Skin Cancer Risks, Treatments and Prevention

Source: AARP.org | July 14, 2004

A great suntan radiates health and vitality — or so it seems. The truth is, a suntan means you've damaged your skin, says New Jersey skin doctor and surgeon Robin Ashinoff. Tanning occurs when the sun's ultraviolet (UV) rays penetrate the skin's inner layer, causing the skin to produce more melanin, or dark pigments, in response to the sun's damage.

Over time, continued exposure to these ultraviolet rays can cause skin cancer, which is on the rise in the U.S.

"Our sunbathing habits from years ago have caught up with us," says Steven Rotter, a skin surgeon in Falls Church, Virginia. "Skin cancer is cumulative. It can take 20, 30, or 40 years to develop."

One in five Americans will develop skin cancer during his or her lifetime, and between 40 percent and 50 percent of Americans who live to age 65 will have skin cancer at least once. Cases of melanoma, the most serious and dangerous form of skin cancer, more than tripled among whites in the U.S. between 1980 and 2003, according to the American Cancer Society.

A decrease in the earth's protective ozone layer and people spending more time in the sun are contributing to rising skin cancer rates, according to Ashinoff. Increased warnings by health experts about the sun's dangers often go unheeded, especially by young people.

Getting sunburned at an early age is a risk factor for developing skin cancer later on. But even though you "set the stage" for skin cancer during the first 18 years of life, it's never too late to protect yourself from the sun, says Ashinoff. That's because cancer is a multi-step process, and the ill effects of the sun's damaging rays build over time.

Other Risk Factors

Other risk factors for skin cancer are:

• Being exposed to a lot of natural or artificial sunlight
• Having fair skin, freckles, blue or green eyes, and blond or red hair
• Having family members who've had skin cancer
• Being treated with radiation
• Taking drugs that weaken your immune system (such as those taken after an organ transplant)
• Having pre-cancerous skin conditions

As with other types of cancer, age is also a risk factor since your skin has been exposed to the sun over a longer period of time.

Detecting Skin Cancer

If you're age 50 or older with no history of skin cancer, you should get a full skin examination as a baseline-check to detect any suspicious or worrisome growths, recommends Rotter. The dermatologist will then determine how often you need to have a checkup.

You also should be on a regular lookout for any skin changes that could be a sign of possible skin cancer. Skin cancer often appears on the head, face, neck, hands, and arms. The two most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, might look like a firm red lump or a small, smooth, shiny, pale, or waxy lump. Skin cancer also can start out as a flat, red, rough, dry, or scaly spot.

The third type of skin cancer, melanoma, might appear as a dark or black spot on the skin. Melanoma only accounts for about 4 percent of all skin cancers but is responsible for 79 percent of skin cancer deaths because it is the most likely to spread.

Because all skin cancer doesn't look the same, you should see a doctor if you notice any suspicious changes on your skin, such as:

• a sore that doesn't go away within a couple of weeks
• any mole or growth that gets bigger or has an odd shape or color
• a spot that itches, bleeds, or forms a scab

Free skin cancer screenings are available in some communities during Skin Cancer Awareness Month every May. You can call your local hospital or the American Cancer Society to find out if your community offers them.

Treating Skin Cancer

The good news about skin cancer is that it's highly curable. Both basal cell and squamous cell cancers have a better than 95 percent cure rate when detected and treated early. The kind of treatment your doctor chooses will depend on the type of cancer you have, the stage your cancer is in, the size of the growth, and your overall health.

Treatment options include:

• Freezing the cancer with liquid nitrogen
• Cutting out the cancerous tissue and some surrounding healthy skin (excisional surgery)
• Zapping the cancer with an intense light beam (laser therapy)
• Removing the growth layer by layer until no cancer cells remain (Mohs surgery)
• Scraping away layers of cancer cells using a circular blade and then destroying any remaining cancer cells with an electric needle (curettage and electrodesiccation)
• Destroying cancer cells with radiation (radiation therapy)
• Killing cancer cells with drugs applied as creams or lotions

Mohs surgery is the most common treatment for skin cancer that appears on the face, says Rotter. That's because it preserves the greatest amount of normal skin tissue, leaves the smallest scar, and has the highest cure rate.

Preventing Skin Cancer

Skin cancer is one of the few cancers we definitely know the cause of — overexposure to the sun's ultraviolet rays. That's why protecting yourself when you're in the sun is the best thing you can do to prevent skin cancer. Your protection should include plenty of sunscreen, clothing, hats, and sunglasses.

