skin between your toes, and even on the palms of your hands. If you see any changes in the size, color, shape, or texture of a mole, if a new mole develops, or if any other unusual change in the skin is found, check with your doctor right away.

What causes skin cancer
Factors that increase the risk of skin cancer include:

• Repeated exposure to bright sunlight, especially when the sun reflects off snow or water
• Sunburn, especially blistering sunburns during childhood
• Skin creams or lotions that contain tar, especially if used over a long period of time. (These are medicines used to treat certain skin problems, such as psoriasis.)
• Exposure to organic arsenic, which may be in pesticides and other chemicals
• Radiation therapy or chemotherapy for cancer

In addition to these causes, heredity is involved in some cases. If you have any close relatives who have had malignant melanomas or premalignant skin spots, you may have a higher risk of skin cancer. Also, if you have freckles or fair skin that doesn't tan easily, you may be at increased risk. And once you have had a skin cancer, you may be at high risk for another episode.

What can you do to reduce the risk?
Treatment of skin cancer, while lifesaving in the most serious cases, can result in deformity, such as loss of part of the nose, ear, or cheek. Therefore, the best approach is to lower the risk of getting skin cancer in the first place. Here are some pointers that can help.

• Minimize sun exposure, especially between 10 am and 4 pm.
• Wear sunglasses and protective clothing, including a wide-brimmed hat that protects the face and ears, a long-sleeved shirt, and pants made of tightly woven fabric.
• Use a sunscreen with both UVA and UVB protection and a sun protection factor (SPF) of at least 15 every day, even when it is overcast.
• Be especially careful when you are on sand, snow, or water or at high elevations.
• Avoid artificial tanning devices, lamps, and booths.
• Take special precautions with children. Avoid direct sunshine. Use hats, clothing, and shade for young children, plus an appropriate sunscreen if sun exposure cannot be avoided. Warn older children about the risks of skin damage from the sun.

ABCDs of melanoma

Many people have moles, and most of these are not dangerous. To help sort the safe moles from the possibly cancerous ones, physicians often use the "ABCD" method. These are the clues to dangerous moles:

A -- Asymmetrical shape

B -- Borders that are irregular

C -- Color that varies from one area to another

D -- Diameter larger than a pencil eraser

If you are concerned about anything you find on your skin, see your doctor right away.

What to look for

When you check your own or your children's skin, watch for any of the following and call your doctor if you suspect something is wrong.

• A rough or red, bumpy area that's bigger than the head of a match and doesn't clear up
• An area of skin that stays irritated, red, or itchy
• An area that keeps cracking or bleeding
• A colored spot that gets bigger
• A brown or black spot that's wider than 1/4 inch (the size of a pencil eraser) or that changes color or size

This information is not a substitute for medical treatment.

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