The lowdown on skin cancer: Types, treatment and staying safe

Skin cancer is by far the most common form of cancer in the U.S., with more Americans diagnosed with skin cancer each year than for all other cancers — combined. In fact, at least 1 in 5 people in the U.S. will develop skin cancer by the age of 70.

Skin cancer cases have been increasing in recent years. It’s most likely due to the combination of better screening, more sun exposure and people simply living longer into old age when the risk for skin cancer increases.

The good news is that even the most aggressive forms of skin cancer are highly treatable when caught early, and the death rate from these cancers is extremely low. Even melanoma has a 5-year survival rate of 99 percent if detected early.

But skin cancer is still somehow shrouded in mystery, misconceptions and doubt. Let’s take a look at the main types of skin cancers, how to identify them, what to expect and how to avoid them…

Basal cell and squamous cell carcinomas

The two most common types of skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCC accounts for about 8 in 10 skin cancers, while SCC accounts for roughly 2 in 10.

BCC starts in the lower part of the epidermis in what’s called the basal cell layer and:

• usually develops on areas of the skin most exposed to sunlight, especially the face, head and neck.
• tends to grow slowly, so it rarely spreads to other parts of the body.
• left untreated, BCC can grow and invade the bone or other tissues beneath the skin.

SCC begins in the flat cells in the upper part of the epidermis closest to the surface and:

• like BCC, SCC tends to develop on sun-exposed areas of the body such as the ears, face, lips, neck and backs of the hands.
• can also develop in scars or chronic skin sores elsewhere on the body.
• sometimes starts as actinic keratosis, a small, pink-red or flesh-colored rough or scaly spot on the skin caused by excessive sun exposure. Because these pre-cancerous spots are often difficult to distinguish from SCC, doctors often recommend their removal.
• is somewhat more aggressive than BCC and is more likely to grow into deeper layers of skin and spread to other parts of the body.

More aggressive skin cancers

When you think “skin cancer,” chances are you’re thinking of melanoma, one of the most aggressive forms of skin cancer. While melanoma is rare, accounting for only 1 percent of skin cancer cases, it represents the majority of skin cancer deaths. And even though the average age for a melanoma diagnosis is 65, this aggressive cancer is becoming more common in young adults — especially young women.

Melanoma occurs when melanocytes, the cells that give skin its tan or brown color, start to grow out of control. Despite commonly held belief, only 20 to 30 percent of melanomas are found in existing moles. The rest pop up on apparently normal skin, which can make them easier to spot.

While melanomas can develop anywhere, they’re most likely to be found on the chest and back in men and on the legs in women. Other common sites include the face and neck.

Another rare, aggressive form of skin cancer, Merkel cell carcinoma (MCC), begins in the skin’s Merkel cells. These cells are found mainly at the base of the epidermis and are very close to nerve endings that help us sense light touch and feel fine details on objects.

MCC mainly affects older people, with 4 out of 5 MCC cases in the U.S. occurring in people older than 70. Incidences of MCC have skyrocketed by 95 percent over the past two decades.

Like melanoma, MCC is much more likely to spread than other types of skin cancer. Once these cancers have started to migrate to other areas of the body, they can be difficult to treat.

Two of the rarest forms of skin cancer are Kaposi sarcoma (KS) and lymphoma of the skin. A skin lymphoma is defined as cancer that starts exclusively in the lymph nodes of the skin and accounts for only 4 percent of all non-Hodgkin’s lymphoma cases.

KS is a cancer that develops in the cells that line lymph or blood vessels. It usually appears as tumors on the skin or mucosal surfaces inside the mouth but can also develop in the lymph nodes, lungs or digestive tract. It most commonly occurs in people with acquired immune deficiency syndrome (AIDS).

KS skin lesions often appear on the legs or face and usually cause no symptoms beyond painful swelling. However, if Kaposi sarcoma forms on internal organs, it can cause life-threatening bleeding or breathing problems.

Methods for spotting skin cancer

Unfortunately, skin cancer can be a wily opponent. It can appear in many shapes and sizes and sometimes take over an existing mole or dark spot on your skin that you’ve become accustomed to.

That’s why it’s so important for you to check your skin regularly for anything new, changing or unusual in these areas, especially if you are at elevated risk for skin cancer.

The American Cancer Society recommends checking your skin about once a month for any changes. Here’s their step-by-step guide to how to conduct this self-check. And dermatologists say you should get a full-body professional exam at least once a year, or more often if you’re in a high-risk group.

