Melanoma and Non-Melanoma Skin Care Detection

Did you know that skin cancer is the most common type of cancer? Even though we just finished the sunny months, let’s do a review!

Skin cancer can be divided into two major groups, melanoma and nonmelanoma (primarily squamous cell and basal cell) cancers.  Malignant melanoma, the deadliest form of skin cancer, is a tumor that arises from skin cells called melanocytes, found in what is known as the basal layer of the epidermis.  Malignant melanoma is the fifth leading cause of cancer in men and the sixth leading cause of cancer in women.  Lifetime chance for developing invasive melanoma increases with age, and whites have a higher (10-fold) incidence of this cancer than that of non-whites.  Basal cell cancer is the most common type of skin cancer overall and arises from cells called basal cells which are found in the epidermis and also in hair follicles and sweat ducts.  Squamous cell cancer is the second most common type of skin cancer and arises from scaly cells found on the surface of skin. Melanoma is the third most common type of skin cancer. 

What is a major cause of skin cancer? Ultraviolet (UV) light exposure and sunburns appear to be two major causes in all types of skin cancers, both melanoma and nonmelanoma skin cancers.  Ultraviolet B radiation causes oxidative stress, DNA damage and impairment of cell repair, premature aging of the skin, and multiple effects on the immune system. Ultraviolet A radiation can lead to the development of melanoma and squamous cell skin cancer by producing reactive oxygen species.  Other risk factors for malignant melanoma include personal or family history of melanoma, weakened immune system or immunosuppressive therapy, and higher socioeconomic group.  Immunosuppression also increases the risk for squamous cell skin cancer. Taking measures to moderate UV light exposure of skin (but balancing the need for vitamin D!) can be protective for all types of skin cancer, and using sunscreen when you are in the sun longer than needed for a boost of vitamin D can be helpful (choose an organic sunscreen to avoid chemicals!).

How can you make a difference? Early detection of both melanoma and nonmelanoma skin cancers is important to assure early treatment and prevention of debility (and possible death, in the case of melanoma).  Self-exam of your skin, with help from a spouse or family members, should be done monthly, and can be an effective screening strategy to identify any new suspicious skin lesions. The American Cancer Society screening guidelines recommend regular skin self-exam for all adults.  Pamphlets for self-exam of the skin are available from the American Cancer Society, the American Academy of Dermatology, and the Skin Cancer Foundation. Clinical examination of the skin by a dermatologist should be done yearly for people at high risk for skin cancer (these could include those with a family or personal history of skin cancer and those with a high number of pigmented moles, or those with specific syndromes such as xeroderma pigmentosum or basal cell nevus syndrome). 

Your self-skin exam is best done in a well-lit room in front of a full-length mirror. A hand-held mirror can be used to look at areas that are hard to see, such as the backs of the thighs. A family member can help by looking at the back and scalp. Getting familiar with the location and size of existing moles is important! Taking photos is a good idea, to track them over time.  It is best to do these exams after a bath or shower, and, of course, to be thorough!

It is important that you recognize the difference between normal and suspicious moles. A normal mole is usually an evenly colored brown, tan, or black spot on the skin.  It can be either flat or raised, and either round or oval.  Moles are usually less than 6 millimeters (1/4 inch) in size, about the width of a pencil eraser.  Moles can be present at birth or arise during childhood or young adulthood; new moles that appear later in life should be checked by a health care provider. The most important warning sign for melanoma is a new mole on the skin or a mole that is changing in size, shape, or color.  Another important sign is a mole that looks different from all the other moles on the skin. These too should be checked by a health care provider.

The “ABCDE” screening guideline can help you to recognize when a mole needs further attention (you can see color images of normal and abnormal moles at www.skincancer.org; I highly recommend you take a look!)  This guideline is as follows:

-Asymmetry:  one half of the mole does not match the other.

-Border:  mole edges are irregular, ragged, notched, or blurred.

-Color:  color is patchy and not the same all over, may include shades of brown, black, pink, white, blue.

-Diameter:  mole is larger than 6 mm across (although sometimes melanomas are smaller than this).

-Evolving:  mole is changing in size, shape, or color over time.

However, keep in mind that some melanomas do not “fit” the ABCDE guidelines and may present as: a sore that does not heal; spread of pigment from the border of a mole into the surrounding skin; redness or a new swelling beyond the border of a mole; itchiness or pain in a mole; or change in the surface of a mole (scaliness, bleeding or oozing of a mole).

Basal cell skin cancers can have the following presentation: flat, firm, pale or yellow areas similar to a scar; itchy, raised, reddish patches; small pink or red translucent or shiny, pearly bumps which could have blue, brown, or black areas; pink growths with raised edges and a lower area in their center which may contain abnormal blood vessels; or open sores with oozing and crusting that either don’t heal, or heal for a while but then come back.

Squamous cell skin cancers can appear as rough or scaly red patches which might crust or bleed; raised growths or lumps with a lower central area; open sores that ooze or crust and don’t heal or heal but return again; or wart-like growths.

Fortunately, imaging studies such as x-rays and CT scans are NOT needed for early detection of skin cancer--just careful visual exam of the skin.  So, grab a mirror and start inspecting!