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Skin Cancer
Overview
What is skin cancer?

Skin cancer is the most common form of cancer. Fortunately, it is also the most curable. There are 2 forms of skin cancer: melanoma (the less common but more serious kind) and nonmelanoma (the more common, very treatable type). More than 1 million people will be diagnosed with skin cancer this year. Most will have nonmelanoma types of skin cancer. Almost all skin cancers are the result of too much exposure to ultraviolet light, which is found in sunlight and in lights used in tanning salons.

Why is the sun so bad for my skin?

The sun's rays, which are called ultraviolet A and ultraviolet B rays (UVA and UVB rays) damage your skin. This leads to early wrinkles, skin cancer and other skin problems.

Being in the sun too often for too long can lead to skin cancer, even if you don't burn. A tan is the body's attempt to protect itself from the sun's harmful rays.

Are tanning booths safer?

No. Tanning booths use ultraviolet rays. Makers of the booths may claim that they use "harmless" UVA rays. But both UVA and UVB rays cause skin damage. While UVA rays take longer than UVB rays to damage the skin, they go deeper into the skin than UVB rays.

What is melanoma?

Melanoma is a type of skin cancer. It begins in skin cells called melanocytes (say: "mel-an-oh-sites"). Melanocytes produce the substance that gives your skin its color.

The body is made up of many types of cells. Normally, cells grow, divide and die. Sometimes, cells mutate (change) and begin to grow and divide more quickly than normal cells. Instead of dying, these abnormal cells clump together to form tumors. If these tumors are cancerous (also called "malignant"), they can invade and kill your body's healthy tissues. From these tumors, cancer cells can metastasize (spread) and form new tumors in other parts of the body. By contrast, noncancerous tumors (also called "benign") do not spread to other parts of the body.

Most other skin cancers don't spread, but melanoma can spread through the whole body. If it is found early, it can be cured. If it is found late, it may cause death.

Symptoms
On what parts of the body is skin cancer most likely to occur?

Most skin cancers occur on parts of the body that are repeatedly exposed to the sun. These areas include the head, neck, face, tips of the ears, hands, forearms, shoulders, back, chests of men, and the back and lower legs of women.

What does skin cancer look like?

It's important to find skin cancer as early as possible. The best way to do this is to keep an eye on your skin, especially moles. The ABCDE rule can help you remember what to look for when you're checking any moles on your skin. If you notice any of these signs, talk to your doctor right away.

Signs of skin cancer: The ABCDE rule

A for asymmetry: A mole that, when divided in half, doesn't look the same on both sides.

B for border: A mole with edges that are blurry or jagged.

C for color: Changes in the color of a mole, including darkening, spread of color, loss of color, or the appearance of multiple colors such as blue, red, white, pink, purple or gray.

D for diameter: A mole larger than 1/4 inch in diameter (about the size of a pencil eraser).

E for elevation: A mole that is raised above the skin and has an uneven surface.

Where do melanomas occur?

Melanomas can be anywhere on your body. In men, they are most often on the chest, stomach or back. In women, they are most often on the lower legs.

What does a melanoma look like?

A melanoma might look like a mole or a bump or growth on your skin. Melanomas often do not look bad at first.

The ABCDE rule can help you remember what to look for when you're checking any moles on your skin.

Other signs include

  • A mole that bleeds
  • A fast-growing mole
  • A scaly or crusted growth on the skin
  • A sore that won't heal
  • A mole that itches
  • A place on your skin that feels rough, like sandpaper

Also be aware that moles can grow in hidden areas of your body, such as between toes, on your scalp or under a nail. If you notice a mole that has changed, or if you have a new mole that doesn't look like your other moles, visit your doctor right away.

Causes & Risk Factors
What are the risk factors for skin cancer?

A number of factors may put you at higher risk of having skin cancer:

  • Having fair skin, red or blond hair
  • Having light-colored eyes
  • Sunburning easily
  • Having many moles, freckles or birthmarks
  • Working or playing outside
  • Being in the sun a lot as a child
  • Having had a serious sunburn
  • Having had skin cancer, or having family members who have had skin cancer
  • Tanning in the sun or with a sunlamp
Who gets melanoma?

Anyone can get melanoma, but some people are more likely to get it. If you answer "yes" to any of the questions below, you may be more at risk. Talk with your doctor about your risk factors.

  • Has anyone in your family had cancerous moles or a melanoma?
  • Do you have many moles larger than a pencil eraser?
  • Do you have more than 50 moles of any size?
  • Did you ever get a bad sunburn that caused blisters when you were a child?
  • Does your skin usually burn but not tan?
Diagnosis & Tests
What's the best way to do a skin self-examination?

The best way is to use a full-length mirror and a hand-held mirror to check every inch of your skin.

1. First, you need to learn where your birthmarks, moles and blemishes are and what they usually look like. Check for anything new, such as a change in the size, texture or color of a mole, or a sore that doesn't heal.

2. Look at the front and back of your body in the mirror, then raise your arms and look at the left and right sides.

3. Bend your elbows and look carefully at your palms and forearms, including the undersides, and your upper arms.

4. Check the back and front of your legs.

5. Look between your buttocks and around your genital area.

6. Sit and closely examine your feet, including the bottoms of your feet and the spaces between your toes.

7. Look at your face, neck and scalp. You may want to use a comb or a blow dryer to move hair so that you can see better.

