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Skin and Sun Safety

Skin cancer is the most common of all cancer types and the number of skin cancer cases has been on the rise for the past few decades. Currently, more than 1 million skin cancers are diagnosed each year in the United States. That’s more than cancers of the prostate, breast, lung, colon, uterus, ovaries, and pancreas combined.

The good news is that there is a lot you can do to protect yourself and your family from skin cancer, or to catch it early enough so that it can be treated effectively. Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. Much of this exposure comes from the sun, but some may come from manmade sources, such as tanning beds.

Nonmelanoma skin cancers (usually basal cell and squamous cell cancers) are the most common cancers of the skin. They are called nonmelanoma because this group of cancers includes all skin cancers except one, malignant melanoma. Cancers that develop from melanocytes, the pigment-producing cells of the skin, are called melanoma. What Causes Nonmelanoma Skin Cancer?

Nonmelanomas (usually basal cell and squamous cell cancers) are the most common cancers of the skin. They are called nonmelanoma because they develop from skin cells other than melanocytes. Because they rarely spread elsewhere in the body, they are less worrisome than melanomas. The exact cause of nonmelanoma cancer is unknown, but there are known risk factors linked to the disease.

The following are risk factors for Nonmelanoma Skin Cancer:

  • Too much exposure to UV (ultraviolet) radiation: The main source of UV radiation is sunlight. People who are often exposed to strong sunlight without protection have a greater risk of nonmelanoma skin cancer
  • Fair skin: The risk of skin cancer is over 20 times higher for whites than for dark-skinned African Americans. This is because melanin offers some protection from UV radiation. People with dark skin have more melanin. People with fair (light-colored) skin that freckles or burns easily are at especially high risk.
  • Men: Men are twice as likely as women to have basal cell cancers and three times as likely to have squamous cell cancers of the skin.
  • Chemicals: Exposure to large amounts of arsenic, a heavy metal used in making some insecticides, increases the risk of nonmelanoma skin cancer. Workers exposed to industrial tar, coal, paraffin, and certain types of oil may also have an increased risk.
  • Radiation: People who have had radiation treatment have a higher risk of getting nonmelanoma skin cancer in the area that was treated.
  • Certain long-term or severe skin problems: Scars from severe burns, areas of skin over severe bone infections, and skin damaged by certain skin diseases are more likely to develop nonmelanoma skin cancers, although this risk is fairly small.
  • Treatment of psoriasis: Some people who have been treated for a long-lasting skin disease (psoriasis) with Psoralen and ultraviolet light (PUVA) could have an increased risk of getting squamous cell skin cancer and perhaps other skin cancers as well.
  • Skin disease: a very rare disease known as xeroderma pigmentosum hampers the skin’s ability to repair damage caused by the sun. People with this disease get many skin cancers, sometimes beginning in childhood.
  • Basal cell nevus syndrome: this rare condition, present at birth, causes some people to have many basal cell cancers. This is often an inherited condition.
  • Weakened immune system: people with weakened immune systems are more likely to develop nonmelanoma skin cancer. For example, people who have had an organ transplant often take medicines to weaken the immune system in order to keep the body from rejecting the organ. The skin cancers in people with weakened immune systems are faster growing and more likely to be fatal.
  • Virus infection: A small number of nonmelanoma skin cancers seem to be linked to infection with human papillomavirus (HPV). This group of viruses can cause warts different from the common type of warts that people get on their hands and feet. The HPV-related warts appear in the genital and perianal area and are linked to skin cancers in these areas.
  • Smoking: Studies show that people with nonmelanoma skin cancers are more likely to be smokers.
  • Earlier skin cancer: Anyone who has had a skin cancer has a much higher risk of getting another one.

Can Nonmelanoma Skin Cancer Be Prevented?

The best way to lower the risk of nonmelanoma skin cancer is to avoid being outdoors in intense sunlight too long, and to practice sun safety when you are outdoors. You can exercise and practice sun safety at the same time. Here are some tips:

  • Seek shade: look for shade, especially in the middle of the day when the sun’s rays are strongest.
  • Cover up: wear a shirt, and a hat with a brim.
  • Use sunscreen: use sunscreen and lip balm with an SPF of 15 or higher. Be sure to use enough (a palmful) and put it on again every two hours and after swimming or sweating. Use sunscreen even on hazy or overcast days. Don’t make the mistake of thinking that because you’re using sunscreen, you can stay out in the sun longer. Staying out longer because you’re using sunscreen just means you’ll end up getting the same amount of UV light as you would otherwise. You won’t reduce your risk that way.
  • Wear sunglasses: wrap-around sunglasses that absorb 99%-100% of the UV rays help protect your eyes and the skin around your eyes.
  • Don’t use tanning beds and sun lamps: these also give off UV light and can increase the risk of skin cancer.
  • Remember to protect children: use the methods above to protect children from too much sun, and teach them to protect themselves as they get older.

