Simple Screening - What to Know to Detect Early Skin Cancers
by Diana Price
Thanks to recent media campaigns, at this point most of us have heard the message that spending time in the midday sun without protection is not a good idea. At some point in our lives, however, the majority of us have broken the rules, either intentionally going after that deadly tan or at the very least spending brief periods outside while forgetting to protect ourselves from the sun.
As a teenager, I remember spending hours lying poolside with my friends to capture the sun’s rays in pursuit of the perfect tan. Yes, I was one of those who used baby oil to deepen my tan and, yes, I knew that this practice was not good for my skin. My friends and I were convinced that by the time we became adults and felt any subsequent effects of our sun worshipping, modern medicine would undoubtedly have come up with a cure for it all—from skin cancer to crow’s feet. With nothing to worry about but tan lines—increasingly important around prom and summer break—we proceeded recklessly along.
Two decades later I can clearly see the cosmetic effects of my earlier quests for the perfect tan. And, more importantly, I clearly feel the regret of that shortsighted behavior. As a nurse, I know all too well that prolonged and unprotected sun exposure can cause more than just painful sunburns and that subsequent, extensive sun exposure can prove to be deadly, responsible for approximately 90 percent of all skin cancers.
Skin cancer is the most commonly diagnosed type of cancer in the United States, and its rates continue to rise. In fact, according to the American Academy of Dermatology, at the rate at which skin cancer incidence is increasing, one in five Americans will be diagnosed with skin cancer in their lifetime.
So what are we being diagnosed with? There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma. The different types of skin cancer refer to the type of cell within the skin from which the cancer has originated. Cells can become cancerous when exposed to the sun’s ultraviolet (UV) rays.
The good news is that BCC and SCC, which are more common than malignant melanoma, are both highly curable. And if malignant melanoma is caught early, prior to spread, it is also highly curable with surgery. The bad news is that once malignant melanoma has spread from its site of origin, it is one of the most deadly of all cancers, responsible for one death nearly every hour in the United States.
Malignant melanoma has a tendency to spread through the bloodstream and the lymph system to distant sites in the body, often invading vital organs such as the brain, liver, and lungs. Once the cancer cells get trapped in these organs, they tend to continue to grow rapidly and crowd out the organs’ normal functions. In these advanced stages, malignant melanoma is difficult to cure with standard therapies. That is why it is important to remove melanoma before it gets a chance to spread.
Because skin cancers are highly curable if detected and treated in the early stages, screening for skin cancer is one of the most important steps that people can take (besides staying out of the sun) to prevent skin cancer altogether or to optimize the chances of a cure.
Some people are at higher risk of developing skin cancer than others. For that reason individuals with risk factors that increase their chances of developing skin cancer are advised to visit a dermatologist for a screening. Risk factors, according to the American Academy of Dermatology, include the following:
- A close blood relative who has or has had melanoma, several more-distant relatives with a history of melanoma, or a family history of other skin cancers
- A personal history of skin cancer
- A history of exposure to UV rays from the sun, tanning beds, or sun lamps, whether intermittent or year-round, even if the exposure was years ago
- A past experience of severe, especially blistering, sunburn
- Fair skin, especially when the person has blond or red hair and blue, green, or gray eyes
- Sun sensitivity or a tendency to burn and freckle rather than tan
- Large, asymmetrical, or unusual-looking mole(s)
- 50 or more moles
- A history of X-ray treatments for acne
- A current regimen of immunosuppressive medications for severe arthritis or to prevent organ rejection
After the initial visit, the dermatologist will recommend to high-risk patients the optimal screening schedule. But keep in mind that even individuals who are not considered at high risk of developing skin cancer are not in the clear; their risk of developing skin cancer is not as high as people with the risk factors, but they are still at risk. At the very least, everybody should speak with his or her healthcare provider regarding screening for skin cancer.
During a screening visit, a dermatologist will often put on glasses that magnify the skin. Dermatologists are trained to identify areas of the skin that may be cancerous—often areas that you or I would not recognize as abnormal with the naked eye.
If your healthcare provider identifies a “precancerous” area of skin, he or she may opt to remove it. Though not cancerous, such areas of concern are potentially cancerous and are therefore most often removed at the earliest opportunity. Removal eliminates virtually all risk that skin cancer will develop at that site. The procedure is typically performed during a short, outpatient visit in which the healthcare provider numbs the area and removes the precancerous skin. Often stitches are not required. The sample is sent to a laboratory to ensure that cancer is not present. Physicians may also burn or scrape the area of skin or apply an agent that will kill the top layers of skin.
