Here in the middle of summer, many people are enjoying vacations on the beach, poolside parties and relaxation, and general fun in the sun. While it’s a time to enjoy, it’s also a time to take the necessary precautions against the very real threat of skin cancer.
According to Dr. Nil Celebi Cherukuri, a dermatologist for Geisinger Medical Center in Danville, most types of skin cancer are associated with sun exposure.
“Just as smoking causes lung cancer,” she said, “ultraviolet radiation causes skin cancer.”
The earlier the age, the greater the danger.
“We have to protect ourselves, but we have to do an even better job at protecting our children,” Cherukuri said, “because their skin is more sensitive to sun damage. They are more likely to get skin cancer as adults.”
Those with a fairer complexion are also more susceptible to sun damage. However, darker skin types can, and do, get skin cancer depending on the amount of time they are exposed to the sun.
Christopher Motto, MD, FACS, of Surgical Specialists of Evangelical, said “most of our sun exposure occurs before the age of 18.”
It takes about 20 years after sun damage before skin cancer develops. So Motto said with more and more efforts toward educating the public about the seriousness of skin cancer and proper ways to prevent it, he hopes to see a decrease in incidents as the years progress.
“The best way to avoid skin cancer is protecting yourself from the sun,” Cherukuri said. She also said it’s best to avoid tanning beds and to avoid the sun between 10 a.m. and 4 p.m. And of course, wear sunscreen whenever you’re outside during the day – even if it’s cloudy.
Motto said sunscreen remains “paramount” to protecting our skin, and he also encourages wearing hats, pants and long sleeves when possible to protect skin from the sun’s harmful rays.
While melanoma accounts for only one percent of all skin cancers, according to www.cancer.org, it is responsible for the majority of skin cancer deaths. The American Academy of Dermatology (AAD) predicts 7,230 people will die from melanoma this year and reports that more than one million in the United States are living with melanoma. The risk of melanoma increases by 80 percent if you’ve experienced five or more blistering sunburns between the ages of 15 and 20.
The AAD lists melanoma as “the most serious type of skin cancer.”
According to Motto, melanoma is a cancer that attacks the pigment cells of the skin, and “changes it from being a normal cell into a cancerous type of cell that can grow and invade and spread to distant parts of the body.”
Most often, it spreads to lymph nodes and other organs.
“It’s one of the more deadly types of skin cancer,” Cherukuri said. “But if it’s caught early on, the prognosis is good.”
Other types of more common forms of skin cancer are basal cell and squamous cell. Cherukuri said she most often sees basal cell cancer, which originates from the cells that make up our skin. “This is the type with the best prognosis,” she said. “It can be locally disruptive, but it almost never metastasizes.”
Squamous cell originates in the squamous skin cells, and is more disruptive than basal cell, but not as aggressive as melanoma, Cherukuri said. It is possible that squamous cell cancer can be “locally disruptive,” she said, “especially in the head and neck areas or in immune-compromised populations, and it can metastasize if left untreated.”
Stages and symptoms
Just like other types of cancer, skin cancer stages are numbered from 1 to 4.
“All stages are concerning,” Motto said, “but the more advanced the stages, the more worrisome it is, and the higher the likelihood that it can spread to other parts of the body.”
According to Cherukuri, the different kinds of skin cancers present themselves differently.
“Melanoma will present like something that looks like a mole that is colorful or growing or changing. Rarely, they may be painful or bleeding.”
Squamous and basal cell cancers, she said, “can look like just a wound that will fail to heal for many, many months. Many people will think that the wound, whatever initiated it, is just a bug bit or they bumped it somewhere. If any wound is not healing, it’s reason to go see a dermatologist because it may actually be a skin cancer.”
Motto said he tells patients to especially be on the lookout for moles that are changing in size and are larger than a pencil eraser or have different colorations, irregular borders, or any that are ulcerated or bleeding.
Typically, in the later stages of skin cancer, the lesion may be larger, but that’s not always the case. Melanomas, Motto said, are notorious for disappearing, so the physical appearance of them is “not always the predictor of the severity,” he said.
Carol Vayda, of Northumberland, said she first realize a warning sign of melanoma in the summer of 1997 when her dog jumped on her back. When she looked to see if she had broken any skin, Vayda noticed a mole that was three colors.
She called her doctor and was referred to Geisinger’s dermatology department. The cancer was surgically removed and tested to make sure it was fully removed. She began getting regular checkups every six months. Two years later, doctors found another on her back, and three years after that melanoma was found inside of her right arm.
She has also had to have basal cells removed on her leg and arm, and a small cancer removed from her forearm. This spring, she had yet another removed from her left arm. So far, the cancer was removed each time, but it’s taken a toll.
“The only thing that is very nerve wracking is the stitches and the healing process and the waiting to see how long before the next one,” Vayda said, adding that she is also allergic to adhesive tape, Band-Aids and Neosporin.
The most effective treatment is when the skin cancer is found early, so doctors encourage people to do regular check-ups on their skin.
“Be aware of what moles you have and see if they’re changing,” Cherukuri said. “We develop most of our moles between ages 2 to 10, but people will continue to develop new moles until the age of 30. If any new moles are developing after the age of 30 or there are ones that have the ‘ugly duckling’ sign — you should get those checked.”
For those who have “worrisome symptoms,” Motto recommends getting a professional screening that lasts approximately 15 minutes and goes over all spots that are of concern. If there are areas that the doctor identifies as signs of cancer, the patient is usually scheduled to come back for another appointment at which time the spots can be biopsied.
Those with a history of skin cancer are usually encouraged to come back every six months to be checked, Motto said.
When cancer is identified, treatment depends on how deep the lesion is.
“For most melanomas, the ones that are caught early,” Cherukuri said, “they’re surgically excised, and then you’re done.”
If the lesion is deeper than 0.7 millimeters, she said, then the patient is referred to surgical oncology, and the lesions would be removed in an operating room and lymph nodes checked to see if the melanoma has spread there. If it has, then there are different options, Cherukuri said, for removing lymph nodes and also for the use of chemotherapy.
Motto said they divide melanoma skin cancer into three general categories of depth — thin, intermediate and thick. A thin category may require an incision, intermediate an incision and lymphnode biopsy and removal, and thick may require treating patients with systemic chemotherapy.
Vayda will return to Geisinger’s dermatology department in September for a follow-up. Though she’s had to deal with a lot of skin cancer scares, she knows — perhaps more than most — how serious it can be, and is glad that it hasn’t been worse for her.
“I had a brother who had his first melanoma on his back, but didn’t catch it as soon as I did,” she said. “He had to be cut more — you could have laid half a grapefruit in the hole. They had to do a skin graph taken from his leg to cover the hole on his back.”
He traveled to many places for treatment and experienced remission for awhile — until it returned and was found attached to his brain. At 62 years old, the cancer took his life.
Vayda encourages individuals to check their body often, looking for spots or moles that are three colors (black, brown and red).
“If you find any, see your doctor and have them checked,” she said. She especially encourages those who got sunburned a lot as children, and who have a lighter complexion, to do so.
Vayda then added perhaps the most well-known yet often disregarded prevention advice: “Always wear the highest number in sunscreen when outside.”