Skin cancer is the most common type of cancer in the United States. It is estimated that one in five Americans will develop skin cancer in their lifetime. The most important step you can take to protect your skin is to reduce sun exposure.

What is Skin Cancer?

Skin cancer develops when skin cells are damaged by ultraviolet (UV) radiation from repeated exposure to the sun or sunburns. Other sources of UV radiation, such as tanning beds and sunlamps, also contribute to the risk of skin cancer. The two most common types of skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), both of which tend to grow slowly and rarely spread to other parts of the body. While they can be treated, they may cause disfigurement if not addressed.

Melanoma is the most dangerous form of skin cancer. Although it accounts for only about 1% of skin cancer cases, it is responsible for the majority of skin cancer deaths. Melanoma grows quickly and is more likely to spread to other parts of the body compared to BCC and SCC.

Skin cancer primarily develops on areas of the skin that receive significant sun exposure, such as the scalp, face, ears, neck, chest, arms, hands, and legs. However, it can also occur in less commonly exposed areas, such as the palms of the hands, under the fingernails or toenails, and in the genital area.

Other factors that can increase your risk of developing skin cancer include:

• Fair skin
• Blond or red hair
• Blue, green, or gray eyes
• Skin that burns easily
• Family history of skin cancer
• Tendency to develop moles or large/abnormal moles
• History of severe sunburns
• Older age

What are the Symptoms of Skin Cancer?

Skin cancer often appears in the most sun-exposed areas of the body, such as the face, ears, neck, lips, and backs of the hands. However, it can also develop in other areas, such as scars, skin sores, or rashes elsewhere on the body.

• Basal Cell Carcinoma (BCC): BCCs usually appear as small, painless bumps with a pink, pearly surface. As they slowly grow, the center may become sore and develop into a crater that bleeds, crusts over, or forms a scab. While often found on the face, BCCs can also develop on the ears, back, and neck.
• Squamous Cell Carcinoma (SCC): SCCs often start as a small, red, painless lump or patch of skin that slowly grows. It may eventually develop into a sore that doesn’t heal. SCCs commonly occur on the head, ears, and hands.
• Melanoma: Melanoma typically appears as a single, dark skin spot that can develop anywhere on the body, but is most commonly found on the back, chest, and legs. It often grows on normal-looking skin but can also arise from an existing mole. A useful guideline for identifying melanoma is the ABCDE rule

:

• A: Asymmetry – One half of the mole or spot does not match the other half in size, shape, or color.
• B: Border irregularity – The edges are uneven, ragged, notched, or blurred.
• C: Color – The pigmentation is uneven and may include different shades of tan, brown, black, red, white, or blue.
• D: Diameter – The spot or mole is greater than ¼ inch in diameter (about the size of a pencil eraser), though melanomas can sometimes be smaller.
• E: Evolving – The mole or spot looks different from others or changes in size, shape, or color over time. It may also begin to itch, hurt, or bleed.

Types of Skin Cancer

1. Basal Cell Carcinoma (BCC): BCC is the most common type of skin cancer, accounting for about 80% of cases. It develops in basal cells, which are located deep in the epidermis. BCCs tend to grow slowly and rarely spread to other parts of the body. However, if left untreated, BCC can grow into nearby areas, destroying skin, tissue, and even bone. If the cancer is not fully removed during treatment, it can return to the same spot. People with one BCC are more likely to develop another in the future.
2. Squamous Cell Carcinoma (SCC): About 20% of skin cancers are SCCs, which begin in squamous cells located in the middle and outer layers of the skin. SCC may develop from actinic keratosis, a precancerous skin growth characterized by rough, scaly patches that often appear on sun-exposed areas. SCC grows more quickly than BCC and is more likely to penetrate deeper into the skin or spread to other parts of the body.
3. Melanoma: This type of cancer originates from melanocytes, the skin cells responsible for pigment production. Although it accounts for only 1% of all skin cancer cases, melanoma is the most dangerous because it tends to grow and spread rapidly. If caught early, melanoma can often be treated successfully, but if it spreads to other areas of the body, treatment becomes more difficult.
4. Merkel Cell Carcinoma: This is a rare but aggressive form of skin cancer that develops from Merkel cells found in the basal layer of the skin. While much less common than melanoma, Merkel cell carcinoma is responsible for more deaths, ranking as the second most deadly form of skin cancer after melanoma. It also tends to grow and spread quickly.

What is Melanoma?

Melanoma, also called malignant melanoma, is the deadliest form of skin cancer. It occurs when melanocytes, the cells that give skin its color, begin to grow uncontrollably. Melanoma is often identifiable as a single, dark skin spot, typically larger than 6 millimeters (mm) (about the size of a pencil eraser), although it can sometimes be smaller.

Melanoma can develop from an existing mole or form on normal-looking skin. Certain factors can increase the risk of developing melanoma, including:

• A new mole that appears after age 30.
• A new mole in an area not usually exposed to the sun.
• Changes in an existing mole.
• Presence of atypical moles that have irregular shapes, resemble a fried egg, or are darker than other moles.
• Having 20 or more moles larger than 2 mm across or five or more moles larger than 5 mm across.

