We now know that all of that sun exposure accumulates, often resulting in skin cancer later in life. Accumulating hours in the sun usually result in basal cell and squamous cell carcinomas. Every single instance of those severe peeling burns we all used to get double the chances of developing melanoma, the deadliest form of skin cancer.
Skin cancer is the most common cancer in the United States. Twenty percent of us will develop skin cancer sometime of our lives. The incidence of basal cell carcinoma has increased 145 percent since the 1970s; squamous cell carcinoma cases have increased 263 percent. Scariest of all — the American Cancer Society estimates that one million Americans are living with untreated melanoma.
The key is to have your skin checked yearly. That’s especially true in a sunny place like Nevada where cloudy days are few and far between. Dr. Chaudhari is our dermatologist and skin cancer expert at Signature Plastic Surgery & Dermatology. She has extensive experience with skin cancer diagnosis and removal, including Mohs micrographic surgery.
What is skin cancer?
Skin cancer occurs when the sun’s ultraviolet rays alter the genetic material in skin cells, causing them to mutate into cancer cells. Your degree of inherent protection can depend on the amount of melanin in your skin. Melanin is responsible for the pigment of our skin, and it acts as a protection against sun exposure.
What causes skin cancer?
When our skin cells receive UV radiation, the melanin turns the skin a darker tone (tanning), as a protection mechanism. That’s why fair-skinned people are more susceptible to skin cancer — they have less melanin in their skin. It’s estimated that up to half of all fair-skinned people who live to be at least 65 years old will develop at least one skin cancer in their lives.
What are the symptoms of skin cancer?
Skin cancer typically develops as suspicious-looking lesions on the skin. The three main forms of skin cancer — basal cell carcinoma, squamous cell carcinoma, and melanoma — occur in different skin cells and have different appearances. Skin cancer growths won’t cause any pain, but they will appear typically on sun-exposed areas such as the shoulders, face, backs of the hands, and the scalp. But they can also occur in places that don’t receive sun exposure, such as on the palms of the hands and even between the toes. This is particularly true with melanoma.
What are the different types of skin cancer?
Everyone, no matter the skin type, should check his or her skin periodically. Have a partner check your back. Here is what the different varieties will look like:
Actinic keratoses are not yet skin cancer. They are precancerous, but if left alone they can turn into basal or squamous cell carcinomas. These precancerous growths will be dry, scaly patches on areas that receive lots of sun exposure. Most people see their first actinic keratoses after age 40.
Basal Cell Carcinoma
This is the most common type of skin cancer. Eight out of 10 skin cancers are basal cell carcinomas. They grow in the lowest layer of the epidermis, the basal cell layer. These cancers usually develop on sun-exposed areas, especially the head and neck. They tend to grow slowly, and it is rare that they spread to other parts of the body. If left untreated, basal cell carcinomas can grow into nearby areas and invade bone or other tissues beneath the skin, making removal potentially disfiguring.
Basal cell carcinomas look like a flesh-colored, pearl-like bump or pinkish patch of skin.
Squamous Cell Carcinoma
The second most common form of skin cancer, squamous cell carcinoma accounts for roughly one fifth of all skin cancers. These cells will look like abnormal versions of the squamous cells that are in the outer layers of the epidermis. Squamous cell cancers appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the hands. They are more likely to spread to other parts of the body than basal cell cancers, but this is still rare.
Squamous cell carcinomas will look like a red firm bump, scaly patch, or a sore that heals and then re-opens.
This deadliest form of skin cancer is also the rarest. But, unlike basal and squamous cell cancers, melanomas are far more likely to grow and spread if left untreated. When melanomas grow downward, they can begin to deposit cancerous cells into the bloodstream, which can then spread the cancer anywhere in the body.
A melanoma will suddenly appear as a new dark spot on the skin. They will also show as a change in the size, shape, color, or elevation of an existing mole. This is more typical in people with over 50 moles.
What are the different types of melanoma?
Most people assume there is just “melanoma.” There are actually four different types of this most dangerous form of skin cancer:
Superficial Spreading Melanoma
This is the most common form. It can arise in an existing mole or appear as a new lesion. When it forms in a mole already on the skin, it tends to grow on the surface for a period of time before penetrating more deeply. It is most likely to occur on the torso in men, the legs in women, and the upper back in both sexes. Superficial spreading melanoma appears as flat or slightly raised and discolored, asymmetrical patches with uneven borders.
This form of melanoma often develops in older people. It also grows close to the surface skin in the beginning. This form typically develops on sun-damaged areas of the face, ears, arms, and upper torso. Lentigo maligna appears as flat or slightly raised, blotchy patches with uneven borders.
Acral Lentiginous Melanoma
This is the most common form of melanoma found in people with darker skin tones, including those with African ancestry. It often forms in areas that are not easy to spot — under the fingernails or toenails, on the soles of the feet, or on the palms of the hands. It appears as a black or brown area.
This is the most aggressive type of melanoma. It makes up 10-15 percent of all cases. These tumors grow deeper into the skin more rapidly than other types of melanoma. They are invasive tumors, meaning they’re likely to already have reached the deeper layer of skin by the time it is diagnosed. These are found most frequently on the torso, legs, and arms, and on the scalp in older men. These appear as a bump on the skin, usually blue-black in color.
What signs should I look for to spot melanoma?
While Dr. Chaudhari will check you for melanoma and other skin cancers during your yearly skin checkups, it’s a good idea to always be on the lookout on your own. With melanoma, you can follow the ABCDE warning signs:
- Asymmetry — If one half of the mole doesn’t match the other half, that’s a concern. Normal moles are symmetrical.
- Border — If the border or edges of your mole are ragged, blurred, or irregular, it should be checked.
