Sonya Addison, MD, is board certified in Internal Medicine, Diabetes, Endocrinology, and Metabolism, and holds a certification by the American Society of Hypertension. She currently practices Endocrinology at Boone Medical Group Diabetes and Endocrinology in Columbia, Mo. This column is for educational and entertainment purposes, and is not meant to replace the advice of your personal medical team.

Summer is coming! School is out (officially this time). The sun is warm and inviting, but it isn’t your friend. I still want you to get outside and get fresh air and sun, but I want you to do it safely.

Basal cell carcinoma and squamous cell carcinoma are the most common skin cancers. In fact, they are the most common cancers in the US. Fortunately, they are also the most treatable. Together, they are called non-melanoma skin cancer.

Basal cell carcinoma (BCC) is the most frequently diagnosed skin cancer. Most common in white individuals, men are 30% more likely than women to get it. Your risk of having BCC is about 30% in your lifetime, and risk increases with age. Lighter skin, childhood freckling, northern European decent, and history of severe sunburns in childhood increases risk. The most important risk factor for developing BCC is sun (or UV) exposure. Brief, intense exposure to sun increases risk more than the same “dose” of UV rays over a longer period. Medications that increase sun sensitivity may also increase risk of skin cancer. Genetic variations may also increase risk.

Squamous cell carcinoma (SCC) has similar risk factors and treatments as BCC. While basal cell carcinoma is almost never fatal, squamous cell may metastasize in 2-5% of patients. These are distinct cancers that rise from different types of skin cells.

Treatment for skin cancer may include surgical excision, topical medications, radiation treatment, cryotherapy, electrocautery, or medication that is injected into the cancer.

Melanoma is much more aggressive, but also more rare. It can quickly spread to any part of the body and may be fatal. Rates of melanoma have increased by 50% in the past 20 years. This is likely due to improvement in diagnostic measures and awareness. While rates of melanoma are increasing, the fatality rate is decreasing a bit. Earlier diagnosis as well as several new therapies are driving this trend. 

There are several different forms of melanoma. This article focuses on the skin. Melanoma may also arise in the retina, nail beds, genitals, and solid organs.

Risk factors for cutaneous melanoma include UV or sun exposure, immunosuppression, having more than 50 moles or nevi, fair skin, blonde or red hair, light colored eyes, and increasing age. While having many moles increases your risk, it is important to know that about 70% of melanomas actually come from a new lesion. Only about 30% come from a mole that you’ve had for a long time.

Treatment of melanoma almost always starts with surgical excision. The surgeon’s goal is to remove the cancer and quite a bit of normal skin around it. This can be painful and disfiguring. The depth of the melanoma helps predict if it will spread. It can spread through the blood and the lymph system. In patients with an early melanoma, excision is almost always curative, and the risk of recurrence tends to be low.

In more advanced cancers, a lymph node biopsy may be recommended to assess for spread. Metastatic melanoma can be found in many different organs, including the lungs, lymph nodes, and brain. In some cases, radiation therapy may be used. A newer type of treatment called immunotherapy is now being used. This class of medications tells the body’s immune system to attack and kill the cancer cells, decreasing spread.

While treatment and prognosis is improving, the best method is to prevent it completely. Use sunscreen that blocks both UVA and UVB rays. Wear hats, sleeves, and stay in the shade when you can. Prevent your children from getting sunburns at a young age. Take action if you see a skin lesion or mole that is new or changing.

Skin cancer screening is most often performed by your medical provider and requires looking at all skin surfaces. Is screening beneficial? Is it accurate? To date, there has not been a randomized controlled trial to assess the benefit of screening for skin cancer. Surprised? So am I. When we think of other screening tools, such as colonoscopy, PAP tests, etc., we know that there is a recommended time interval between exams. Not for skin cancer. Other screening tools have a fairly accurate diagnostic method. Not quite so for skin cancer.

It is easy to think, “well, it’s just a visual exam. What’s the harm?”  Potential harm does exist for skin cancer screening. A fair number of skin lesions are thought to be suspicious, leading to biopsies, surgeries, and treatments that are not necessary. These can be expensive, time consuming, and sometimes, disfiguring.

Because of lack of knowledge, there are no formal recommendations for skin cancer screening. It is important to look at your skin regularly. If you notice a new or changing mole, then have your doctor look at it.  

The “ABCDE” model is most often used to evaluate a skin lesion. This method assess for asymmetry (the two halves are not identical), borders (irregular), color (various shades of black, white, gray, red, or blue), diameter (> 6 mm), and evolution (it changes over time). Skin cancers are not always a new dark spot. They can be flesh colored, nodular, flat, or raised. They may itch, bleed, or ulcerate. If you notice any of these irregularities, then call your medical provider immediately.

Sonya Addison, MD, is board certified in Internal Medicine, Diabetes, Endocrinology, and Metabolism, and holds a certification by the American Society of Hypertension. She currently practices Endocrinology at Boone Medical Group Diabetes and Endocrinology in Columbia, Mo.  This column is for educational and entertainment purposes, and is not meant to replace the advice of your personal medical team.