When asked about the most common form of cancer, most people think of breast, lung, prostate, and colon. While these are all common and deadly cancers, with over 2 million cases a year, there are more cases of skin cancer than all other types of cancer combined. Luckily most skin cancers are easily treated and rarely fatal. But awareness, detection and early treatment are as important for these cancers as the big four listed above.
Skin cancer, however, should not be taken lightly. My wife’s aunt died just shy of her 60th birthday from malignant melanoma and my close friend was recently diagnosed with melanoma in her 30s. She is a personal trainer who eats a vegetarian diet, so even young healthy people need to be vigilant.
One of the last questions I ask every patient, whether they are age 5 or 95, during a physical is: do you have any moles or skin sores that concern you? If the answer is yes, there are three options. Most skin lesions can be documented and observed. I like to measure and take pictures of the area so that we can refer back if needed. This is something you can do at home with a tape measure and a cell phone camera. I often have people bring in pictures of rashes or moles and we can use those as comparisons.
The second option is to treat the area. Many lesions can be treated with creams or freezing with liquid nitrogen. Even precancerous or superficial basal cell cancers can be treated and cured in this manner by primary care providers without need of biopsies or surgery. In more suspicious lesions, biopsies or removal is often the best option. Primary care providers commonly do skin biopsies and lesions removals, so for most patients it is not necessary to see dermatologists or surgeons. These procedures are usually done in the clinic with local anesthesia and rarely require sedation or hospitalization. I have had patients stop in during their lunch hour to get rid of an unsightly mole that had bothered them for years.
The third option is referral. This usually occurs when biopsy results show cancers or pre-cancers, or in people with strong family or personal history of cancer. My wife follows up with a dermatologist yearly because her father and mother have had skin cancers and her aunt died of melanoma. It is often hard for even highly trained eyes to tell the difference between normal moles and cancer, so if you or someone you know thinks your skin looks “weird” do not delay – get checked by your primary care provider.
People can prevent skin cancer. The easiest thing to do is to wear sunscreen. Make it a habit, everyday, even in the winter. Many cosmetics, lotions, even lip glosses have sunscreen because it prevents wrinkles, makes skin look younger, and decreases scarring from nicks and cuts. A good everyday sunscreen is a broad spectrum SPF 15. It is not important the brand, what is important is that it covers UVA and UVB. SPF measures protection against UVA, but UVB is being linked to more cancers. If you are going out in the sun for a while, SPF 30 is recommended. It is recommended to reapply every two hours, which is difficult to remember for most people. I usually will tell people that after your wipe off with a towel to reapply. Even waterproof sunscreen is not wipe proof.
Finally never, never, never “fake bake” or use a tanning bed. A study published in 2014 estimated that more than 400,000 cases of skin cancer may be related to indoor tanning in the United States each year— including 6,000 melanomas. Cancer risk increases over three fold for melanoma and seven fold for other skin cancers. There is no safe level of indoor tanning and because of the intensity of UV light sunscreens do not significantly reduce the risk. There is no data the “base tan” will save you from becoming a lobster on your trip to the Caribbean and no data that it helps seasonal affective disorder or low vitamin D. So do not get in a tanning bed!
Be kind to the skin you are in and you will look good and be healthy for years to come.
By Eric Smiltneek, MD, ThedaCare Physicians–Oshkosh
