Skin cancer statistics

Be aware of the sun's potential to harm your skin.

Summer is in full swing, with your days brightened by the warmth and glow of the sun. But a word of caution: Experts believe that overexposure to the sun is the main cause of the two most common types of skin cancer: basal cell and squamous cell carcinomas.

We're now beginning to see basal cell and squamous cell skin cancers among people in their 20s, says Jeffrey S. Dover, M.D., a dermatologist based in Chestnut Hill, Massachusetts, and a member of the board of the American Society for Dermatologic Surgery. "In years past in America, you just never saw these skin cancers until people were at least in their 30s and 40s. The big reason for the change is that people now go out in the sun more."

A third type of skin cancer, melanoma, is the most deadly. It may be caused by heredity. However, some doctors believe that a history of severe sunburn may contribute to the development of melanoma.

Protection is strong prevention

"Many skin cancers can be prevented," says George J. Hruza, M.D., a St. Louis, Missouri, dermatologist and a board member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Protect yourself and your family by taking these precautions.

* Don't lie out in the sun and try to get a tan. "Though many people associate getting a tan with a healthy glow, a tan is the body's generation of pigment in response to harmful ultraviolet rays," says Hruza.

* When spending time outdoors, use sunscreen (sunblock) that has an SPF (Sun Protection Factor) of 30. Read the label to make sure you are purchasing a sunscreen that protects from UVB (ultraviolet-B) radiation, which is the primary cause of sunburn and skin cancer. The sunscreen also can protect you from UVA (ultraviolet-A) radiation, which has a longer wavelength than UVB rays. UVA rays penetrate deeper into the skin and can cause damage to its elastic fibers. For example, UVA rays come through the window when you're riding in a car.

* Make an application of a moisturizer with an SPF of at least 15 a part of your everyday morning routine. It's still possible to get exposure to harmful rays even if you're indoors.

* Rub on sunscreen prior to an exposure to the sun; don't wait until after you get out in the sun. Be sure to apply the sunscreen thickly and evenly, and reapply it every few hours; once a day is not sufficient. Be sure to reapply sunscreen after swimming or if you are sweating.

* Buy well-fitted clothing made of tightly woven material that sun rays cannot penetrate easily. Wear shirts with long sleeves, pants with long legs, and a hat with at least a 4-inch brim. Or wear clothing with built-in SPF 30.

* Beware of tanning beds because they may put you at risk for skin cancer and wrinkling.

* Completely shield babies from the sun's rays. As your children reach toddler-age and older, protect them with sunscreen, proper clothing, and moderate sun exposure.

Clues that it might be skin cancer

Learn how to detect different skin cancers. This knowledge may save the life of someone you love.

Basal Cell Carcinoma

Fair-skinned individuals who burn easily are most vulnerable to basal cell carcinoma, which annually accounts for about one million cases of skin cancer in the United States.

The total amount of sun an individual has accumulated over the years also is a factor. Patients who are treated with radiation for some health problems may be at risk for basal cell skin cancer even 25 years later.

A basal cell cancer can be red to skin-colored; tends to appear like a bump, which is relatively firm or rubbery to touch; and sometimes has a waxy, almost translucent look. It's not uncommon for an enlarged blood vessel to run through it, showing up like a little red line.

"About 85 percent of basal cell carcinomas occur on the head and neck, but they also can occur on the arms, legs, chest, and back," says Hruza. Over time, as this cancer gets bigger, the skin can ulcerate. Sometimes it bleeds when a patient rubs a towel over it while drying off after a bath or a dip in the pool.

"Basal cell carcinomas almost never kill people," says Dover. "But they can get big and start to ooze, crust, and smell. They can erode and take away part of your nose or ear. So they have to be treated.

"It is very rare for a basal cell cancer to metastasize (spread) to other areas of the body. It tends to grow locally in the area where it develops. However, if it's not treated, it can be very destructive. Over time, it can invade through the skin into the muscle and into the bone."

Depending on the nature of a basal cell cancer, as well as the age and health of the patient, the choice of treatment can vary. Frequently used treatments include scraping and burning (curettage and electrodesiccation), cutting the cancer out (routine excision), or Mohs micrographic surgery. Mohs surgery, a procedure with a cure rate as high as 99 percent, is being used increasingly to remove certain skin cancers. Only a doctor who is specially trained in this technique may perform the surgery.

The patient is placed under local anesthesia in an outpatient setting. The surgeon cuts out the cancer and evaluates the cancer's edges, or border, under the microscope, including the underside where cancer roots may extend. If the microscopic study shows remaining cancer cells, the surgeon removes more tissue.

Less frequently used treatments include cryosurgery (freezing with liquid nitrogen) and radiation therapy, which usually is reserved for elderly or debilitated patients who are not considered appropriate candidates for other treatments.

Researchers are looking for new ways to prevent and treat skin cancers, says Hruza. For example, two approaches that are now being tested are using derivatives of Vitamin A for prevention, and using a prescription cream for treatment of both basal cell and early squamous cell skin cancers.

Squamous Cell Carcinoma

Key risk factors for squamous cell carcinoma include having fair skin and a history of skin damage from sun exposure.

Other risk factors are taking certain medications that suppress the immune system (such as anti-rejection medicine taken by organ transplant patients) and undergoing treatment with ultraviolet light (such as for the skin condition psoriasis). Undergoing radiation treatments for other health problems may place a person at risk even 25 years later.

A squamous cell skin cancer tends to start out looking like a red, flaky, or scabby patch on the skin. The patch gradually thickens into a real bump, frequently with an ulcer.

This type of carcinoma, expected to account for about 200,000 new cases of skin cancer this year, often remains localized. Some squamous cell skin cancers grow much quicker than others. "Statistics vary on the risk of a squamous cell cancer spreading to other parts of the body," says Hruza. "Generally, it's thought to be in the two to ten percent range. The ones around the ears and lips tend to be the most aggressive." But in severe cases, it spreads to other areas, such as the bone, liver, or brain.

Dover has this advice: "If you have a tender, scaly spot on your skin that doesn't go away, see your doctor. It could be a squamous cell."

Squamous cell cancers are treated by cutting them out using routine excision or Mohs surgery.

Melanoma

The rarest and most deadly skin cancer is melanoma, also referred to as malignant melanoma. It tends to run in families and annually accounts for about 50,000 cases of skin cancer.

Dover says that many patients who do not have a family history of the disease also develop melanoma. "Often it's plain bad luck," he says.

How sun damage fits into the risk for melanoma is not clear-cut. "Melanoma may or may not be related to sun exposure," says Dover.

Some researchers believe that experiencing several severe sunburns, particularly during childhood, can increase a person's risk of having a melanoma later in life. "We're not talking here of gradual sun exposure, such as what farmers might get," says Hruza. "We're talking about really bad sunburns."

One thing is clear: If not diagnosed and treated early, melanoma often spreads in the body and kills its victim. About 7,700 people die from melanoma each year.

Melanoma is more likely to appear on the trunk of the body or on the extremities than on the head or neck. When men have melanomas, they often are on the back, says Hruza. Among women, melanomas more typically develop on the legs.

This skin cancer looks different from either basal cell or squamous cell carcinoma. A melanoma has a molelike appearance. It tends to be a brown or black flat spot on the skin that gradually enlarges and thickens, becoming a little bump or nodule. The melanoma can be an existing mole that starts changing, or it can be a new molelike growth.

The American Academy of Dermatology has developed an easy-to-remember list of tips that can help you readily detect melanoma: