Skin Cancer - It's Not Just For The Pale

With summer just around the corner and clear, lengthening sunny days already upon us, the danger of skin cancer increases. The most common of all cancers in the U.S. (and Delmarva has the highest rate in the state), skin cancers are almost exclusively caused by one thing: overexposure to the sun's UV rays.
The two most common types are basal cell cancer and squamous cell cancer. Skin cancer is an atypical growth of the skin, which can, even when small, metasticize, sending cancer cells throughout the body. And they do this without warning.

Basal cell carcinoma usually affects the head, neck, back, chest, or shoulders. The nose is the most common site. Signs of basal cell carcinoma can include skin changes such as a:
Firm, pearly bump with tiny blood vessels in a spiderlike appearance (telangiectasias).
Red, tender, flat spot that bleeds easily.
Small, fleshy bump with a smooth, pearly appearance, often with a depressed center.
Smooth, shiny bump that may look like a mole or cyst.
Scarlike patch of skin, especially on the face, that is firm to the touch.
Bump that itches, bleeds, crusts over, and then repeats the cycle and has not healed in 3 weeks.
Change in the size, shape, or color of a wart or mole.

Squamous cell carcinoma usually affects the face, head, or neck. Signs of squamous cell carcinoma include any:
Persistent, firm, red bump on sun-exposed skin.
Patch of skin that feels scaly, bleeds, or develops a crust. The patch may get bigger over a period of months and form a sore.
Skin growth that looks like a wart.
Sore that does not heal or an area of thickened skin on the lower lip, especially if you smoke or use chewing tobacco or your lips are often exposed to the sun and wind.

Skin cancer generally develops in the epidermis, the outermost layer of skin, so a tumor is usually clearly evident. After repeated overexposure to the sun, especially when it results in sunburn, skin cancers can appear, but not usually quickly. These often take years, even decades, to make their presence obvious. Case in point: We recently buried a friend who, as many of us did, spent much his youth shirtless in the summer months, and every year, as he said, "Got that first sunburn to usher in every new year's summer. It was a rite. We played, mowed lawns, went to the beach. Little kids, ten years old. We didn't have a clue." It wasn't until his early 50's that his already developed skin cancer became apparent, first with a small, odd change in the skin at the hairline of his forehead. Starting then and over the years he had over half of his face removed and grafted over with skin from his back and buttocks. "The face didn't hurt much, but sitting down was a bitch." This continued for nearly twenty years, but the battle was a losing one. Over the span of his last ten his cancer (melanoma) metasticized to his liver (chemo and radiation), his spleen (removed), his bones (more chemo and radiation), and, finally, his brain (he refused further treatment). He died at 72, with nearly twenty years of continuous cancer treatment behind him.


Risk: Lighter isn't better - but darker isn't all that great

Your Skin Phototype
Your risk of developing skin cancer among other factors highly depends on your skin type. In 1975, Fitzpatrick, a respected dermatologist created a standard for classifying individuals according to their skin color and burning and tanning responses to sun light exposure. Basically a low number means a higher risk. However, there are people with skin type 3 and darker who develop skin cancer, so having a phototype of group III, IV or V is certainly no guarantee of immunity.








Things to look out for.

Remember the public service announcements about cancer they used to show on tv? The "warning signs" of cancer?
Well, for skin cancer, the only warning sign is the appearance of a change in the skin. It can be in "normal" skin, or signal its presence in a heavily pigmented area, like an existing mole. It can be very small and in an area to which you don't usually pay much attention, like your back. (Yet another good reason to share the shower from time to time. )
Free skin cancer screenings can also be available in many locations.




A small offering of just some of the looks of melanoma. All of these examples are about the size of a pencil eraser or smaller.
Note the skin colors of the hosts - not everybody's light-skinned.










What to do?
It's mostly a matter of exposure. And then a matter of time. To limit exposure, wear light colored or white clothing, UVA and UVB rated shades, a good hat and use sunblock (no, just having the sunblock isn't the same as using the sunblock), making sure to use it (or an SPF rated lip balm) on lips and ears. Limit exposure time, even on hazy or overcast days. Exposure occurs wherever the skin meets the sun, including, of course, the beach, but also the golf course, the boat, the playing field, the open car window and the backyard. Open shade won't protect you from reflecting rays, but completely covering skin areas will nearly guarantee their safety.













What if...?
If you already have a suspicious patch of skin, however small, pick up your phone and call a dermatologist or your primary doctor. Can't get into the dermatologist's office until next fall or winter because they have no appointment openings sooner than that? Call a plastic surgeon and ask if they have skin cancer experience and openings, which they probably do. Get treatment early.