The Skin Cancer Guide: Part 1
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The Skin Cancer Guide: Part 1

In the first installment of a three-part series, we give you a dermatologist-approved detection guide that just might save your life.

Freckle, Mole, or Cancer?

Heather Fraelick

Heather Fraelick
Gloucester, Massachusetts
Diagnosed with melanoma at 25
Recurrence at 27
Now healthy at 29

Heather Fraelick was 25 when she noticed the pink, raised spot on her right forearm. "It looked like a bug bite," she says, but when it bled and didn't seem to heal she went to the dermatologist. The bump didn't have the classic look of a melanoma, the most dangerous form of skin cancer --but it was. "I was absolutely shocked, and I learned how deadly melanoma can be if it isn't caught early," she says. "It was much more invasive than I expected, which was really frightening." A surgeon removed the lesion as well as five lymph nodes under her arm. Luckily, all were cancer-free, which meant it hadn't spread.

Two years later, though, she noticed a tiny freckle on the scar. The melanoma had recurred, but the surgeon was able to successfully remove it. As an athlete who played sports for years without sunscreen and visited the tanning salon before her prom, Fraelick, now 29, has learned her lesson. Although she lives on the ocean in Gloucester, Massachusetts, she never goes outdoors without wearing protective clothing and plenty of sunscreen.

Lee Cavanaugh is glad she had a recurring blemish on her hairline checked out. "I was shocked that it was skin cancer because I was only 32," says the New York City interior designer. She had the basal-cell tumor removed surgically and now she's examined by her doctor every six months. "No more basking in the sun. I'm into sunless tanners now," she says.

Fraelick's and Cavanaugh's stories aren't rare. Doctors are seeing more and more skin cancer among people in their 20s and 30s. "When I was a resident, skin cancer wasn't a disease young people got," says James M. Spencer, MD, a dermatologist in St. Petersburg, Florida. "Now I see it in somebody every month." The rates in 40- and 50-year-olds continue to rise, too. He speculates that increased UV exposure is to blame. "Your grandmother didn't fly to Jamaica for a vacation, and she sure didn't go to a tanning salon, either," he adds.

No matter your age, skin color, or sun habits, early detection is key. Follow our guidelines for keeping an eye on your (and your family's) skin. Then make an appointment if anything seems vaguely suspicious. It could save your life!

Basal-Cell Cancer

What It Is
About a million cases of this most common type of skin cancer are diagnosed each year. It starts in the deepest layer of the epidermis.

Is It Dangerous?
It seldom metastasizes and is almost never fatal, but it's serious just the same. Some basal-cell cancers spread along the surface of the skin, while others can go deep. "It can grow under the skin like tentacles," says Julie Karen, MD, a New York City dermatologist. If a cancer has progressed that far, surgery to remove it can lead to serious scarring or disfigurement; unlucky patients have lost an ear, a nose -- even an eye. Fortunately, basal-cell cancer takes years, maybe decades, to do that kind of damage and can usually be cured if you find it early.

Triggers
The major cause is exposure to UV radiation from sunlight. Tanning salons greatly increase your risk, too. Arsenic, found in contaminated meat, poultry, or water, may cause it, and patients on immunosuppressant drugs after transplant surgery also are at higher risk.

Where You Get It
Most frequently on any part of the body exposed to the sun, but it can show up elsewhere. Behind the ears is common, according to Dr. Spencer. And up to 10 percent of all skin cancers occur on the eyelids, most of which turn out to be basal.

Treatment
Sometimes the biopsy alone will get rid of the cancer. Doctors can also scrape or burn off superficial cancers or use photodynamic therapy. This involves treating the skin with a chemical that lets a certain wavelength of light destroy cancerous cells without seriously harming healthy cells. (Your skin may turn pink and flake, so you'll have to avoid sunlight for 48 hours.) Deeper basal-cell tumors usually need surgery. If the cancer is large, growing fast, is in a visible spot like your face, or has been previously treated and has recurred, it may be a candidate for Mohs surgery, followed by plastic surgery or laser treatment, if needed.

What's New
Chemotherapy creams (5-fluorouracil and imiquimod) can kill basal-cell cancer on the skin's surface, leaving few or no scars. "It's a viable option for young people with a large but shallow lesion on the back or chest that would scar if you remove it surgically," says Sandra Read, MD, a dermatologist in Washington, D.C., who adds that chemo cream is only for patients willing to apply it three to five times a week for up to four months and put up with inflammation, soreness, and redness during treatment.

For any suspicious mole or bump, ask about high-frequency ultrasound with elastography, a noninvasive technique that's an accurate alternative to biopsy for all skin-cancer types.

Basal-Cell Cancer: What to Look For

The Skin Cancer Foundation cites five typical signs: an open sore, a reddish patch, a shiny bump that may be translucent or pearly, a pink growth with an elevated edge and crusted center, or a scarlike area that is white, yellow, or waxy. Here, some examples:

Squamous-Cell Cancer

Squamous-Cell Cancer spot 1
Squamous-Cell Cancer spot 2

What It Is
The second-most-common type of skin cancer, it occurs in the upper layers of the epidermis and is diagnosed in more than 250,000 people each year.

Is It Dangerous?
"Often squamous-cell gets lumped with basal-cell cancer, but it can be more dangerous," says Dr. Spencer. In fact, some 2,300 Americans die from it each year. Squamous-cell cancer grows slowly, over years, and early treatment can cure it. But once it has spread, the five-year survival rate is 50 percent.

