Skin Cancer 2009

Skin Cancer -Living in the Texas Hill Country

by Terri Armen, RN

 

Skin cancers are the most common forms of cancer occurring in humans with approximately one million new cases diagnosed annually, and an increasing number of cases being diagnosed each year.   If you live to age 65, you stand almost a 50% chance of being diagnosed with one or more forms of skin cancer.  Most skin cancers are caused by excessive sun exposure over a lifetime, and the amount of sun exposure accumulated by age 18 is implicated significantly.  MedicineNet Medical Editors recommend looking out for warning signs of skin cancer. The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn't heal. Skin cancers don't all look the same. For example, the cancer may start as a small, smooth, shiny, pale, or waxy lump. It can also appear as a firm red lump.  It may or may not itch and is not necessarily painful.  Sometimes, the lump bleeds or develops a crust. Skin cancer can also start as a flat, red spot that is rough, dry, or scaly, so it is recommended that you consult a physician if a change occurs or persists for more than two weeks. 
There are three major types of skin cancers, and it should be noted that early diagnosis is typically equated with a greater likelihood of cure.   Since skin cancers typically develop in the outermost layer of the skin (the epidermis), they are visible and more easily detectable at an early stage.  Space prohibits elaborating on these so be sure to consult a physician should you suspect a skin cancer.
The three most common types of skin cancer are: 

• Basal cell carcinoma:  The most common form of skin cancer which accounts for approximately 90% of all skin cancers in the United States.  It is usually slow growing and has a lower potential to spread to other organs (metastasize).  It can be treated with a wide excision (by a skilled physician or dermatologist) or by a procedure called Moh’s micrographic surgery whereby a skilled and trained physician removes involved tissue with some surrounding tissue and sends it immediately to a pathologist who is standing by to analyze it for involvement.  If there is no apparent cancer in the margins surrounding the excised tissue, then no further removal of tissue will occur; if some cancer is detected, then the surgeon will continue to remove tissue until the pathologist deems the tissue cancer-free.   Even upon a clear reading by the pathologist, it will be important to receive follow up screenings and examinations because there is a 40%-50% of likelihood of another cancerous lesion occurring elsewhere on the body, most likely on sun-exposed areas.  There are other options for treatment  and/or prevention of future lesions that should be discussed with your dermatologist. 
• Squamous cell carcinoma:  Another common form of skin cancer that arises in the squamous mucosa or epidermis of the skin, which look like thin flat cells or fish scales under the microscope.  Squamous cells are found in the tissue that forms the surface of the skin, the lining of hollow organs of the body, and the passages of the respiratory and digestive tracts. Squamous cell carcinomas may arise in any of these tissues.  Risk factors include light or fair complexion and history of sun exposure as well as some other less common factors such as exposure to heat, arsenic, x-rays, etc..   A precursor to this type of cancer is actinic keratosis and can be described as rough, red bumps in areas of sun-exposed skin, most commonly on the back of hands, forehead and cheeks.  These can occur decades following excessive sun exposure.  This type of skin cancer is diagnosed with a punch biopsy where a “disc” of tissue is removed and examined by a pathologist and treatment is similar to that of basal cell carcinoma; however, this type of skin cancer has a higher risk of metastasis but can achieve a high chance of cure with early diagnosis and treatment.
• Melanoma:  A more serious form of skin cancer that arises in the cells of the skin called the melanocytes, this form of skin cancer, if not detected and treated early and aggressively, has a high potential for metastasizing and is associated with a significant mortality rate (death).  Most melanomas  are brown to black looking lesions.  Signs that might indicate a malignant melanoma include change in size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding.  If you suspect that you have this type of cancer, as evidenced by any change of your skin or moles,  you should seek medical advice as soon as possible. 

PREVENTION (Taken from MedicineNet.com)
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.
Common sense preventive techniques include:

• Limiting recreational sun exposure;

• Avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);

 

• Wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;

• Regularly using a waterproof or water resistant sunscreen with UVA protection and SPF 30 or higher; or per a top dermatologist, David Colbert, MD, UVA and UVB protection as offered in Neutrogena Age Shield Face Sunblock with Helioplex.  The Helioplex stabilizes the sunscreen so that it lasts longer in the sunlight, and it provides antioxidant protection to the skin against damaging free radicals. 

 

• Undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor; and

• Avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."

 

References:
http://en.wikipedia.org/wiki/Skin_cancer#Treatment
http://www.medicinenet.com/sun_protection_and_sunscreens/article.htm#
http://www.medicinenet.com/skin_cancer/article.htm

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