Dr. Bruce Lattyak: Skin cancer prevention and early detection
Special to The Union
Skin cancer is the most commonly diagnosed cancer in the United States, accounting for over half of all cancer cases, according to the American Cancer Society. Furthermore, the incidence of skin cancer is rising dramatically, particularly in California and other sun-drenched states.
Sun exposure and skin complexion
The most common risk factors for developing skin cancer are sun exposure and a fair complexion. Ultraviolet (UV) rays from sun exposure are a major risk for skin cancer as they damage the skin DNA. The two types of UV radiation that penetrate the Earth’s atmosphere and reach the surface are UVA and UVB rays. UVB rays are higher energy and harm the skin DNA more directly than UVA rays and are therefore more likely to cause skin cancer. UVA rays penetrate the skin more deeply and are closely associated with wrinkling, sagging, and premature skin aging. Nonetheless, both UVB and UVA rays are linked to skin cancer. Prolonged cumulative exposure over many years increases the risk of developing skin cancer, as do severe sunburns, particularly when suffered as a child. UV rays are the strongest between 10 am and 4 pm, and during the spring and summer months. UV exposure also increases with altitude and as one gets closer to the equator. Surface reflections can also increase UV exposure, for example water, sand, or snow. The effect of cloud cover on UV radiation is more variable, but it is important to remember that you can still get significant UV ray exposure on a cloudy day. Tanning beds, another source of UV radiation, also increase the risk of cancer.
Anyone can develop skin cancer, regardless of their complexion, race, or ethnicity. However, fair-skinned individuals are at higher risk for skin cancer because they do not produce as much of the pigment melanin, which helps protect skin cells from the damaging effects of UV radiation. While sunburns, especially sunburns in childhood, increase your risk of developing skin cancer, you do not need to have a history of sunburn to get skin cancer. The effect of cumulative exposure is analogous to the correlation between cigarette smoking and lung cancer: the more sun exposure you receive over a lifetime, the greater your risk of developing skin cancer.
Other risk factors
Aside from sun exposure and skin complexion, the following are important risk factors for developing skin cancer:
Personal history of skin cancer
Family history of skin cancer
Having several, irregular, or large moles
Use of tanning beds
History of organ transplant
Medications that suppress the immune system or increase sensitivity to light
Certain autoimmune diseases e.g. lupus
Certain inherited conditions e.g. xeroderma pigmentosum, albinism
Medical conditions that suppress the immune system e.g. HIV disease/AIDS
History of certain types of HPV infection (warts)
Skin Cancer Prevention
Because Nevada County residents enjoy abundant sunshine at considerable altitude, mild weather, and a year-round outdoor lifestyle, we are at particularly high risk for developing skin cancer. Here are some ways to decrease this risk:
Limit prolonged sun exposure between 10 am and 4 pm. Try scheduling routine activities such as golf or tennis in the early morning or late afternoon. Even if you’re just walking down the street or jogging in the park, seek shade whenever possible.
Wear a wide-brimmed hat. The hat should provide shade to the nose, ears, and neck. Baseball caps may protect the scalp and face but they leave the ears and back of the neck exposed.
Use sunscreen every day and reapply liberally, especially after swimming or exercising, and teach your children the same habits. Make it part of your daily routine, like brushing your teeth. Look for an SPF rating of at least 15 for everyday use, and use cosmetics that contain sunscreen. If you are planning to be in direct sunlight for more than a few minutes or if you have any of the above risk factors for skin cancer, use a sunscreen with an SPF rating of at least 30 (blocks 97 percent of UVB rays), especially if engaging in water or snow activities.
Wear UV filtering sunglasses.
Wear UPF rated sun-protective clothing, preferably with a rating of 30 or higher.
Avoid the use of tanning beds.
Perform monthly self skin exams
There are 2 broad categories of sunscreens: physical and chemical. Physical sunscreens, otherwise known as sunblocks, contain zinc oxide and/or titanium dioxide. They protect your skin by deflecting or blocking UV rays. Physical sunscreens are effective against the entire spectrum of both UVB and UVA rays.
Chemical sunscreens include many ingredients with those hard-to-remember names (e.g. octocrylene, avobenzone, octinoxate etc…); they work by absorbing UV rays. Most individual chemical sunscreens are only effective against a narrow spectrum of either UVB or UVA rays, therefore they are often combined to achieve broad spectrum protection. The main advantage of chemical sunscreens is that they tend to be easier to apply and blend in to the skin without a visible film or residue. However, chemical sunscreens are more likely to irritate sensitive skin and may cause allergic reactions, and some may generate free radicals that can lead to skin damage and premature aging. Also, it is important to remember that chemical sunscreens take about 20 minutes to be effective after applying.