- Color — Normal moles are a single shade throughout. If your mole has changed color or if it has different shades of tan, brown, black, blue, white, or red, then it should be checked.
- Diameter — If a mole is larger than the eraser of a pencil, it needs to be checked.
- Evolving — If a mole evolves by shrinking, growing larger, changing color, itching or bleeding, or other changes, it should be checked. Melanoma lesions often grow in size or gain height rapidly.
Am I at risk for developing skin cancer?
Everyone living in sunny Las Vegas is at risk for developing some form of skin cancer. There’s just too much sun out there, and we all typically spend a lot of time out in it. The main risk factor for developing all types of skin cancer is natural and artificial ultraviolet light. Basal cell and squamous cell cancers typically result from accumulated UV exposure over time. You can think of it as a continually increasing tally over your lifetime, eventually producing cancerous growths. Melanoma also develops from accumulated exposure but is more a result of scorching sunburns.
Here are various risk factors for skin cancer:
- One blistering sunburn during childhood or adolescence (and most of us have had a few) doubles a person’s chances of developing melanoma later in life. Five or more of these types of sunburns increases your melanoma chances by 80 percent.
- People over 65 are more at risk for all skin cancers due to accumulated exposure.
- Exposure to tanning beds increases the risks for all skin cancers.
- People with more than 50 moles have a higher risk for melanoma.
- People who have had melanoma have a nine-fold increased risk for developing another melanoma compared to the general public.
- From 40 to 50 percent of people with fair skin will develop at least one skin cancer in their lives.
- People with blond or red hair are more susceptible to develop all skin cancers.
How is skin cancer treated?
The treatment for any form of skin cancer is to remove or destroy the lesion. Dr. Chaudhari can do this with a variety of surgical methods, depending on the size, type, and location of the skin cancer growth. For basal cell and squamous cell carcinomas (along with some melanomas), Dr. Chaudhari is trained in Mohs micrographic surgery, which has incredibly high rates for removing all of the cancer cells.
Here are the different treatment options we employ for skin cancer at Signature Plastic Surgery & Dermatology.
Skin Cancer Surgery
Surgery is the typical treatment method. Depending on the size and location of the removed growth, the wound may be sutured closed, covered with a skin graft, or allowed to heal on its own.
These are the surgical procedures:
Electrodesiccation and Curettage
With small or superficial basal cell or squamous cell growths, Dr. Chaudhari removes the surface of the skin cancer with a blade or often a scraping instrument known as a curette. Then the base of the cancer is seared with an electric needle. This both closes off blood vessels and kills any stray cancer cells. In some cases, the underlying area is frozen with liquid nitrogen, rather than cauterized with electricity.
This involves cutting out the cancerous lesion with a scalpel, along with a margin of healthy skin around it. The sample is then sent to a lab to confirm that removal was successful.
Spraying liquid nitrogen onto growths is the preferred method for removing precancerous actinic keratoses, but it can also be used on very thin basal cell and squamous cell carcinomas with little depth. The problem with this method is that the freezing time may need to be prolonged, which can possibly damage nerves in the area.
This method has the highest success rate for completely removing basal cell and squamous cell carcinomas, with overall cure rates approaching 99 percent. It isn’t used as often for melanoma. For these procedures, Dr. Chaudhari removes the cancer layer by layer. After a layer is removed, it is examined immediately in the lab to check for any remaining cancer cells on the borders. If cancer cells are still found, another layer or ring is removed. This process is continued until the sample shows itself to be clean. This is especially effective for removing growths on the face, as only the minimum amount of tissue is removed.
Topical Treatments for Skin Cancer
Topical treatments can be successful on superficial carcinomas with little depth. They can even be effective for treating the lentigo maligna form of melanoma. These drugs work by inflaming the area where they are applied. The body responds by sending white blood cells to attack the inflammation. These white blood cells go after the mutated Skin cancer cells. Aldara, Efudex, and Fluoroplex are three of the most used drugs.
What can I do to protect myself against skin cancer?
The sun and our skin just don’t make good friends. The ultraviolet radiation present in the sun’s rays is what damages human skin cells. How do you protect yourself from the sun’s UV rays? Protect yourself with sunscreen of 30 SPF or higher and with protective clothing. Wear hats, sleeves, and whatever else you feel can shield your skin from sun exposure.
You need to realize that tanned skin is sun-damaged skin; tanning is nothing more than the skin’s protection mechanism. As a response to the UV radiation that is damaging it, the melanin in our skin darkens to absorb more of the sun’s rays. This helps to lessen the burning effect of the sun’s energy.
You don’t have to stay inside like some kind of vampire. You don’t have to stop being active outdoors. After all, we do need sun exposure because it is a great source of vitamin D. You just need to be smarter than we were in the past. Do what you want to do — go hiking, biking, play golf, go to the pool — but just do so thinking of ways to protect your skin.
The most effective way to protect yourself is to schedule yearly skin checkups with Dr. Chaudhari at Signature Plastic Surgery & Dermatology. She will examine your skin, looking for signs of skin cancer and other suspicious lesions. She’ll use nitrous oxide to freeze precancerous growths, stopping them from developing into basal cell or squamous cell carcinomas. Skin cancer is easily and successfully treated if it is caught early.
How do I examine myself for skin cancer?
You can check the areas you can see, such as your arms, face, neck, shoulders, legs, ankles, and stomach. You’ll need someone else to give your back and the backs of your legs a look. The goal is to check every part of your skin, including your scalp, behind your ears, even under your arms. Look for any moles or growths that are new, have changed shape or color, bleed regularly, or itch. Change is key. Change often denotes lesions moving from pre-cancerous to cancerous.