SKIN CANCER

Skin cancer is the most prevalent of all cancers. It is estimated that more than one million Americans develop skin cancer every year. Everyone should develop a regular routine inspection of their body for any skin changes such as a growth, mole, sore or sudden skin discoloration. A dermatologist should be consulted should any of these occur. The following descriptions may be helpful in assisting with the recognition of skin cancers.

Precancerous Skin Conditions
Actinic keratoses are small scaly spots most commonly found on the face, lower arms, and back of hands in fair-skinned individuals who have had significant sun exposure. If not treated, some actinic keratoses may become skin cancers requiring more extensive treatment. If diagnosed in the early stages, actinic keratoses can be removed by cryotherapy (freezing with liquid nitrogen) or other dermatologic procedures. Sunscreens help prevent actinic keratoses.

Basal Cell Carcinoma
Basal cell carcinoma is a skin cancer usually appearing as a raised translucent patch or nodule. These skin cancers are usually found on the head, neck, and hands, and occasionally can appear on the trunk as red areas. Basal cell carcinomas seldom occur in African-Americans, but they are the most common skin cancers found in fair-skinned persons. People who have this cancer often have light-colored eyes, hair and complexions, and do not tan easily. These tumors do not spread quickly and can take many months or years to grow to a diameter of one-half inch. Untreated, the cancer will begin to bleed, crust over, heal, and then the cycle repeats. Although this cancer rarely spreads to other parts of the body (metastasizes), it can extend below the skin to the bone and cause considerable local damage.

Squamous Cell Carcinomas
This skin cancer is the second most common in fair-skinned persons and appears as a bump, or a red, scaly patch. It is typically found on the rim of the ear, the face, lips and mouth and is rarely found in dark-skinned persons. This cancer can develop into large masses and can metastasize. When found early, the cure rate for both basal and squamous cell carcinomas is good. Mohs micrographic surgery has cure rates approaching 99% for primary lesions.

Melanoma
More than 40,000 new cases of malignant melanomas occur yearly in our country causing in excess of 7,000 deaths. It is important to note that the death rate is declining because patients are seeking help earlier. Like the less aggressive skin cancers, basal cell and squamous cell carcinomas, melanoma is almost always curable when detected in its early stages. Excessive sun exposure, particularly sunburn, is the most important preventable cause of melanoma, especially among light-skinned individuals. Heredity also plays a part since a person has an increased chance of developing melanoma if a family member has had a melanoma. Atypical moles (dysplatic nevi), which may run in families, and a high number of moles, can serve as markers for people at higher risk for developing melanoma.

Melanoma has its beginnings in melanocytes, the skin cells that produce the dark, protective pigment called melanin. It is melanin that makes the skin tan, acting as partial protection against the sun. Melanoma cells usually continue to produce melanin, which accounts for the cancers appearing in mixed shades of tan, brown, and black. Melanoma can also be red or white. Melanoma can spread to other parts of the body through the bloodstream and the lymph drainage system, making treatment essential.

About 40-50% of the malignant melanomas develop from pigmented moles; almost all the rest arise from melanocytes in normal skin. The very rare malignant melanomas of childhood almost always arise from large pigmented moles (giant congenital nevi) present at birth. Halo nevi usually resolve spontaneously but very rarely are melanomas. Although melanomas are more common during pregnancy, pregnancy does not increase the likelihood that a mole will become a melanoma. Nevi frequently change in size or shape during pregnancy.

Melanoma may suddenly appear without warning, but it may also begin in, or near a mole or another dark spot in the skin. It is important to know the location and appearance of the moles on our bodies so any change will be noticed.

Warning signs of melanoma include: changes in the surface of a mole; scaliness, oozing, bleeding, or in the appearance of a new bump; spread of pigment from the border into a surrounding skin; and change in sensation including itchiness, tenderness or pain. Dark-skinned people can develop melanoma especially on the palms of the hands, soles of the feet, under nails, or in the mouth. The most important step you can take is to have any changing mole examined by a dermatologist so that any early melanoma can be removed while still in the curable stage. The warning signs of melanoma can be easily remembered by the pneumonic "ABC" as shown below:

ABCDE's of Melanoma:

• Asymmetry
  
• Border irregularity
  
• Color variability
  
• Diameter
  
• Evolving