Common locations for melanoma include the face (especially in older individuals), the upper trunk (in men), and the legs (in women). Melanoma can also appear under fingernails or toenails, in the genital area, and even inside the eyes.

Melanoma is typically easy to spot early on. It’s essential to regularly check your skin for any new moles or changes to existing moles. People at increased risk for melanoma should have regular check-ups with a dermatologist. A doctor or dermatologist may remove atypical moles that appear to be at higher risk of becoming cancerous.

To diagnose melanoma, a small sample of the mole or spot is removed and examined under a microscope to check for cancer cells.

There are five stages of melanoma, ranging from stage 0 to stage 4. Each stage is defined based on the tumor’s thickness, how deep it has penetrated the skin, and whether it has spread to other parts of the body. The higher the stage, the more advanced the melanoma, and the worse the prognosis tends to be.

If melanoma is caught early and treatment begins when the tumor is less than 0.75 mm deep, the chances of a cure are very high. More than 95% of people with early-stage melanoma remain cancer-free for at least eight years after treatment. However, survival rates decrease significantly for deeper or more advanced melanomas.

How Can You Prevent Skin Cancer?

To reduce the risk of developing skin cancer, follow these sun protection guidelines:

1. Sunscreen: Always apply sunscreen to exposed skin 15 to 20 minutes before heading outside, and reapply every two hours or after swimming or sweating. Use at least two tablespoons of sunscreen to cover your face and body, and apply a nickel-sized amount to your face. Be sure to cover less obvious areas like the ears, tops of the feet, and backs of the legs.When choosing a sunscreen, consider:
   • Broad-Spectrum Coverage: This ensures protection against UVB rays (which cause sunburn) and UVA rays (which penetrate deeper into the skin and contribute to aging and wrinkles). Both types of rays can damage DNA and increase the risk of skin cancer.
   • SPF (Sun Protection Factor): Use sunscreen with an SPF of 30 to 50. SPF 30 blocks 97% of UVB rays, while SPF 50 blocks 98%. Higher SPFs provide minimal additional protection.
   • Water Resistance: While no sunscreen is completely waterproof, water-resistant sunscreen can offer some protection in water or during heavy sweating. However, reapply after swimming or sweating.
2. Clothing: Wear a wide-brimmed hat (at least four inches wide) and wrap-around sunglasses that block UV rays from the sides. When it comes to clothing, synthetic fabrics like polyester, Lycra, nylon, and acrylic are recommended because they have fibers that are tightly woven, providing better protection from the sun. Darker colors offer more UV protection than lighter colors.Some clothing is specially designed for sun protection and has an ultraviolet protection factor (UPF) rating, indicating how well it blocks UV rays. For example, a shirt with a UPF of 50 allows only 1/50th of the sun’s UV rays to penetrate the fabric.
3. Timing: Avoid the sun between 10 a.m. and 2 p.m., when UV radiation is strongest.
4. Regular Skin Checks: Get a professional skin check from a dermatologist every one to two years, or more frequently if you have a history of skin cancer or a strong family history. At home, regularly check your own skin for any unusual spots, growths, or changing moles. Ask a family member to help examine areas you cannot easily see, such as your back or scalp.

How is Skin Cancer Treated?

Most skin cancers are highly treatable when detected early. The specific treatment depends on the type of skin cancer, its size, location, and whether it has spread.

• Melanoma: The primary treatment for melanoma is surgery. The tumor is removed along with a 0.5 to 2-centimeter margin of healthy skin, depending on the tumor’s size. Mohs surgery, a specialized procedure where the tumor is removed layer by layer and examined for cancer cells, may be used for certain cases. If the melanoma is over 1 millimeter deep, the doctor will check if the cancer has spread to nearby lymph nodes. If cancer is found in the lymph nodes, they may be removed, although it has not been proven that removing all the lymph nodes improves survival chances.For thicker tumors or those that have spread to other parts of the body, immunotherapy and targeted drug therapies are often used. Radiation and chemotherapy may be considered when other treatments are no longer effective.
• Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC): Treatment for these cancers can include:
  • Surgical excision: Removing the cancerous tissue and some surrounding healthy skin.
  • Curettage and electrodessication: Scraping away the tumor and using an electric probe to kill any remaining cancer cells.
  • Cryotherapy: Freezing the cancer cells with liquid nitrogen.
  • Radiation therapy: Targeted beams of radiation to destroy cancer cells.
  • Mohs surgery: As with melanoma, this surgery is often used for BCC and SCC to minimize the removal of healthy tissue.
  • Topical or injected medications: Drugs may be applied directly to the tumor or injected into the area to target cancer cells.
  • Laser therapy: Using a narrow beam of laser light to destroy the tumor.

Early diagnosis and treatment are key to successful outcomes for skin cancer. Protecting your skin from sun exposure, performing regular self-examinations, and visiting a dermatologist for routine skin checks are the most effective ways to prevent and catch skin cancer early.