May is Melanoma and Skin Cancer Awareness Month. This is appropriate because the weather is getting warmer and more people are spending more time outside in the sun. We want to ensure all of our readers are properly educated on signs, symptoms, risk factors, and treatment options for skin cancer. Skin cancer may be the most common type of cancer, but it also cancer you can SEE and cancer that is very curable if caught EARLY! Now is a great time to get a full-body skin check to find out if you have any suspicious lesions that could be cancerous. Earlier detection of skin cancer means easier treatment and smaller scars.
Skin cancer is the most common type of cancer in the United States followed by breast cancer and lung cancer. There are three main types of Skin Cancer: Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma. Early detection of skin cancer is key for the best possible treatment outcomes and cures.
Basal cell carcinomas (BCC) are typically pink and pearly and often look like a pimple or a bug bite that will not heal. Sometimes they can even look like a patch of eczema or psoriasis that doesn’t respond to steroid creams. Basal cell carcinomas are commonly found on sun-exposed areas of the skin. They are the mildest form of skin cancer and do not tend to spread to other organs. There are some invasive or more aggressive types of basal cells too, but usually basal cell carcinomas just sit on the surface of the skin and grow there. In general, they are usually easy to treat and cure, especially if they are found early.
There are a few different ways you can treat basal cells. Probably the most common way to treat a basal cell carcinoma is a procedure called electrodessication and curettage, or EDC. Some people call it the scrape and burn method. They can also be cut out and closed with stitches. Nova Dermatology offers both of those procedures in the office. Another common procedure is called Mohs surgery. It is a special type of skin cancer surgery reserved for skin cancers on certain areas of the body, like the head and neck or for large or very invasive basal cells. Specially trained dermatologic surgeons perform Mohs.
Risk factors for basal cell carcinomas include:
Squamous cell carcinomas (SCC) tend to be thick, red or yellow, crusty bumps or patches. Sometimes people think it is a wart, skin tag, or crusty scab. These can also look like a rash that will not go away. Sometimes these grow from a precancerous lesion called an actinic keratosis. While squamous cell carcinomas are most commonly found on areas of the body that have had a lot of sun exposure, they can also be found on the genitals, especially if there is a history of genital warts. Like BCCs, squamous cell carcinomas can also be superficial or invasive, but the invasive ones can metastasize or spread to other organs, so those are not considered to be quite as wimpy as basal cells.
Like basal cell carcinoma, the very superficial squamous cell carcinoma in situ, or SCCIS, can also be treated with the scrape and burn method. Otherwise, depending on the location, you will probably need an excision or the Mohs procedure.
Risk factors for squamous cell carcinomas include:
Melanoma is the most serious type of skin cancer because these spread to other organs of the body the most frequently. These usually look like very dark or black moles that sometimes grow quickly, but occasionally they are pink and look more like BCCs. When evaluating a suspicious mole, we use the ABCDE’s to help us decide if we need to do a biopsy. The alphabet can be very helpful to evaluate suspicious spots that could possibly be melanoma.
Asymmetry– If you draw a line through the middle of a mole, does it look the same on both sides?
Border irregularity– Is the mole perfectly round? Or does it have jagged borders or no borders?
Color variation– Is the mole the same color throughout? Or does it have many colors?
Diameter– Is it larger than a pencil eraser (>6mm)?
Evolution– Is the mole changing in any way?
Some also have added the “EFG rule” to help identify nodular and amelanotic melanomas. Nodular melanomas are usually very symmetrical and do not always have strange colors. They tend to grow very quickly though.
Elevated– Nodular melanomas are elevated, not flat (other types of melanomas can be flat though)
Firm– If you touch the bump, it will feel hard.
Growing– These melanomas grow quickly and need to be addressed quickly too. If you notice a spot that is rapidly growing, it is important to get it evaluated as soon as you can.
The ABCDE’s apply mostly to looking for melanoma, but the “E” applies to any skin cancer. If you notice any spot that has changed or is growing rapidly, or bleeding, then it is a good idea to make an appointment to have it evaluated and biopsied if necessary.
We prefer to catch them when they are smaller, but the depth of the lesion is more important than the diameter. So, a special type of biopsy needs to be performed when we suspect melanoma. It is important to get under the entire spot instead of just testing a small piece of these. We usually do what is called an “excisional biopsy” which will require stitches. And, if the results come back positive for melanoma, depending on how deep the mole was according to the dermatopathologist who analyzes it under the microscope, you will either simply need another larger excision or you will need to have lymph nodes removed to see if the cancer has started to spread to other areas. Sometimes additional blood testing or scans such as MRIs, CTs and PET scans are needed.
Dermatologists will often biopsy a mole because it looks “atypical.” It often has at least one or two of the ABCDEs of Melanoma. There is a spectrum of atypical moles:
Pre-melanoma or Melanoma
Proper sun protection techniques are essential as we start thinking about spending more time outside enjoying the warmer weather. There are many ways to protect yourself from the sun’s harmful rays, and it is best to try to do all of them at the same time. The Australians have a catchy way to promote sun protection and help you remember the 5 SunSmart steps
SPF (Sun Protection Factor)
UPF (Ultraviolet Protection Factor)
EPF (Eye Protection Factor)
Sunglasses have their own UV rating system. The American Academy of Ophthalmology recommends a rating of UV400 or higher. This means it will block up to 99-100% of both UVA and UVB. The Australians, who take skin cancer and sun protection very seriously, have even created their own Eye Protection Factor (EPF) rating. EPF of 9 or 10 is equivalent to UV400 rating. There is also something called the Australian Standard AS1067:2016 for sunglasses, and under that you want to look for lens categories 2, 3, or 4.
If you have any spots that sound like the above descriptions, or any spots that have changed and look different from how they looked a few months or years ago, then schedule an appointment for a full-body skin check to get those spots and all of your other spots evaluated to see if they need a biopsy.
Skin cancers can recur even after they have been removed properly. It is important to follow up with your dermatology specialist every 6 to 12 months to make sure the site is still healed and also to check for new spots. It is also important to take proper sun avoidance precautions to protect yourself from further sun damage that could cause more skin cancers.