Triggers
The major one is sun exposure, but squamous-cell cancer can also develop at the site of a chronic wound, for example, in patients who have diabetes. Smoking or a depressed immune system increases risk, as does exposure to arsenic. Squamous-cell cancer may also be linked to human papillomavirus. The good news is that the HPV vaccine immunizes against the specific strains thought to increase risk, so it should help reduce the incidence of squamous-cell cancer, says Elizabeth Hale, MD, who teaches dermatology at New York University. The vaccine was approved by the FDA for young men (9 to 26) in September 2009.

What to Look For
This type of cancer usually resembles a wart or a sore that doesn't heal. It may bleed and crust repeatedly. Examples at right.

Where You Get It
Although it most often shows up on sun-exposed areas such as the face, neck, hands, and arms, squamous-cell cancer can grow anywhere on the body.

Treatment
Because these tumors have the potential to metastasize, most require traditional or Mohs surgery. If surgery isn't possible owing to the lesion site -- near vital nerves, say -- you may undergo radiation to destroy the cancer cells. Fewer than 5 percent of squamous-cell cancers spread to other organs, but those that do need some combination of surgery, chemotherapy, and radiation.

What's New
Researchers are looking at the potential of immunotherapy, which stimulates your immune system, to battle squamous-cell cancer.

Melanoma

What It Is
The most serious form of skin cancer, melanoma forms in the melanocytes, epidermal cells that produce your skin's pigment. Although it can be diagnosed at any age, melanoma is now the most common type of cancer among people in their mid to late 20s.

Is It Dangerous?
Absolutely. Although only 3 percent of people with skin cancer have melanoma, it causes more than three-quarters of the deaths, nearly 8,700 each year. Melanoma has a very high cure rate if caught early, but that number falls to 15 percent once the cancer has spread.

Triggers
As with all skin cancers, sun exposure is a major cause, but heredity plays a role, too. Several gene mutations increase the chance of developing melanoma, and having a parent or sibling with the disease raises your risk by 50 percent. The lighter your skin, the higher your risk. However, melanoma is more deadly in the few African Americans who get it, possibly because it is often diagnosed too late for a cure. A recent study in the Irish Journal of Medical Science suggests that having either breast cancer or melanoma may raise your likelihood of developing the other disease; a genetic mutation may be to blame.

What to Look Fo
Most melanomas are brown or black, although they can contain other colors, too.

Where You Get It
Melanoma can appear anywhere on the body. If you have darker skin, you're likely to get it on less-pigmented areas, such as on your palms, nail beds, or even on the soles of your feet.

Treatment
Superficial melanomas can be cut out surgically, but if the cancer is deeper than 1 mm your doctor may also remove and biopsy one or more lymph nodes to see whether the cancer has spread. Mohs surgery is usually not considered appropriate for malignant melanomas. Melanomas may leave large scars, so some patients ask about using a plastic or reconstructive surgeon to minimize the damage. An oncologist may also prescribe chemotherapy and radiation in certain cases.

What's New
Potential treatments for advanced melanoma now in clinical trials include immunotherapy, a process that employs vaccines and drugs that cut off the cancer's blood supply or attack the genetic mutation that caused the disease. If you're diagnosed with a melanoma that has spread, you may want to consider enrolling in a clinical trial. You can search for one by logging on to clinicaltrials.gov.

Melanoma: What to Look For

The "ABCDE" acronym has been shown to help detect melanoma, the most dangerous type of skin cancer. Make an appointment with a dermatologist immediately if you find anything suspicious.

A is for asymmetry: The two sides of the mole don't match.



Melanoma cancer spot 2

B is for border: Look for jagged, irregular edges.



C is for color: A variety of colors in a single mole.



Melanoma cancer spot 4

D is for diameter: Melanomas are usually larger than a pencil eraser.



Melanoma cancer spot 5 before

E is for evolving: The mole has changed in some way (color, size, shape, elevation).

Before:



After:

Mohs Surgery: A Cleaner Cut

Mohs micrographic surgery is a specialized technique that takes more time than conventional surgery but has a higher cure rate and may produce less scarring. The surgeon removes extremely thin (1-mm) slices of tissue, examining each layer under a microscope until he can't see evidence of cancer cells anymore. By doing this, surgeons avoid removing more tissue than is necessary. And more importantly, they're less likely to leave behind any cancerous cells, which can grow like the roots of a tree. Although Mohs has been available for decades, it's grown rapidly in the past 15 years and now accounts for about one in five skin-cancer procedures, says Cincinnati dermatologist Brett Coldiron, MD. As studies have shown it improves patient outcome, more surgeons have trained in it. You can go to mohscollege.com to find a "fellowship trained" surgeon, suggests David Kriegel, MD, director of the Division of Mohs Micrographic Surgery at the Mount Sinai School of Medicine, in New York City.

Peri Silverman had New York City surgeon Elizabeth Hale, MD, remove a basal-cell cancer on her left temple. "Both my parents have had skin cancer, so I figured I would eventually get it -- but not at 34. It took three passes and three hours to get it all. They gave me a local anesthetic each time, so it didn't hurt," she says. "The site was twice as big as the original red spot on my skin, but a month after surgery the scar is already fading."

For large wounds, especially on the face, some patients ask a plastic surgeon to do the sutures after Mohs surgery to get the most unobtrusive scar possible.

Get Checked Do you have a suspicious spot or mole? This summer marks the 25th anniversary of the American Academy of Dermatology's National Skin Cancer Screening Program, which offers free skin checks around the country. Most of the screenings happen in May, but some are available year-round. Go to aad.org to find a screening near you.

Are you addicted to tanning?
We'll tell you why and help you break the habit in our Skin Cancer Guide: Part 2.

Pledge to wear sunscreen every day this summer. Sign up at LHJ.com/healthpledge.

 

Originally published in Ladies' Home Journal, June 2010.

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