By checking yourself regularly, you'll get familiar with what's normal for you. If you find anything unusual, see your doctor. The earlier skin cancer is found, the better.

What does a normal mole look like?

A normal mole is solid tan, brown, dark brown or flesh colored. Its edges are well-defined. It's usually smaller than 1/4 inch in diameter and has a round or oval shape. It should be flat or dome-like.

How can I tell if my mole isn't normal?

The main thing to look for is any change in a mole that you have or the appearance of a new mole. Most normal moles appear by age 30. Any moles that appear after age 30 should be watched carefully and brought to the attention of your family doctor.

Prevention
How can I prevent skin cancer?

The key is to avoid being in the sun or using sunlamps. If you're going to be in the sun for any length of time, wear clothes made from tight-woven fabric so the sun's rays can't get through to your skin, and stay in the shade when you can. Wear long sleeves and a wide-brimmed hat to protect your face, neck, shoulders and ears.

Remember that clouds and water won't protect you--60% to 80% of the sun's rays go through clouds and can reach swimmers at least one foot below the surface of the water. The sun's rays can also reflect off water, snow and white sand.

What are the safe-sun guidelines?

Safe-sun guidelines are the following 4 ways to protect your skin and reduce your risk of skin cancer. Each is just part of a program to prevent skin cancer. To greatly lower your risk, you must follow all of the safe-sun guidelines.

1. Avoid the sun.

Sunlight damages your skin. The sun is strongest during the middle of the day, between 10 a.m. and 4 p.m. During these hours, the sun can do the most damage to your skin. Sunburns and suntans are signs that your skin has been damaged. The more damage the sun does to your skin, the more likely you are to get early wrinkles, skin cancer and other skin problems.

2. Use sunscreen.

Use a sunscreen or sunblock with a sun protection factor (SPF) of at least 15, even on cloudy days. Check the expiration date—some ingredients in sunscreen break down over time. Use plenty of sunscreen and rub it in well. You should put the sunscreen on 30 minutes before you go into the sun. Put the sunscreen everywhere the sun's rays might touch you, including your ears, the back of your neck and any bald areas on the top of the head. Be sure to apply enough sunscreen to cover all skin that may be exposed to the sun. Put on more sunscreen every hour or so if you're sweating or swimming. If you are using a sunscreen spray lotion, keep the spray bottle close to the part the body you are spraying. If you spray from too far away, you may not cover all skin that the sun's rays will touch.

But don't think that you're completely safe from the sun just because you're wearing sunscreen. Sunscreen cannot give you 100% protection against the sun's harmful UV radiation.

3. Wear a wide-brimmed hat, protective clothing and sunglasses.

If you have to be out in the sun, cover up your skin. A wide-brimmed hat will help protect your face, neck and ears from the sun. A hat with a 6-inch brim all around is the best. Baseball caps don't protect the back of your neck or the tops of your ears. Wear sunglasses to protect your eyes from the sun. Choose sunglasses that block both ultraviolet-A (UVA) and ultraviolet-B (UVB) rays; wear sunglasses that wrap and are rated to block at least 99% of UVA sunlight. Sun exposure increases your risk of getting cataracts.

Wear protective clothing, such as long-sleeved shirts and long pants made of tightly woven fabric. If the clothes fit loosely, you will feel cooler. Special sun-protective clothes are available from several companies.

Remember that you are often exposed to the sun while driving, especially your hands and arms.

4. Don't try to get a tan.

Don't use tanning salons or sunlamps. Tanning booths and sunlamps damage your skin just like real sunlight does.

What else should I do?

Some doctors think it's a good idea to do a monthly skin check. Ask your doctor about this. If your doctor thinks it's a good idea for you, check your skin once a month for signs of skin cancer, such as irregular moles. The earlier skin cancer is found, the greater the chance that it can be cured. Try doing your skin check on the same date every month. Pick a day that you can remember, like the date of your birthday or the day you pay bills. Look for any changes in a mole or the appearance of a new mole. Any moles that appear after you turn 30 years of age should be watched carefully and shown to your doctor.

Sunburns in childhood are the most damaging. Children younger than 6 months of age should never be outside in direct sunshine. Children 6 months of age or older should wear sunscreen every day.

Other Organizations
Bibliography
Questions to Ask Your Doctor
  • I have a mole that's getting bigger. Could it be skin cancer?
  • I spent a lot of time in the sun as a child. Should I be checked for skin cancer regularly?
  • My father had skin cancer. Am I more likely to have it, too?
  • What is the best way to protect my child from the sun?
  • I like to swim. Will the water protect me from the sun?
  • I have skin cancer. How will I be treated?
  • I have darker skin. Can I still get skin cancer?
  • What should I look for when I do a self-examination of my skin?
References
  1. Diagnosis and Management of Malignant Melanoma by BG Goldstein, AO Goldstein(04/01/01, http://www.aafp.org/afp/20010401/1359.html)
  2. Early Detection and Treatment of Skin Cancer by AF Jerant, JT Johnson, CD Sheridan, TJ Caffrey(07/15/00, http://www.aafp.org/afp/20000715/357.html)