Since anytime is a good time to talk about skin cancer, I thought this would be a great time to address some of the most common questions I am asked in the office regarding skin cancer. As the month progresses, I welcome more questions from our readers. In the meantime I hope you find these helpful.
I've been diagnosed with skin cancer by my dermatologist, but I've been told it's nothing to worry about. So why does it sound so bad when I hear about it in the news?
One of the greatest things that the media have done for dermatology is help to raise skin cancer awareness. Unfortunately, it has not done a great job of making clear that there are different types of skin cancer. One of the most common misunderstandings about skin cancer is that it is synonymous with the word melanoma. Melanoma is a very specific type of skin cancer that arises from pigment-producing cells in the skin known as melanocytes. Melanomas, when found early, are very treatable, often with a simple in-office surgery. A melanoma that has been ignored for long periods of time or isn’t caught until after it has spread deeper in the skin or to other parts of the body, however, can be an extremely serious disease that endangers your health and, unfortunately, leads to death. That being said, if you've had a skin cancer and was told it's "nothing to worry about," it's likely that you had a type of skin cancer called basal cell carcinoma. Basal cell carcinomas are the most common type of skin cancer in the United States and worldwide. They arise from the cells that make up the bottommost layer of the skin, known as basal cells. Unlike melanomas, basal cell carcinomas grow very slowly and do not spread to other parts of the body. They often appear as small, shiny pink bumps with broken blood vessels on areas of frequent sun exposure, especially the head and neck. Lastly, another fairly common type of skin cancer is squamous cell carcinoma. Like basal cell carcinomas, squamous cell carcinomas have a strong relationship to long-term sun exposure and sun damage. They are more common in those who might have a weakened immune system, such as anyone taking anti-rejection medications for an organ transplant. Squamous cell carcinomas do have the potential for spreading to other parts of the body but in general are a much less aggressive type of skin cancer than melanoma. There are many other types of cancers that can arise in the skin, but basal cell and squamous cell carcinomas are by far the most common, and together they affect more than 2 million Americans each year.
I've had "precancers" in the past, but never a skin cancer. What does this mean?
Actinic keratoses are often referred to as "precancer" lesions. These are often seen as small, scaly pink bumps on areas that have been exposed to the sun, such as the scalp (especially in men who have less hair protecting the skin in these areas), the face, and hands. Sometimes the scale peels off, but over time it usually returns, and the spot itself does not go away with time. Actinic keratoses are basically areas of skin that contain abnormal cells due to long-term damage from UV radiation. Over a long period of time, when untreated, these abnormal cells can eventually progress to the point that they become a type of skin cancer, namely squamous cell carcinoma. While it's difficult to say exactly what the risk is for one of these lesions to turn into a skin cancer, we estimate that over a 10-year period, there is a 1-2% chance that a single actinic keratosis will progress to squamous cell carcinoma. While this is very low, someone who has had one actinic keratosis will likely get more over time, increasing the risk over time of getting a skin cancer if these are left untreated. That is why your dermatologist will recommend treating them, often with a simple procedure called cryotherapy, where cold liquid nitrogen is sprayed directly onto the spot to destroy the abnormal cells. There are other ways of treating these as well, such as special creams, and your dermatologist can help determine which is the best method for you.
I've never had a skin cancer, but I've had a lot of sun damage and burns in the past. Should I see a dermatologist?
Long-term sun exposure is a strong risk factor for developing skin cancer. My general recommendation is that if you've had lots of sun exposure, even in the distant past, you should have your skin checked once a year by your regular doctor. If your doctor sees something concerning for a skin cancer, he or she can refer you to a dermatologist for further evaluation. This is particularly important around the age of 50, when many of the sun-related skin cancers begin to occur more frequently. Meanwhile, anyone with a first-degree relative – that is, a sibling, parent, or child – with a history of melanoma should have a thorough skin exam every year, whether by your primary care physician or a trained dermatologist. This should begin as early as possible, as the outcomes of melanomas are strongly affected by how early they are detected.