When doing your monthly self-check, you should look for the following:

• Any growth that increases in size and appears tan, brown, black, pearly, transparent or multicolored
• Any mole, birthmark or brown spot that grows in size or thickness, changes color or texture or is bigger than a pencil eraser.
• Any spot that continues to itch, hurt, bleed or crust or scab over, or any open sore that doesn’t heal within three weeks

You can use the Skin Cancer Foundation’s ABCDEs of melanoma to determine whether a new or changing skin growth warrants concern, but further examination by a dermatologist is recommended.

How skin cancer is treated

Most skin cancers are treated the same way: the tumor is surgically removed. One common procedure is

excisional surgery, where the entire tumor is cut out along with a surrounding border of “normal” skin as a safety margin. The tissue is then sent to a lab to make sure those margins are cancer-free.

Excisional surgery can be used for BCCs, SCCs and melanomas and is usually the only treatment needed. However, if cancer cells are found in the safety margin, a second surgery may be required.

In another procedure, the physician uses local anesthesia to numb the cancerous area and scrapes off part or all of the lesion with a sharp ring-tipped curette. Then, they cauterize the area with heat or chemicals, which stops the bleeding and destroys any residual abnormal cells that may have been left behind.

For more superficial BCCs, the surgeon has the option to use cryosurgery, a process that freezes the growth with liquid nitrogen. This eliminates the need for cutting into the skin. Laser surgery is also an option at this stage, in which the doctor may use a laser tool to remove the skin’s outer layer and possibly variable amounts of deeper skin.

With melanoma, MCC and more aggressive SCC, the doctor must check to see if the cancer has spread to other areas of the body. If it has, the patient may require chemotherapy, radiation or other anticancer therapies to eradicate the remaining cancer cells.

The ins and outs of sunscreen

There’s no doubt the vast majority of skin cancers are caused by repeated, prolonged exposure to the sun’s ultraviolet rays. And since staying out of the sun altogether is very difficult, the next best thing is to use some sort of physical sun protection.

Because I am at a higher risk of skin cancer, I’ve been known to wear long sleeves, pants and a hat for sun protection even in summer. But when the temperature climbs well above 80F, wearing all that clothing can get uncomfortable. So, I reach for a bottle of sunscreen with protection against both UVA and UVB rays.

When you use it properly, sunscreen can decrease your risk of skin cancer and help prevent premature skin aging. Daily use of SPF 15 sunscreen can lower your SCC risk by 40 percent and melanoma risk by 50 percent. However, if you’re spending the entire day outside, it’s recommended you use a sunscreen that’s at least SPF 30.

Unfortunately, most people don’t use sunscreen the way they’re supposed to. Here are some tips to get the maximum benefit from your sunscreen:

• Apply sunscreen 30 minutes before going outdoors so that it has time to achieve its full effect
• Apply it before you put your clothes on to ensure protection even when your clothing shifts
• Reapply at least every 2 hours, or after 40 minutes of swimming, to ensure consistent protection
• Use one ounce, or a shot glass full, to cover your entire body every time you apply

This last point is especially important because with the growing popularity of spray-on sunscreens, people often don’t use nearly enough sunscreen for full coverage. Make sure you spray until there’s a thick coating of sunscreen on your body, then rub it in thoroughly.

There are two main types of sunscreen: physical and chemical. Physical sunscreen includes minerals like titanium dioxide and zinc oxide that block and scatter the rays before they penetrate your skin. The upside of this sunscreen is that it’s environmentally friendly. But its disadvantage is that it tends to stain everything you touch white, sometimes permanently (like the inside of your car door — ask me how I know).

Chemical sunscreen ingredients like avobenzone and octisalate absorb UV rays before they can damage your skin. They tend to go on clear, so you don’t have the staining problems that come with mineral sunscreens. However, they’re often not safe for coral reefs or marine life. And you should check to make sure the chemical sunscreen you’re using doesn’t contain cancer-causing substances like benzenes.

If you have any questions as to whether the sunscreen you’re using is safe, you can use this tool from The Environmental Working Group to check the brand and see what its safety rating is.

If you would like to take your sun protection next level, you can read about 3 lesser-known secrets for reducing skin cancer risk.

Sources:

Skin Cancer Facts & Statistics — Skin Cancer Foundation

Skin Cancer — American Cancer Society

Melanoma symptoms — Cancer Treatment Centers of America

Treatment Glossary — Skin Cancer Foundation

Self Exams Save Lives — Skin Cancer Foundation

All About Sunscreen — Skin Cancer Foundation