If the dermatologist or other healthcare provider suspects skin cancer, often the area will be removed and sent to the lab for diagnosis. If the area is found to be cancerous, the diagnosis should identify whether it is BCC, SCC, or melanoma. Often the initial surgical removal may have eliminated all the cancer. If not, patients may be asked to come back for further removal or evaluation of potential spread.
Even if the skin cancer is not life threatening, early detection and treatment may lead to less scarring from surgical removal and may minimize treatment.
Take Matters into Your Own Hands
Regular screening visits to the dermatologist are one important way you can take control of your health. The American Academy of Dermatology advises that everyone, at the very least, should “check your birthday suit on your birthday.” The National Cancer Institute recommends monthly self-evaluation of the skin, which may help find changes that should be evaluated by a physician. Look for any changes in your skin, including moles that may have grown, changed color, or developed asymmetrical borders. If any changes have occurred between skin assessments, do not hesitate to see a dermatologist. Use a handheld mirror or ask for help from a significant other to check those hard-to-see areas, such as the backs of the thighs, the scalp, and the upper back. Dark streaks under the fingernails or toenails, moles on the bottom of the feet or between the toes, dark spots that you can see on your eyeball or even inside your mouth—all should be evaluated by a healthcare provider because skin cancer can occur anywhere.
Shelly Higgins, an active, 40-year-old mother of four-year-old twin boys from Bellevue, Idaho, credits her own self-screening with the early detection of a recent early-stage SCC. “Be very diligent in screening your body for things that were not there before or things that may have changed,” she says. Having first noticed a “funny-looking mole” on her ear, Shelly made an appointment with her dermatologist to have it evaluated. Her doctor “saw nothing weird” about the mole Shelly was concerned about, so, she says, “feeling dumb for making the appointment, I showed him another one that was very small and a funny color on the bottom of my leg. He went pale, called the nurse in, and took it off pronto.” The sample was then sent to a laboratory for diagnosis.
Waiting for the results, Shelly says, was excruciating. Because her father was a Stage III melanoma survivor, Shelly could not help but fear the worst. The two weeks that she had to wait before receiving any type of diagnosis seemed to last forever: “I was horrified. I have children, and I just felt very frightened that I would not see them grow up. I was scared of the unknown and wondering if what I would find out would be a death sentence.” Finally, she says, after many sleepless nights, the results indicated that it was not melanoma but SCC.
Waiting for those results, Shelly says, had been “the worst time for me and my husband,” but with the results in hand they could move forward with surgery and recovery. Shelly had surgery to ensure that all the cancer was removed, and she recovered well. “They grafted from my upper hip and took out a sizable chunk” from the lower leg where the cancer had been. In retrospect, Shelly says, she “learned a lot about the process and hope that I never have to deal with this again.” She continues to be screened regularly—initially
every three months and now every six months.
Stories like Shelly’s speak to the value of self-screening and early detection, reminding us all to remain vigilant in the face of our skin cancer risk.
The Cancer/Vitamin D Link
Results from recent studies have indicated that individuals with higher levels of vitamin D (measured by exposure to the sun) in their body may have a reduced risk of developing certain types of cancer, although these suggestions need further confirmation. Although vitamin D is synthesized in the skin from exposure to the sun, it may also be obtained from food. The American Academy of Dermatology states, “Vitamin D from food and dietary supplements offers the same benefits—without the danger of UV exposure—as vitamin D obtained from the sun. Vitamin D cannot be used by the body until it is processed by the liver and the kidneys. The usable form of vitamin D resulting from this process is the same, regardless of how it enters the body.” Many food sources are fortified with vitamin D.
In addition, “Maximum production of vitamin D occurs after brief exposure to UV radiation. The exact amount of time depends on many factors, including location, time of day, time of year, and skin type. For a fair-skinned person in Boston or New York, at noon in June it is two to five minutes. After this, any additional vitamin D that the body produces will not be stored for future use. Additional unprotected exposure will result in an increased risk of premature aging and skin cancer.”
Lathering on the sunscreen, trying to stay out of the sun during the midday hours, and wearing clothing and hats to protect against the sun’s damaging rays will help prevent skin cancer not to mention premature aging. Because most of us have been out in the sun unprotected and have experienced a more-than-mild sunburn at some time during our lives, screening for skin cancer provides the best chances of catching precancerous areas or early skin cancers. An initial screening with a dermatologist may be beneficial to establish a baseline reading of the skin, with recommendations for a personalized skin-screening schedule based on the baseline examination. One of the best things people can do is perform skin checks on themselves and see a dermatologist right away if they notice any changes in their skin.
Again, the good news is that skin cancer is highly curable in its early stages. It is up to each of us to screen for these early stages so that precancerous or cancerous areas may be completely removed to optimize these high chances for a cure.