Have you had a bit too much sun for your own good? Decades of boating, fishing, hiking, golfing and just plain drowsing on the deck contribute to your lifetime exposure and risk of developing skin cancer. But there are simple steps you can take now to reduce your risk and catch worrisome skin blemishes before they turn into a threat – particularly malignant melanoma, the most dangerous form of skin cancer.
“The biggest misconception is that there is no turning back once you have accumulated sun damage and sunburn,” says Dr. Daniela Kroshinsky, an assistant professor at Harvard Medical School and medical dermatologist at Massachusetts General Hospital. “But adopting good sun habits prevents accumulation of additional damage that could contribute to the overall risk for melanoma and even more so for non-melanoma skin cancers and pre-cancers.”
Add to that a reasonable level of surveillance for suspicious skin blemishes, and you can drastically reduce the chance of getting into the danger zone.
Sunlight primarily consists of three wavelengths: UVA, UVB and UVC. Earth’s ozone layer filters the most damaging UVC rays. UVA represents 95 percent of the sun’s energy that reaches Earth’s surface, and penetrates deepest into the skin. UVB carries just 5 percent of the sun’s energy but can still burn the skin’s outermost layer.
Men at risk
Nearly twice as many men die of melanoma as women. “Older men are the population at greatest at risk for a bad outcome because they do not access care and they don’t look at their skin as much as other groups do,” Dr. Kroshinsky explains.
That’s unfortunate, because if it’s caught before it spreads, melanoma is highly treatable. According to the American Cancer Society, the five-year survival rate for people whose melanoma is diagnosed and treated before it spreads is 98 percent. After the cancer spreads, survival plummets to 16 percent. It is fortunate, then, that the skin is the only organ entirely available to inspection.
“That’s the beauty of dermatology – the skin is an accessible organ,” Kroshinsky notes. “This isn’t like your heart or lungs, where you have to wait until you have chest pain or develop a cough that won’t go away. It’s an organ that you can look at every day.”
Skin’s accessibility also means it is vulnerable to damage from exposure to UV radiation in sunlight. That is why it’s so important, especially after accruing a lifetime of UV exposure, to adopt good sun-protection habits and keep an eye out for suspicious skin blemishes.
Types of cancer
According to the American Academy of Dermatology, one in five people in the United States will develop skin cancer at some time in their lives. There are three types:
Squamous cell cancer begins in the middle layer of the epidermis, affects only its surroundings, but eventually forms a raised patch with a rough surface.
Basal cell cancer is associated with the lowermost epidermal layer. The cells invade surrounding tissues, forming a painless bump that later becomes an open ulcer with a hard edge.
Malignant melanoma, which accounts for 75 percent of skin cancer deaths, occurs in the pigment-producing cells (melanocytes) in the basal layer of the epidermis or in moles. The cells reproduce uncontrollably and invade distant body sites.
Assess your risk
Your risk of developing a skin cancer depends primarily on two factors: genetics and sun exposure history.
Genes: Do you have red hair, fair skin and blue eyes? Then you are at higher risk than someone with darker skin. Do you have a first-degree relative (parent, sibling) who has been diagnosed with melanoma? Do you or others in your family tend to develop a lot of moles and skin blemishes, some of which have turned out to be “atypical” or abnormal in growth, shape, size, or color? These are all risk factors for skin cancer.
Exposure: The more sun exposure in your life, the higher your overall risk for skin cancer. In particular, repeated sunburns or blistering sunburns boost your lifetime risk.
If your sun-exposure or family history suggests elevated risk, Kroshinsky recommends that you discuss it with your primary care provider.
“Talk to your doctor,” she advises. “Ask if, based on moles and amount of sun damage, you should be looked at by a dermatologist.”
The risk assessment should include a quick check of your medications. Some can leave you more sensitive to the sun. These include the commonly prescribed fluoroquinolone antibiotics like Cipro and some blood pressure medications.
Check your skin
The doctor’s role: Once your baseline risk is known, either your primary doctor or a dermatologist can perform the needed skin exam at an appropriate frequency. For people at normal risk, every one to two years might be sufficient. Being at greater risk may warrant more frequent screening. Kroshinsky examines people with atypical moles every six months and people with a history of non-melanoma pre-cancers every three months.
Your role: Learn how to identify worrisome skin blemishes. Certain features indicate that a mole should be examined by a doctor.
“Look for anything that is new, that looks different from other things on your body, or anything that’s changing, growing or bleeding,” Kroshinsky says. “Also, anything that doesn’t heal in a week or two.”
A simple rubric, the ABCDE of malignant melanoma, should guide your self-exams. Make sure to include areas hidden from your view, with the help of a spouse, intimate partner, or friend. These areas include the back, buttocks, and rear thighs; the neck and top of the head; and the soles of the feet and between the toes. Skin checks can save your life.
“Most of these cancers, if you catch them early and remove them, they’re cured,” Kroshinsky says.
Develop safe sun habits
Do not spend extended periods in the sun with your skin exposed and unprotected. The longer you’re exposed, the higher your risk.
“We counsel people to avoid prolonged sun exposure between 9 a.m. and 4 p.m.,” Kroshinsky says. “But that’s the peak time when people like to do things.”
If you are out, take these steps:
1. Wear a hat with a brim that covers the ears and shades the nose.
2. Always use sunscreen.
3. If it is comfortable, wear long sleeves and pants. Boaters and fisherman beware: Reflected light off the water surface can increase exposure.
Use sunscreen properly
When you use sunscreen, use it properly. Many people use sunscreen but burn anyway because they did not apply enough, did not replenish it often enough, or applied it after actually becoming exposed to the sun. Here are Kroshinsky’s sunscreen recommendations:
When: Apply the sunscreen at least 20 to 30 minutes before you go out in the open sun.
What: Use a broad-spectrum sunscreen that protects against UVA as well as UVB rays. Use a sunscreen with an SPF rating of at least 45.
How much: Adults should apply 6 teaspoons (1 ounce) on your body and face, or about the volume of a shot glass. Be sure to coat the ears, back of the neck and exposed skin on the head.
How often: Reapply every hour if you are in the water or sweating heavily. Reapply every two to three hours if not in the water or not sweating. Reapply the sunscreen frequently even if the product you buy is formulated to be sweat- or water-resistant.
The ABCDE of melanoma
If you spot a mole or skin blemish with one of these characteristics, have it examined by a doctor:
Asymmetry: One half does not match the other half.
Border irregularity: The edges are ragged, notched, or blurred.
Color: The pigmentation is not uniform. Different shades of tan, brown, or black are often present. Dashes of red, white and blue can add to the mottle appearance.
Diameter: Melanomas usually are greater than 1/4 inch (6 mm) in diameter, or about the width of a pencil eraser, when diagnosed, but they can be smaller.
Evolving: A mole or skin lesion looks different from the rest or is changing in size, shape, or color.