A few simple steps can help prevent skin cancer
- Skin cancer is the most common form of cancer in the United States
- Sun protection is the best way to keep your skin safe
- Having darker skin does not protect you from skin cancer
Think of the sun as a big yellow "frenemy." While its light warms and cheers you, and your skin converts its rays into bone-building vitamin D, the star we orbit is also capable of causing irrevocable damage to your skin. Each year there are more new cases of skin cancer than cases of breast, prostate, lung and colon cancers combined—and over 90 percent of them are associated with sun damage. While awareness of the skin's vulnerability to sun exposure has increased over the past few decades, rates of skin cancer are actually on the rise.
Although having a fair complexion increases your risk of developing skin cancer, there's a widespread—and dangerous—misconception that people with darker skin are immune to the disease. As a result, people in this population tend to be diagnosed at a more advanced, less treatable stage and are more likely to die of the disease.
Know the Risk Factors for Skin Cancer
"People are still in denial about the dangers of sun exposure," says Ashfaq Marghoob, M.D., director of Memorial Sloan-Kettering's regional skin cancer clinic in Hauppauge, NY. "The bottom line is that when you get a tan, you may also be getting skin cancer."
A tan is actually your body's attempt at protecting itself from the sun's ultraviolet (UV) radiation. UV rays trigger the skin's upper level, or epidermis, to send pigments to darken the surface. "It's like a shield or umbrella to protect the skin's DNA from sun damage," explains Petra Rietschel, M.D., Ph.D., director of the Melanoma-Sarcoma program at the Montefiore-Einstein Center for Cancer Care in New York City.
When DNA in skin cells is damaged, the affected cells can proliferate and become cancerous. The two most common types of skin cancer, accounting for over 90 percent of all cases, are called basal cell carcinoma and squamous cell carcinoma. (Basal and squamous cells are part of the epidermis.) These cancers tend to be slowgrowing and rarely spread to other parts of the body. They develop on areas that have been exposed to the sun over time, like the face, ears, neck, lips and backs of the hands.
Much less common, but potentially much more deadly, is melanoma, which begins to grow at the bottom of the epidermis, where pigments are generated, and can enter the bloodstream and spread to other organs of the body if not detected and treated early. The biggest risk factors for melanoma are having a family history of it and having had several blistering sunburns, though cumulative exposure may also be a factor.
Protect Your Skin
Fortunately, skin cancer is one of the most preventable cancers and among the easiest to detect. When it comes to sun protection, "slip, slap, slop" is the motto embraced by Martin A. Weinstock, M.D., Ph.D., professor of dermatology and community health at Brown University in Providence, RI. "Slip on a shirt, slap on a hat, slop on the sunscreen," he says.
It's also important to thoroughly check your skin once a month and have it checked annually by a doctor. Non-melanoma skin cancers usually appear as a sore that doesn't heal, a scaly lesion or a waxy-looking bump that doesn't go away. With melanoma, lesions are often visible at a point when they are curable. Check moles and other pigmented spots for skin cancer warning signs using the "ABCDE" guidelines:
- Asymmetry (lacking balanced proportions);
- a Border that's irregular or poorly defined;
- inconsistencies in Color;
- having a Diameter greater than a pencil eraser;
- or Evolving in size or shape.
More important, though, says Rietschel, is to identify "ugly duckling" spots or moles that don't look like they belong with the others. "Not everyone has the same kinds of moles, so what looks unusual for one person might not be suspicious for another," says Dr. Rietschel. "The ugly duckling theory takes everyone's individuality into account."
Treatment for skin cancer is determined by the size, type, depth and location of the lesion. Localized treatments include cryosurgery (where liquid nitrogen is used to freeze the cells), laser therapy, topical drugs and surgery to remove tissue. A procedure called Mohs micrographic surgery has a 98 percent cure rate for non-melanoma cancers. Skin is removed in thin layers and each is examined under a microscope until a layer with no abnormal cells appears.
Melanomas can be surgically removed if they haven’t spread beyond the skin. If they have spread, treatments include chemotherapy and drug therapies that enhance the immune system’s anticancer response, such as the new drug ipilimumab, which was approved by the FDA this spring. Other new melanoma treatments appear promising as well. Perhaps the biggest breakthrough is in a therapy known as PLX4032, which targets the gene responsible for tumor growth. "This new drug has prolonged survival in clinical studies," says Dr. Marghoob. "It’s very exciting."
A New Treatment for Melanoma
A new targeted therapy offers one of the first real rays of hope in decades to people with advanced melanoma. The drug, which is currently awaiting FDA approval, is known as PLX4032 or RG7204. About 50 percent of all melanoma patients have mutations in a gene called BRAF that causes cells to grow uncontrollably, leading the lethal skin cancer to spread throughout the body. This therapy blocks the cancer-causing gene and halts the formation of tumors. Until now, treatments for advanced melanoma—which include systemic chemotherapy and immunotherapy—have not significantly prolonged survival. The most recent trial, a multi-center study led by Memorial Sloan-Kettering Cancer Center in New York City, concluded that treatment with PLX4032 resulted in significant tumor shrinkage in 80 percent of participants. Researchers believe that combining it with other available therapies may prevent recurrences in many patients.
Ashfaq Marghoob, M.D., director of Memorial Sloan-Kettering’s regional skin cancer clinic in Hauppauge, NY.
Petra Rietschel, M.D., Ph.D., director of the Melanoma- Sarcoma program at the Montefiore-Einstein Center for Cancer Care in New York City.
Martin A. Weinstock, M.D., Ph.D., professor of dermatology and community health at Brown University in Providence, RI.
From our sister publication, Remedy’s Healthy Living, Summer 2011