Physical sunscreens, on the other hand, are effective immediately after application and tend to be much less irritating to delicate skin. In fact, zinc oxide is the main ingredient in diaper rash cream. The main disadvantage of physical sunscreens is that most traditional formulations are thick and opaque, and tend to leave a white film or residue that is cosmetically unappealing. However, more advanced physical sunscreen products are now available that break up the zinc oxide or titanium oxide into tiny particles (micronization), resulting in sunblocks that blend in seamlessly without any visible residue.
UPF rated clothing
Ultraviolet Protection Factor (UPF) is a rating for clothing that indicates how much of the sun’s UV radiation passes through a given fabric. A fabric with a rating of 30, for example, will allow only 1/30th of the sun’s UV rays to pass through. Therefore, the higher the UPF rating of a given material, the more effectively it protects you from the sun. SPF, by contrast, stands for Sun Protection Factor and applies only to sunscreens and other sun-protective skin products. SPF measures how many times longer it takes for sun-exposed skin to redden when using a given product, compared to unprotected skin.
In general, light-colored, thin, and loosely-woven fabrics have a lower UPF. Cotton T-shirts typically have a UPF of 7-10, depending on the color. Dark denim jeans, by contrast, have a UPF of around 1700. The Skin Cancer Foundation recommends wearing clothing with a UPF of 30 or higher. Try to wear long-sleeved shirts and long pants when practical. There are many clothing options today that are lightweight and comfortable yet highly protective. For clothing that is not UPF rated, a simple way to test its ability to protect your skin is to hold it up to the sunlight. The more light you can see through it, the less protective it is.
You can detect most skin cancers early with regular skin exams. Early detection leads to easier, less invasive treatment and a decreased risk that the cancer spreads to other parts of the body (metastasis). Get into the habit of examining yourself at least once per month. By familiarizing yourself with your skin appearance and mole/freckle pattern with regular examinations, you will be more likely to notice a suspicious lesion at an early stage. You can use a mirror and/or the help of a loved one to examine hard to see areas e.g. ears, scalp, and back side.
Below are some key features of the most common types of skin cancer. If you notice anything that fits these patterns or any skin lesion that’s new or changing, have it checked promptly by your doctor. People who have significant risk factors for skin cancer should also get regular professional skin cancer screening exams.
Basal cell carcinoma (BCC)
BCC is the most common type of skin cancer. It can have any of a number of different appearances:
Flesh-colored, pink, red or brown shiny bumps with a pearly sheen, often with blood vessels
Pink growths with raised edges and a shallow depressed center
Raised reddish patches that look like a rash, frequently itchy
Flat, firm, pale white or yellow areas that look like a scar
Open sores that bleed easily or won’t heal
Squamous cell carcinoma (SCC)
SCC can appear as any of the following:
Hard or crusty lesions
Open sores that bleed easily or won’t heal
Rough or scaly red patches
Rapidly growing smooth growths or lumps, sometimes with a plug in the center
Melanoma is less common than BCC or SCC, accounting for approximately 4% of diagnosed skin cancers in the United States. However, because of its potential to spread if not caught early, it accounts for 80% of the deaths due to skin cancer. The fact that melanoma has a very high cure rate when diagnosed early stresses the critical importance of regular self skin exams. Most but not all melanomas are pigmented i.e. exhibit a shade of brown, black, or other dark color. The typical signs of melanoma can be memorized using the A-B-C-D-E guide developed by the American Academy of Dermatology:
ASYMMETRY: One half of the mole does not match the other.
BORDER IRREGULARITY: Mole edges are irregular, scalloped, or poorly defined.
COLOR VARIED: The mole contains more than one shade of brown, black, or sometimes blue, white, pink, or red.
DIAMETER: The mole measures more than 6 millimeters (about ¼ inch) across – the size of a pencil eraser
EVOLVING: A mole or skin lesion that looks different than the rest or is changing in size, shape or color
Finally, most skin cancers do not cause symptoms. However, if you notice any skin lesion that bleeds, causes pain or tenderness, or itches excessively, you should have it evaluated by your doctor.
In summary, skin cancer is extremely common, particularly in Nevada county. The good news is that common sense preventative measures and regular skin exams can go a long way to reducing your risk of skin cancer and facilitating early diagnosis and treatment.
Dr. Bruce Lattyak is a Board-Certified Plastic Surgeon, specializing in treatment of skin cancers and plastic and reconstructive surgery. He works in Grass Valley.
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