May is National Skin Cancer Awareness Month!

By: Dr. Mitchell Kaye

Advanced Cosmetic Surgery Center of Kentucky

This month we will take a break from Cosmetic Plastic Surgery topics and focus on skin cancer, which is appropriate given that May is National Skin Cancer Awareness Month. Some of the statistics are a bit sobering. Each year in the US, nearly 5 million people are treated for skin cancer. In 2006, in the most recent study available, 3.5 million cases were diagnosed in 2.2 million people. Each year there are more new cases of skin cancer in the U.S. than the combined number of new cancers of the breast, prostate, lung and colon. One in five Americans will develop skin cancer in the course of their lifetime and between 40 and 50% of Americans who live to age 65 will have either Basal cell or Squamous Cell carcinoma (the two most common types) in their lifetime.

There is no question that sun exposure and other ultraviolet irradiation (UV) sources such as tanning beds are the primary cause of skin cancers, although genetics play a role as well. Racial groups also have different rates of skin cancer, with white sun-exposed, older males leading the pack. However, all racial groups can develop skin cancers at various rates and with different patterns of disease.

Contrary to popular belief, 80% of a person’s lifetime sun exposure is not acquired before age 18. In fact, only about 23% of a person’s lifetime exposure occurs by age 18. The greatest amount of UV exposure in Americans occurs between ages 40-60. About 86% of melanoma cases, a particularly dangerous skin cancer, are due to UV irradiation from the sun. As a bonus, the daily use of sunscreen by adults under age 55 can reduce skin aging. Over 90% of visible changes of skin aging are caused by the sun. Therefore the daily use of sunscreen can prevent many or most skin cancers as well as the preventable aging effects of the sun. That’s a pretty good deal.

Although most people think a nice tan is attractive and a sign of good health, it is a disaster for your skin. The use of tanning beds is particularly dangerous. Nearly 30 million people tan indoors in the U.S. every year. Two to three million of them are teens. Now for the bad news. More people develop skin cancer because of tanning than develop lung cancer because of smoking. Just one indoor UV tanning session increases the users’ risk of developing squamous cell carcinoma by 67% and basal cell carcinoma by 29%. Just one indoor tanning session increases the users’ chances of developing melanoma by 20%, and each additional session during the same year boosts the risk almost another 2%.

Actinic keratosis (AK) is the most common pre-cancer and affects more than 58 million Americans. About two-thirds of all squamous cell carcinomas and 1/3 of all basal cells start as actinic keratoses. These appear to the patient as a red, scaly, raised spot that does not go away. They can be easy to ignore since there are usually no other symptoms, although they may itch or bleed if rubbed or scratched. They are directly related to sun and UV light exposure and are found on exposed areas such as the face, hands, forearms and upper chest for sun exposure and anywhere on the body for indoor tanners. Treatment involves correct diagnosis, sometimes by biopsy, and destruction with liquid nitrogen, medications or sometimes removal. Some people develop many of these lesions over time and good preventive care can prevent them from developing a skin cancer.

Basal Cell Carcinomas (BCC) are the most common skin cancer and the most common malignancy in humans. These too are related to sun and UV exposure. BCC can have several appearances including: a tan raised growth, flat ulcer, pale ill defined scar and others. Some are indistinguishable from AK, and in fact may arise from them. They are locally destructive, but relatively few travel to other areas in the body, unlike the more aggressive squamous cel l carcinomas or melanomas. Treatment involves surgery and careful follow-up for new or recurrent lesions in most people. Some recurrences or patients with extensive disease or medically unstable patients are treated with radiation therapy.

Squamous Cell Carcinomas (SCC) are also a sun and UV exposure cancer. They can look like red, scaly, flat areas, ulcers or raised growths. Biopsy is very important in establishing a diagnosis. The main difference in SCC from BCC is that the former is much more likely to spread away from the original site, for example to lymph nodes, making it a more aggressive and potentially deadly disease. Luckily this generally occurs in SCCs that have been neglected and have been present for a long time. It is also more common and aggressive in patients who are on immunosuppression, for transplant or rheumatoid arthritis treatment for example. Treatment is similar as that for BCC.

Melanoma is the most deadly skin cancer and unfortunately it is becoming more common. Sun exposure due to lifestyle, tanning and possibly a stronger sun exposure due to climate change are the probable causes. It is important to note that only a few sunburns in ones’ life dramatically increase the risk of this disease, as does indoor tanning. Fair skinned, sun exposed people are at highest risk, although all humans can develop this disease. It can also occur in non-skin areas; such as the mouth, nailbeds and rectum. Warning signs include: change in size or appearance in a pre-existing mole, a bleeding or painful skin lesion, red, white or blue color change in a skin lesion especially if the skin lesion has irregular borders or is greater than the diameter of a pencil eraser (6mm). The acronym ABCD reminds us that skin lesions with: Asymmetry, Bleeding, Color change and Diameter greater than 6mm require immediate evaluation. Any of these symptoms warrants prompt attention by a physician who deals with skin cancer on a daily basis. Treatment begins with proper diagnosis and includes history, physical exam, biopsy and other tests as indicated. The stage of the disease relates to the depth of invasion of the skin and presence or absence of spread elsewhere in the body. Treatment includes surgery, radiotherapy in some cases and more recently the use of immunotherapy and tumor vaccines.

In summary:

1. Protect your skin against the sun with good quality sunblock before exposure and preferably on a daily basis. Re-apply often
2. Remember the ABCDs
3. Examine your body regularly for skin lesions with suspicious changes and if they are present GET THEM EVALUATED.
4. No tanning beds.
5. Have these problems checked and treated by an appropriately trained and experienced skin cancer surgeon or dermatologist.

Dr. Mitchell Kaye sees patients in his practice for Skin Cancer evaluation and treatment. At your office visit, he will perform an evaluation and if necessary, a skin biopsy is taken and sent to pathology for definitve diagnosis. Based on that result, a skin excision may be performed in the office or out-patient facility based on Dr. Kaye’s recommendation.