Melanoma, Other Skin Cancers, and Prevention and Protection!

 

Dr. Shannon M. Clark discusses all things skin cancer with dermatologist, Dr. Jennifer Deaver Peterson, of The Pearl Dermatology! Watch the full video at the end!

What is melanoma?

Melanoma is a less common form of skin cancer with about 200,000 new diagnoses every year in the United States. Melanoma derives from the cells that make pigment for our skin, melanocytes. Only about 20-30% of melanomas develop in an existing mole, the remainder arise on apparently normal skin.

Why is early detection so important?

Melanoma has a very high cure rate (5 year survival rate of 99%) if it is found very early in the disease while the cancer is still very thin; however, melanoma can spread quickly in the body if it becomes too thick and/or deep. One American dies hourly from melanoma.

What other skin cancers should I know about?

1 in 5 Americans will develop skin cancer by the age of 70. Therefore, skin cancer is very common. The most common type of skin cancer is called basal cell carcinoma (BCC) affecting almost 4.5 million Americans a year. It can affects men and women and occurs most commonly on skin surfaces exposed to excessive ultraviolet light. This type of skin cancer is slow growing and rarely spreads to internal organs.

The second most common skin cancer is known as squamous cell carcinoma (SCC), and affects more than 1 million Americans a year. Although rare, large SCCs have the potential to spread to lymph nodes and internal organs.

Together BCC and SCC are known as non-melanoma skin cancer (NMSC).

What are the signs of melanoma? Of other skin cancers?

Melanomas often have one or more features of the ABCDE rule and can appear on any surface of the skin.

A = asymmetry, the appearance of the lesion looks different from left to right or top to bottom

B = borders are irregular and not smooth

C = colors that are varied, with hues of black, dark brown, blue, white, or red color

D = diameter greater than 6 mm

E = evolution or changing

In women, melanoma occurs most frequently on their backs and legs.

BCCs most commonly appear as a shiny, pink or red, raised bump on the skin surface. It may have an appearance of a large acne lesion, but the key is that it does not heal within a month of its appearance.

SCCs typically have a hard, crusted or scaly, pink to red colored appearance. Women often develop SCC on their lower legs.

What are the risk factors?

The most common risk factors for skin cancer include sun exposure, indoor or outdoor tanning, previous sunburns, family history, more than 50 moles, long-term exposure to x-rays, and a history of smoking.

Patients with a decreased ability to tan such as those with pale skin, blue, green, or grey eyes, and/or red or blonde hair are at increased risk for skin cancer, but skin cancer occurs in ALL skin colors and on ALL surfaces of the body.

Occasionally we will see skin cancer develop in a non-healing open sore (ulcer), in the scar of a third degree burn, or in a patient with a history of a weakened immune system.

Scientists have recently found a few genes associated with both melanoma and breast cancer, such as CDK2NA and BRCA2.

How can it be prevented?

While the number of new cases of melanoma is on the rise, the death rates are decreasing which we feel is due to earlier detection of melanoma.

Dermatologists are all about skin cancer prevention and early detection.  Even without a personal or family history of skin cancer, it is advised to have your skin checked every 1-2 years. Below is a list of skin cancer prevention strategies:

  1. Avoid indoor and outdoor tanning. For patients wanting a healthy tan glow to their skin, I recommend either sunless tanner applied at home or applied by a technician at a spa with an airbrush technique.
  2. Wear sunscreen daily. Not only does is help to reduce your chance of skin cancer, it also helps to limit skin aging by reducing the formation of fine lines, wrinkles, rough skin texture, and brown spots.
  3. With strong and/or continuous sun exposure, apply sunscreen 30 minutes before sun exposure and then reapply every 2 hours or after water exposure or excessive sweating.
  4. With strong sun exposure, wear wide brimmed hats, sunglasses, and sun protective clothing and seek shade (ie umbrellas, porches, canopies) in peak hours of the day. Use “rash guards”, these are long sleeved, breathable, SPF fabric slightly fitted shirts originally worn by surfers. They are wonderful while swimming, snorkeling, playing in the sand, fishing, and any activity that you may not be able to reapply sunscreen as often as you had planned.
  5. Remember to protect your family… and yourself. My patients often remember to take care of their children, but forget to reapply sunscreen to themselves.
  6. Stop smoking. Smoking is a risk factor for skin cancer and premature skin aging.
  7. Know the ABCDs of melanoma and check your skin monthly so you become familiar with your moles. If a spot has changed or is new and does not improve in 1 month, see your dermatologist.

What is the role of tanning bed use and history of sunburns?

Damage from UV exposure is cumulative and increased your skin cancer risk over time. While
damage builds up over time and triggers mutations that cause the skin cells to multiply rapidly. This can lead to malignant tumors. UVA rays, like those found in tanning beds, penetrate more deeply. UVA rays also lead to premature aging.

The WHO classifies tanning beds as a group 1 carcinogen … along with plutonium, cigarettes, and solar radiation. The risk of melanoma increases by 75% with a history of indoor tanning.

The risk of melanoma doubles if > 5 sunburns, but just 1 blistering sunburn in childhood or adolescence more than doubles a chance of developing melanoma later in life.

What products do you recommend to best protect my skin? How and when should they be applied?

Regular daily usage of SPF >15 reduces the risk of developing melanoma by 50%. Apply SPF every day, even when it is cloudy. Now a SPF is intended to be applied 2 mm thick, but very few people will apply it this way. Studies have shown most patients rub it in to be 0.5 mm thick,  this actually decreases the SPF effectiveness. Therefore, as dermatologists we recommend using the higher SPFs. At least SPF 30 for everyday usage. SPF 50 for outdoors usage or for daily usage if there is a history of melasma.

I prefer my patients use mineral based SPF. These are zinc or titanium based sunscreens. They are more gentle to the skin, sit on the surface of the skin to block rays, and are better for our environment (ex. coral reefs). These come in many forms – creams, powder, lotion, sticks, and sprays. My favorite mineral based sunscreen brands are Coola and Colorescience, they are more translucent and have a very nice aesthetic feel to them.

It is also important to use special sunscreens to protect the eyelids and lips. These too should be mineral based as they will be applied to sensitive areas of the skin. I really like the Colorescience Total Eye 3 in 1 for the eyelids and use it daily as my eye primer. It also does not run in your eyes if you are perspiring. I also love the Colorescience lip shine SPF 35 and the Color Balm SPF 50 for cheeks and lips.

We know UV light causes inflammation in our skin, but visible (blue) light and infrared light do too. While these other light sources are not contributing to skin cancer, they do create more inflammation in the skin, accelerate aging, and exacerbate melasma and rosacea. I really like sunscreens which also contain iron oxides to help protect from these forms of light.  There are also a variety of topical antioxidants which have been found to decrease inflammation from sun. These include SkinCeuticals CE Ferulic and Phloretin.

Other items to use:

Eyes – Sunglasses

Hats – broad brimmed

Rash guards – SPF 50 and think of how they will be worn if too tight then the weave is stretched and the SPF factor will decrease. Lululemon, Athleta, Le Tarte, Rip Curl, Quiksilver, etc.

How can I best protect my kids?

Stick with mineral based SPF. Try sticks for face as they are fast and easy to apply (Coola, Colorescience, and CeraVe have options). Bonus, they won’t cause irritation in the eyes. If you use sunscreen sprays, then do not apply them on or near the face. If you have a wiggly one that is hard to catch, then use a long sleeve rash guards for their body, and lotion or spray for legs and hands.

Watch the video below!