Towne Health is a monthly article covering diverse health care topics in the interest of providing information to our fellow residents about important health topics.
By: Penny D’Souza, DO & Terra Wubbenhorst, MD
With so many fun outdoor activities this summer it is important to remember to take care of one’s skin. Skin cancers are the most common of all the different types of cancer. Luckily, skin cancer is a highly preventable and highly treatable (when caught early) condition. The basic types of skin cancer include: melanoma, basal cell, and squamous cell. Less common types of skin cancer include: Merkel cell, Kaposi sarcoma, and skin lymphomas. Dermatologists are specialized doctors that diagnose and treat skin disorders, including skin cancer.
Sun exposure is the biggest risk factor for skin cancer development because the sun’s ultraviolet rays can damage the DNA in our skin cells, leading to cancer. Melanin is a pigment in the skin that helps protect against the UV rays and people with darker skin colors have a lower risk of developing skin cancer. People with light skin, especially if it freckles or burns easily, are at a higher risk. It is important to note that although a tan is caused by increased amounts of melanin in the skin, there is no such thing as a “safe tan.” Some people may try to achieve a “safe tan” or “base tan” in order to prevent sunburns, but the skin has already been damaged by the tan! Any tan is an indication of sun damage, whether from the sun or from a tanning bed (tanning beds use UVB rays to darken the skin).
Other risk factors include: older age, male sex (may be related to increased sun exposure), family history of melanoma, having a large number of moles, certain chemicals (such as arsenic), radiation exposure, previous skin cancer, long-term or severe skin injury or inflammatory skin disorders, weakened immune system, certain HPV (human papilloma virus) strains, and certain inherited diseases (such as xeroderma pigmentosum).
Detection & Screening
While many physicians may due a skin screening at your annual physical, it is important for each individual to check their own skin regularly for any changes. A monthly exam is recommended of the entire body, including soles of feet and between toes, entire scalp, behind ears, genitals, and under nails. A partner can help examine the harder to see areas or a handheld mirror can be used. Many skin cancers can look like normal skin or do not follow the typical characteristics of their type of cancer. The most important thing to look for is a new or changing spot on your skin.
Basal Cell: These lesions are usually found on sun-exposed areas of the body, especially the head, face, and neck but can occur anywhere. They are often fragile and bleed easily. These cancers can present as: flat, firm, pale or yellow areas, similar to a scar; raised, reddish patches that may be itchy; small, pink or red, translucent, pearly bumps which may contain blue, brown or black areas; pink growths with raised edges and lower area in the center, possibly with blood vessels spreading out from the center; open sores that do not heal or heal and come back.
Squamous Cell: Appear commonly in sun-exposed areas like the head, ears, back of hands, neck, and lips. These cancers may look like: rough/scaly red patches which may crust or bleed; raised growths or lumps, sometimes with a lowered area in the center; open sores that do not heal or heal and come back; wart-like growths.
Melanoma: A new or changing mole, moles that appear later in life (most develop in childhood/early adulthood), and a mole that looks different from other moles on your body (ugly duckling sign) should be checked out by a dermatologist.
The ABCDE rule is also helpful in determining if a mole may be melanoma, but not all moles follow the rules. A dermatologist should check moles that meet any of the ABCDE criteria.
A- Asymmetry – one-half of the mole does not match the other half
B- Border – edges are irregular, ragged, notched, or blurred
C- Color – color is not consistent throughout the mole and may contain different shades of brown or black, even patches of red, pink, blue, or white
D- Diameter – larger than 6mm (about size of pencil eraser)
E- Evolving– mole is changing in shape, size or color
Need help remembering these rules or keeping track of your moles? Try Body Mole Map available through the American Academy of Dermatology: https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/detect/body-mole-map
In the event your physician finds a suspicious spot, most often they will perform a biopsy (removal of a small area of skin). This is typically performed in the office and involves minimal discomfort. You will be given an injection of local anesthetic to numb the skin and a small area will be removed, often a small suture will be used to close the skin. The sample will be sent out for testing to confirm if cancer is present, and if so, what type. If caught early, sometimes the biopsy removes the entire cancerous spot; if not you may be required to undergo more testing or an additional procedure to remove the remaining cancer. Although many skin cancers are superficial (are located on the top layer of skin), some forms of skin cancer can extend deeper in the skin or spread to distant areas of the body. Keep in mind that what you see on the surface may not reflect the entire size of the cancer below the skin. The best chance for a cure is to catch it early, so be sure to check your skin regularly.
Sunscreen is important, especially in south Texas. Be sure to lather up before heading outdoors and to wear protective clothing, eyewear, and headgear and to seek out shade when available. It is important to make sure your sunscreen protects against both UVA & UVB (broad-spectrum coverage). Also, the American Academy of Dermatology (www.aad.org) recommends using SPF 30 or higher (SPF 30 blocks 97% of UVB rays, but no sunscreen blocks 100%). It is important to reapply sunscreen every 2 hours because the sunscreen loses its effectiveness over time and after sun exposure. Water-resistant sunscreens are available and should be reapplied every 40-80 minutes, depending on the product’s labeling. (if you stay dry, follow the 2 hour rule). No sunscreen is waterproof. Sunscreen is not recommended for children 6 months of age or younger and small children may need a product for sensitive skin (look for zinc oxide or titanium dioxide containing products). Keep in mind that “sensitive skin” is a term not defined for sunscreen by the FDA.
Dr. D’Souza is a Towne Lake resident and board certified cardiologist practicing in Northwest Houston. Her professional interests include women’s health, heart disease prevention and heart failure.
Dr. Wubbenhorst is a Towne Lake resident and board certified anesthesiologist with fellowship training in critical care. She currently practices in West Houston.
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