Detecting Nonmelanoma Skin Cancer

Nonmelanoma skin cancer can be found early. The American Cancer Society recommends a cancer-related checkup, including a skin exam when you have your regular health exams.

You should also check you own skin once a month. This is best done in front of a full-length mirror. A hand-held mirror can be used for areas that are hard to see. You should know the pattern of moles, freckles, and other marks on your skin so that you’ll notice any changes. Be sure to show your doctor any area that concerns you.

Friends and family members can also help by telling one another about abnormal-appearing areas of skin. The key warning signs are a new growth, a spot or bump that’s getting larger, or a sore that doesn’t heal within 3 months.

Basal cell carcinomas often appear as flat, firm, pale areas or as small, raised, pink or red, translucent, shiny, waxy areas that may bleed following minor injury. You might see one or more irregular blood vessels, a depressed area in the center, or blue, brown, or black areas.

Squamous cell cancer may appear as growing lumps, often with a rough surface–or as flat, reddish patches that grow slowly.

Both of these types of nonmelanoma skin cancer may develop as a flat area showing only slight changes from normal skin.

What is Melanoma Skin Cancer?

Melanoma is a cancer that begins in the melanocytes. Because most of these cells keep on making melanin, melanoma tumors are often brown or black. Melanoma is almost always curable in its early stages. But it is also likely to spread to other parts of the body. Melanoma is much less common than basal cell and squamous cell skin cancers, but it is far more serious.

Risk factors for Melanoma Skin Cancer

  • Moles: A mole is a benign (not cancerous) skin tumor. Certain types of moles increase a person’s chance of getting melanoma. People with lots of moles, and those who have some large moles, have an increased risk for melanoma.
  • Fair skin: People with fair skin, freckling, light hair or blue eyes have a higher risk of melanoma. But anyone can get melanoma.
  • Family history: Around 10% of people with melanoma have a close relative (mother father, brother, sister, child) with the disease. A strong family history of breast and ovarian cancer could mean that certain gene changes (mutations) are present. Men with this gene change have a higher risk of melanoma.
  • Immune suppression: People who have been treated with medicines that suppress the immune system, such as transplant patients, have an increased risk of developing melanoma.
  • UV radiation: Too much exposure to UV radiation is a risk factor for melanoma. The main source of such radiation is sunlight. Tanning lamps and booths are another source.
  • Age: About half of melanomas occur in people over the age of 50. But younger people can get melanoma, too.
  • Gender: Men have a higher rate of this cancer than women.
  • Xeroderma pigmentosum (XP): This is a rare, inherited condition. People with XP are less able to repair damage caused by sunlight and are thus at greater risk of melanoma.
  • Past history: A person who has already had melanoma has a higher risk of getting another melanoma.

How is Melanoma Skin Cancer Detected?

Self-exam: It’s important to check your own skin about once a month. You should know the pattern of moles, freckles, and other marks on your skin so that you’ll notice any changes. Self-exam is best done in front of a full-length mirror. A hand-held mirror can be used for areas that are hard to see. A family member can check areas such as your lower back or the back of your thighs.

Spots on the skin that change in size, shape, or color should be seen by a doctor right away. Any unusual sore, lump, blemish, marking, or change in the way an area of the skin looks or feels may be a sign of skin cancer.

Doctor’s Exam: Part of a routine cancer checkup should include a skin exam.

Normal Moles: It’s important to know the difference between melanoma and a harmless mole. A normal mole is most often an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised. It can be round or oval. Moles are usually less than 1/4 inch in diameter, or about the width of a pencil eraser. Moles can be present at birth or they can appear later. Several moles can appear at the same time. Once a mole has developed, it will usually stay the same size, shape, and color for many years. Moles may fade away in older people. Most people have moles, and almost all moles are harmless. But it is important to recognize changes in a mole– such as its size, shape, or color– that suggest a melanoma may be developing.

Abnormal Moles (A,B,C,D): You should see your doctor if you have a mole or growth that worries you. Your doctor may have you see a dermatologist, a doctor who specializes in skin problems. There are methods that help doctors tell the difference between a harmless growth and one that might be cancer. Using these methods could mean that a biopsy is not needed.

The ABCD rule can help tell a normal mole from a melanoma:

A: Asymmetry — one half of the mole does not match the other half.

B: Border irregularity — the edges of the mole are ragged or notched.

C: Color — the color of the mole is not the same all over. There may be shades of tan, brown, or black, and sometimes patches of red, blue, or white.

D: Diameter — the mole is wider than about 1/4 inch (although doctors are now finding more melanomas that are smaller).

Other important signs of melanoma include changes in size, shape, or color of a mole. Some melanomas do not fit the descriptions above, and it may be hard to tell if the mole is normal or not, so you should show your doctor anything that you are unsure of.

Information on this page courtesy of the American Cancer Society (www.cancer.org)