Skin cancer is the most common form of cancer in the United States. One in five Americans will develop skin cancer during his or her lifetime; each year more than 3.3 million people in the U.S. are treated for it.
Overall rates of skin cancer are similar for men and women. The most dangerous form of skin cancer — melanoma — will affect more than 29,000 women this year, and 3,800 women will die from it. Until age 49, more women develop melanoma than men (1 in 206 women versus 1 in 297 men); overall, one in 52 women will develop melanoma in her lifetime.
Interestingly, New England has a higher incidence of skin cancer than other regions of the country. Experts say that’s likely because the proportion of white people is greater in these states and those with lighter skin are more likely to suffer sunburn, which is a leading cause of skin cancer. Also, New Englanders may be less vigilant about sun protection than those who live in year-round sunny climates. When the weather is nice here we want to go out and we may forget our sunscreen and hat.
Excess exposure to ultraviolet (UV) light is the primary cause of skin cancer. Ultraviolet light causes damage to the DNA in skin cells and increases skin cancer risk. There are three types of UV light — UVA, UVB and UVC — but UVA and UVB are most often associated with skin cancers.
Equally as dangerous are artificial UV sources such as tanning beds. The Centers for Disease Control and Prevention in Atlanta warn that indoor tanning exposes you to both UVA and UVB. It is particularly dangerous for teens and young adults; people who begin indoor tanning during these years have a higher risk of getting melanoma. Many states now have restrictions on the use of tanning beds. Gov. Charlie Baker signed a bill this February that bars anyone under 18 from using or operating a tanning bed.
There are three types of skin cancer.
The most common form is basal cell carcinoma, most often on your head, neck and arms. If left untreated, it can invade surrounding tissue and grow into nerves and bones.
Squamous cell carcinoma often forms on the most sun-exposed parts of your body, such as the rim of your ear, face, neck, arms, chest and back. It can grow deep in the skin and can cause damage and disfigurement.
Melanoma is the most serious form of skin cancer. There is a convenient way to look for warning signs of melanoma: ABCDE. A is for asymmetry — if one half of a mole looks different from the other. B is for border — if it is irregular, scalloped or undefined. C is for color — the mole has variation in its color. D is for diameter — how big it is. And E is for evolving — if the mole changes in size, shape or color.
In all cases, early diagnosis and treatment are important. Following diagnosis, surgery is the most common treatment for skin cancers and is carried out in three stages: biopsy, resection and closure.
Most skin cancers are spotted by a dermatologist, who takes a tissue sample (called a biopsy) for examination by a pathologist. Results of the biopsy determine the diagnosis.
Many patients with basal cell or squamous cell carcinoma are referred to a dermatologist who specializes in Mohs surgery, in which affected layers of skin are systematically removed and examined while the patient waits to ensure that no cancer tissue remains. The wound is then closed either by the Mohs dermatologist or by a plastic surgeon.
Sometimes, stitching alone is not enough, and a skin graft is needed once the cancerous tissue is removed. A “flap” is used to close a wound by rearranging tissue from around the area of the wound. A “pedicle flap” is used by taking skin from somewhere close to the wound. And a “free flap” uses tissue from a different part of the body.
The type of surgery performed is determined by the size and depth of the lesion and what lies underneath. For example, if the lesion is on your nose and there is only cartilage underneath it, a basic skin graft won’t work since the graft needs something to attach to.
Here are some tips for you and your family:
Stay in the shade whenever possible, especially in the middle of the day.
If you are in the sun, cover up — wear a long-sleeved shirt, a hat with a brim, and UV-blocking sunglasses.
Use broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher on all exposed skin and reapply every two hours.
Keep newborns out of the sun and make sure your children always use sunscreen when outdoors.
Make a skin check part of your annual checkup with your primary care clinician and do self-examinations regularly.
Dr. Helen Perakis is a plastic surgeon with Cooley Dickinson Medical Group Plastic Surgery. This column, which appears monthly, is written by health care professionals affiliated with Cooley Dickinson Hospital in Northampton.