Many people spend most of their time indoors during the cold winter months every year – and when summer comes – they spend hours on end outdoors, enjoying their favorite activities, and often trying to get a ‘perfect tan’. But that perfect tan or ‘healthy glow’ is not generally so healthy, as it can come at a cost to your health.
Exposure to ultraviolet light from the Sun’s radiation and tanning beds is the greatest contributing factor to developing skin cancer. Other contributing factors do exist, like a family history of skin cancer or exposure to certain toxins, however these are more rare causes.
Cancers affecting the skin occur when ultraviolet radiation causes mutations in the cells of the epidermis, which is the outermost layer of the skin that humans constantly shed. These mutations sometimes cause these cells to multiply and replicate uncontrollably, resulting in an abnormal mass of cells (a ‘tumor’), which is essentially skin cancer.
Types of Skin Cancer
The layer of the skin called the epidermis is composed of multiple types of cells, including basal cells, squamous cells, and melanocytes. The various types of cancer are named for which type of cell is affected, hence the main types of skin cancer are called basal cell carcinoma, squamous cell carcinoma, and melanoma.
Basal Cell Carcinoma
Basal cell carcinomas usually appear as red, waxy or pearly-looking bumps on the face and upper body. However, they can occur anywhere sun exposure occurs, and even have different appearances, such as flattened pink-red spots or even blue or grey lesions. Keys for any type of skin cancer are lesions that enlarge, bleed, or scab for no apparent reason, become painful, and, importantly, don’t go away!
Squamous Cell Carcinoma
Squamous cell carcinomas can look much like basal cell carcinomas – abnormal-looking red bumps – but they are generally a bit more rough-textured, firm, and scaly, and can grow large rapidly. Like basal cell carcinoma, they most often occur on sun-exposed areas of the head and neck, arms, and upper body. As with most skin cancers, they are significantly more common in lighter-skinned persons, however, darker-complected individuals are also at risk.
Melanoma is due to abnormalities of the cells that make pigment in the skin, melanocytes. These cells are present in equal amounts in all people, no matter the skin color, only they are innately more active in those with darker skin colors. The pigment these cells produce is what protects the skin from the cancer-causing ultraviolet radiation of the sun, and why darker-complected people get skin cancer much less frequently than lighter-colored individuals.
(As an aside: a person’s skin tone has been developed by thousands of years of evolution as a response to the amount of ultraviolet radiation our ancestors were regularly exposed to)
However, that said, people of all colors can develop melanoma.
Most commonly, melanomas develop from ‘moles’, which are collections of melanocytes and can be anywhere from skin-colored in everyone, to very dark-colored, especially noticeable in lighter-complected individuals. When these cells go bad, they result in melanoma, which is the most dangerous of ALL cancers due to its very aggressive nature to spread throughout the body.
While many melanomas occur for unknown reasons, most are directly related to excessive ultraviolet radiation, just like other skin cancers, and typically occur in sun-exposed areas. Overall, the majority of melanomas present as dark lesions that look unusual or are changing. Abnormalities to look for a change in symmetry- (a)symmetric, jagged or irregular (b)orders, variations in (c)olor, enlarging with (d)iameter >6mm, and changing in any way or (e)volving. This includes unexplained pain or bleeding. Dermatologists call these changes the ‘ABCDEs’ of melanoma and instruct patients to use these criteria to help them know when a mole should be evaluated by an expert.
Although the 3 types above make up the great majority of skin cancers, there are many less common types, including Merkel cell carcinoma, sebaceous carcinoma, dermatofibrosarcoma, and Kaposi sarcoma, amongst others. Overall, these other types of skin cancers are more rare and it is not as evident to what extent excessive sun exposure plays in their development.
Risks for Skin Cancer
Skin cancer can strike anyone regardless of skin tone, but as noted previously, it affects people with lighter complexions with much greater frequency. People dramatically increase their risk by these factors:
- Actively tanning – including tanning beds
- History of sunburn – especially multiple, severe, and at a younger age.
- Family history of skin cancer
- Living in sun-drenched regions
- Having an abundance of moles
The ABCDE system can help you spot skin cancer on a mole or a spot on your skin:
- A – Asymmetrical shape
- B – Border is irregular
- C – Color changes
- D – Diameter is large or growing
- E – Evolving in ways above or other unusual changes, like bleeding
Treatment of Skin Cancer
While there are multiple ways skin cancer can be treated, including topical medications, scraping off, radiation treatment, or sometimes oral medications, the method most advised is to have it surgically excised, or ‘cut out’. The gold standard for excision is a technique called Mohs surgery in which a specially-trained surgeon cuts out cancer in the office while the patient is awake and then checks the specimen under the microscope in ‘real-time’ to make sure it is completely removed. For certain skin cancers, including many melanomas, it is necessary to have removed by a general surgeon, who may or may not need to check for lymph node involvement.
However, in reality, the choice of treatment relies on many different variables, including the particular type of skin cancer, size, location, patient health, insurance coverage, and other variables. At Lakeview Dermatology, we take the time to counsel all of our skin cancer patients individually to discuss their treatment options in detail to help determine the treatment plan that is best for their particular circumstance.
Dermatologists in Fort Worth
If you have a personal history of any type of skin cancer in the past, it is highly suggested you have a full-body skin exam at least yearly, if not more often. Additionally, if you notice a mole or other lesion on yourself or a loved one that looks unusual or is changing, it is always best to have it evaluated by a professional, sooner rather than later.
We welcome you to message our team at Lakeview Dermatology and we will be happy to schedule you to evaluate any concerning lesions or to perform your yearly skin cancer surveillance exam.
You can contact Dr. Matthew Mittelbronn at Lakeview Dermatology today at (817) 752-5256 or make an appointment online, and don’t forget to always cover up and wear sunscreen year-round!