Skin Cancer: Types and Risk

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Millions of people are diagnosed with skin cancer every year. With 9,500 being diagnosed daily, statistics show nearly one in five people will develop skin cancer in their lifetime.

Rick K. Wilson, MD, FASDS, FABVLM, Director of Dermatology at Cooper Clinic, says being educated about skin cancer is crucial in fighting it. Most skin cancer cases are preventable, and even when they’re not, early detection is the best way to fight it.
 
“Having an annual skin cancer screening provides a high probability of early detection and successful treatment,” Wilson said. “Even though skin cancer is diagnosed in millions of people, it kills far less than that a year.”

Types of skin cancer    

“Each cancer behaves differently,” Wilson says. “Some people will come in and say there’s been something on their back for 15 years and we can treat it. Other people will come in with malignant melanoma and it’s metastasized. Then they can die within a few months or years.”

• Basal cell carcinoma is the most common type of skin cancer making up 75% of cases. It often appears as a slightly transparent bump on the skin, though it can take other forms. Basal cell carcinoma occurs most often on areas of the skin exposed to the sun, such as your head and neck.
   
• Squamous cell carcinoma makes up 20% of skin cancer cases. This form begins as a growth in the squamous cells, which make up the middle and outer layers of the skin.
   
• Melanoma is the least common of the three major skin cancers—comprising 5% of skin cancer cases—but the most serious type. It develops in the cells called melanocytes that produce melanin, the pigment that gives your skin its color. Melanoma can also form in your eyes and, rarely, inside your body, such as in your nose or throat.

Causes

Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. With the rays having a cumulative effect on our skin over the years, Dr. Wilson says lifestyle can have a huge impact on developing skin cancer.

“If someone is outside for thousands of hours, that’s a thousand hours of your skin being cooked,” Wilson said. “Sooner or later genetic damage occurs to the cells and will develop into skin cancer.”

When daylight hours are the longest, greater UV radiation damage occurs. Beginning in March and lasting until November, UV rays are at their harshest. But cooler temperatures are not a good indication you’re safe from skin cancer development.

“It’s a common misconception we can only develop skin cancer when it’s hot outside,” Wilson said."UV rays are always with us when there’s sunlight. Even when it’s 40 degrees outside, there’s still radiation. The rays are diminished, but the radiation effects are still having a cumulative effect on your body.”

There are two kinds of UV rays. UVB, which makes up 5% of the sun’s radiation and causes burning, and UVA rays, which are more harmful and penetrate the skin. UVB rays are prominent only during the summer months, but UVA rays remain all year. Even in the winter, snow reflects UVA rays to harm your skin. Wilson says elevation can also have a huge impact on skin cancer.

“I’ve seen people climb Mt. Everest a single time, who later develop subsequent skin cancer,” Wilson said. “It’s below freezing but it’s not about the temperature. It’s about radiation. And in higher elevations, there’s so much radiation beating down on you.”

The winter can also bring an increase in another activity that increases the risk of developing skin cancer—tanning beds.

“I wish we could get rid of tanning beds,” Wilson said. “they’ve contributed to a melanoma epidemic in younger females.”

The longer wavelengths produced by tanning beds have been shown to increase the risk of malignant melanoma, according to Wilson.

“We’ll diagnose a woman from the ages 15-30 with melanoma and it’s so common to find out they’ve spent hours in tanning beds,” Wilson said. “Someone in their 30s may have the skin of a 50-year-old due to frequent use of a tanning bed.”

Precancerous conditions

Actinic keratosis, a precancerous condition, is a rough, scaly patch on the skin that develops due to sun exposure. It grows slowly, usually appearing in the 40s to 50s and later, often appearing on the face, ears, scalp, arms and neck.

Although actinic keratosis isn’t painful, if left untreated these abnormalities can turn into skin cancer.

One treatment option is a chemical peel. Chemical peels are a noninvasive way to aggressively exfoliate the skin cells that comprise the actinic keratoses. After confirming you’re a good candidate for a chemical peel, your doctor will apply a thin layer of solution to the lesion. The solution is left on the lesion for 10 to 15 minutes. Then, the doctor may apply a chemical neutralizing solution before cleansing the area.

There are a variety of advantages of a chemical peel compared to other more invasive skin procedures. A chemical peel can be performed in a doctor’s office under local anesthesia. There are minimal scarring risks associated with chemical peels, and it is less costly than alternative treatments.

Another treatment option is laser surgery. Laser surgery uses a wavelength of light that is focused on a narrow beam. This high-intensity light is used to shrink or destroy visible actinic keratosis as well as those that may still be forming.

A series of laser treatments not only remove or dramatically reduce the lesions but can also improve skin quality overall.

How to prevent skin cancer

Sunscreen is the tried-and-true method to protect yourself. But they’re not created equally. 
“There are many lotions and potions you can find over the counter,” Wilson said. “They may not all use an approach that provides for a good sunscreen.”

Wilson says there are two basic kinds of sunscreens, chemical sunscreen and chemical-free sunscreen. Chemical-free sunscreens use minerals such as zinc oxide and titanium dioxide which offer great protection and minimal effects on the body. Cooper Clinic Dermatology recommends using sunscreen with sun protection factor (SPF) of 30 to 50.

For more information about sunscreen and other ways to protect your skin, read our "Staying safe while in the sun" blog.

Detecting skin cancer

A full-body skin cancer screen is the best way to detect skin cancer. If you have noticed spots or moles on your skin that have changed do not wait to schedule an appointment. To identify melanoma, learn your ABCDEs:  

Asymmetry – Melanoma is often asymmetrical, which means the shape isn’t uniform. Non-cancerous moles are typically uniform and symmetrical in shape.
 
Border – Melanoma often has borders that aren’t well defined or are irregular in shape, whereas non-cancerous moles usually have smooth, well-defined borders.

Color – Melanoma lesions are often more than one color or shade. Moles that are benign are typically one color.

Diameter – Melanoma growths are commonly larger than 6 mm in diameter, which is about the diameter of a standard pencil.

Evolution – Melanoma will often change characteristics, such as size, shape or color. Unlike most benign moles, melanoma tends to change over time. If you have a mole or skin growth, watch it for signs of change. 

If you notice any of the ABCDEs of melanoma, make an appointment right away to be evaluated by a dermatologist.

Many doctors only provide a full-body screen if it is specifically requested. At Cooper Clinic, a full-body skin cancer screening is our standard screening method for all patients.

Treatment

Treatment options for skin cancer vary depending on the size, type, depth and location of the lesions. Small skin cancers limited to the surface of the skin may not require treatment beyond an initial skin biopsy that removes the entire growth.

If additional treatment is needed, options may include:

• Freezing - Your doctor may destroy actinic keratoses and some small, early skin cancers by freezing them with liquid nitrogen (cryosurgery). 
   
• Excisional surgery - This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out the cancerous tissue and the surrounding margin of healthy skin. 
   
• Mohs surgery - Your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin.
   
• Chemotherapy - In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Systemic chemotherapy can be used to treat skin cancers that have spread to other parts of the body.

Due to sun exposure, everyone is at some degree of risk for skin cancer can. And what may seem like a cosmetic imperfection could be deadly if not treated. Talk to your doctor about your risk of skin cancer, regularly evaluate your skin for moles and other spots on your skin and schedule an annual skin cancer screening.

For more information about Cooper Clinic Dermatology’s skin cancer screening with a board-certified dermatologist or to book your screening, visit cooperclinicdermatology.com or call 972.367.6000.