Go heavy on the sunscreen. Buy sunscreen products that protect against both UVA and UVB rays. You also can check for the Skin Cancer Foundation seal of recommendation, although some companies might not include the seal on its labeling even though their product has the Foundation's approval. The Foundation awards a seal of recommendation to products that meet safety and effectiveness guidelines developed by an independent committee of scientists.

Rotter recommends sunscreen with a Sun Protection Factor (SPF) of 30 or higher. A sunscreen with SPF 30 allows you to stay in the sun 30 times longer than you could without sunscreen before burning. That means if you normally burn after 20 minutes in the sun, SPF 30 will protect you from burning for 10 hours, if used properly. That means:

• Reapplying sunscreen after sweating or swimming, even if it claims to be waterproof
• Reapplying sunscreen every hour and a half to two hours otherwise
• Applying sunscreen a half hour before going in the sun
• Using enough sunscreen — one ounce, or about a shot glass full — every time you apply it, and applying it thoroughly (don't forget your lips — you can buy lip balm that contains sunscreen)
• Using sunscreen even on cloudy days, when you can still get sunburned
• Using sunscreen regardless of your skin tone

People with darker skin can still get skin cancer even though their risk is lower than lighter-skinned people, says Rotter. And no one is immune from the aging effects of the sun. Who can't live without a few extra wrinkles?

Cover up. Don't assume sunscreen alone is enough protection. Wear a long-sleeved shirt and pants, a wide-brimmed hat to protect your ears and neck, and sunglasses that screen out both UVA and UVB rays. Sunglasses that also block rays from coming in from both sides of your head are especially good.

Overexposing your eyes to sun can cause eye problems such as cataracts, as well as burn sensitive skin around your eyes. There also are lightweight clothes especially made to provide extra protection against the sun. These clothes have a label listing the ultraviolet protection factor (UPF), or the level of protection they provide from the sun's rays. The higher the UPF, the greater the protection.

Check your medicines. Some medicines can make you more sensitive to the sun, which means you have to be extra careful. These include certain antibiotics, antihistamines, antidepressants, diuretics, and non-steroid, anti-inflammatory drugs such as ibuprofen. Ask your doctor or pharmacist about the medicines you're taking.

Check your watch. It's best to avoid the sun when the rays are strongest — between 10:00 am and 4:00 pm.

Seek shade. Find a tree or bring an umbrella to put your beach blanket or chair under.

Check the Ultraviolet (UV) index. The UV index is a forecast of how much ultraviolet light is expected to reach the earth when the sun is highest in the sky. The UV index is usually published with the weather forecast in daily newspapers or included in television weather reports. The federal government just revised guidelines for the UV index to urge people to use even greater caution in the sun.

And don't assume you're safer just because you live in Maine rather than Florida or Arizona. "You need to use precaution regardless of where you live," says Rex Amonette, a dermatologist and past president of American Academy of Dermatology. "Some of the very worst burns I've seen have been in places with the highest altitudes — like Colorado and Utah."

Health experts also warn against tanning salons and beds because artificial sunlight is just as dangerous as natural sunlight.

So how can you get that healthy look without a suntan? Try other healthy lifestyle habits: take care of your skin, get enough rest, eat well, stay physically active, and drink plenty of water. You may not have a tan, but you'll have a healthy glow — minus some wrinkles!

Sources: American Academy of Dermatology, American Cancer Society, Mayo Clinic, National Cancer Institute, National Institute on Aging, Skin Cancer Foundation, U.S. Environmental Protection Agency, U.S. Federal Trade Commission

AARP Resources

Stay Healthy, Practice Prevention
Find out which cancer and other health screenings you should be getting once you turn 50.

Preventing and Controlling Cancer
Healthy lifestyle choices, such as avoiding the sun, staying active, and eating a healthy diet, can reduce your cancer risk.

Additional Resources

American Academy of Dermatology Public Resources
Includes skin cancer quiz, skin cancer risk profile, how to locate a skin cancer screening facility near you, how to perform a self-examination, yearly skin screening checkup notification, and pictures of what some forms of skin cancer look like.

Skin Cancer Foundation Seal of Recommendation
Sun-protection products that win the Skin Cancer Foundation's seal of recommendation meet stringent requirements for safety and effectiveness.

Books

Find these books online at Borders.com

"100 Questions and Answers About Melanoma and Other Skin Cancers"
Edward F. McClay, Jodie Smith, Mary-Eileen T. McClay, Jones & Bartlett Publishers, Inc., July 2003

"Understanding Skin Cancer"
Richard Essner, Oxford University Press, January 2004