Preventing, recognizing and treating skin cancer

We’re fortunate to live in an area that has many more clear days than cloudy ones. The bright, beautiful weather is one thing that draws people to live in the Four Corners, and anyone who has ever endured month after month of gray skies knows that living where it’s sunny can result in a sunny disposition.

But all of that sun has a downside. Exposure to the UV radiation the sun produces is the primary cause of skin cancer. As summer approaches and longer days give us even more reasons to enjoy the outdoors, Cortez family physician Jill Schenk, MD, has a piece of advice we should all heed: protect your skin.

There are three main types of skin cancer: squamous cell, basal cell, and melanoma. These three cancers show up in different ways on the body. Schenk says anyone who has a sore or abnormal spot on their skin that does not clear up within a month, a mole or other lesion that appears very suddenly, or any type of irregularly shaped or colored mole should have it checked out by their primary care provider.

Squamous cell cancer starts out as a pre-cancerous lesion called actinic keratosis. “These are little crusty spots on the skin that just don’t heal up. If you do nothing, in 5-10 years they can become a squamous cell skin cancer,” said Schenk. Caught early, these lesions can be “frozen” off in the doctor’s office. If they’re not treated until a little later, they might have to be cut out instead. Pre-cancerous spots may also be treated with a chemical peel which is sometimes necessary to treat a large area. “When I see patients with these types of lesions I recommend that they get checked every 6-12 months. The original spots might not come back, but very often new ones appear,” said Schenk.

Basal cell cancers tend to first appear on the skin as a small ulceration that may or may not bleed. “The problem with basal cell skin cancer is that it’s challenging to remove the entire lesion, especially on places like the nose,” said Schenk. This is why it’s important to have suspicious spots on the skin evaluated sooner rather than later. “When a lesion gets large, like eraser sized, we have to take a large chunk of skin out.” Basal cell cancer tends not to migrate throughout the body. Instead, basal cell invades and destroys local issue which can result in disfigurement, even when it’s removed.

Melanoma is the third type of skin cancer and by far is the most serious. “Melanoma has a variety of presentations. The classic appearance is a dark, multi-colored, irregularly shaped mole, but that’s not always the case, which makes it challenging to diagnose,” said Schenk. “If a lesion shows up suddenly or is larger than an eraser, or starts to grow, that’s a big concern.” At this point it’s possible that the cancer has spread to local tissue, to the lymphatic system, or to a variety of organs in the body. “It can go anywhere, and it can show up again years after the original lesion has been removed,” said Schenk.

The good news is the skin cancer is highly preventable. You simply need to protect your skin from the dangerous UV rays of the sun. “If you’re going to be outside between 10 a.m. and 4 p.m. for more than five minutes, then wear broad-spectrum sunscreen,” said Schenk. She recommends, at minimum, an SPF of 15 (30 is better). In addition, wearing a large-brimmed hat and long sleeves is a smart move when gardening, irrigating, hiking, horseback riding, or engaging any other activity that will keep you outside for an extended period of time.

If you’re tempted to venture outside without protecting your skin, consider these statistics. One in five adults will have some type of skin cancer during their lifetime. It’s the most common type of cancer, outranking breast, prostate, lung, and colon cancer. Eighty-six percent of melanomas and 90 percent of squamous cell and basal cell cancers are caused by sun exposure. It’s estimated that the annual cost to treat melanoma in the U.S. in 2010 was $2.63 billion. “We could reduce these costs dramatically if everyone would just use sunscreen,” said Schenk, noting that taxpayers pick up a large portion of the health-care tab. “Daily use of SPF 15 or higher sunscreen will reduce squamous cell cancer by 40 percent and melanoma by 50 percent,” said Schenk.

The risk for melanoma (the most common form of cancer in people aged 25-29) doubles in individual who have had more than five sunburns over the course of their lives life or if they experience a single blistering sunburn during childhood. “It is especially important to protect children and babies when they are outdoors because their skin is so sensitive to the damaging effects of UV radiation,” said Schenk.

As with all cancers, early detection is essential. In the case of melanoma, the five-year survival rate is 98% if it’s detected early. That figure goes down to 60% if the cancer gets into the lymphatic system and drops to 15% if it spreads to another organ in the body. Tell you health-care provider about any unusual moles or growths and ask for an “all over” skin check when you have your annual physical.

For anyone concerned about what’s in sunscreen and the myths that chemicals in the products are causing an increase in skin cancer diagnosis, Schenk says to put that worry aside. “There is no evidence that I’m aware of that sunscreens are carcinogenic. But the UV rays from the sun definitely cause skin cancer,” she said.

In addition, Schenk says tanning beds should never be used. “One tanning bed session increases the risk of squamous cell skin cancer by 67%, and the vast majority of melanoma in people under 30 is attributed to tanning beds,” said Schenk.

If the risk of getting skin cancer isn’t motivation enough to make you cover up and protect your skin when going outdoors, perhaps the desire to remain younger looking will be. “Ninety percent of visible changes of aging such as wrinkles and dark spots are caused by sun damage,” said Schenk. “People who use sunscreen daily have 25% less skin aging than those who don’t.” You can’t turn back the clock, but it’s never too late to start protecting your skin and maintaining a youthful appearance for as long as possible.

Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colorado. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal health-care provider.

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