Lorien Sites, MD: dermatologist
Monday, March 26, 2012
TOPIC: Skin Cancer Awareness
Jennifer Martin, MD: dermatologist
News notes via www.skincancer.org and www.webmd.com
What is Skin Cancer?
Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors. Cancerous tumors may spread, invading and damaging nearby tissue. In some cases, skin cancers can spread to vital organs, becoming deadly.
Fast Facts about Skin Cancer
- Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.
- Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.
- One in five Americans will develop skin cancer in the course of a lifetime.
- Over the past 31 years, more people have had skin cancer than all other cancers combined.
- Nearly 800,000 Americans are living with a history of melanoma and 13 million are living with a history of nonmelanoma skin cancer, typically diagnosed as basal cell carcinoma or squamous cell carcinoma.
- Actinic keratosis is the most common precancer; it affects more than 58 million Americans. Approximately 65 percent of all squamous cell carcinomas arise in lesions that previously were diagnosed as actinic keratoses. In patients with a history of two or more skin cancers, 36 percent of basal cell carcinomas arise in lesions previously diagnosed as actinic keratoses.
- Basal cell carcinoma (BCC) is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the US. BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.
- Squamous cell carcinoma (SCC) is the second most common form of skin cancer. An estimated 700,000 cases are diagnosed each year in the US,10 resulting in approximately 2,500 deaths.
- Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.11
- About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.
- Treatment of nonmelanoma skin cancers increased by nearly 77 percent between 1992 and 2006.
- One person dies of melanoma every hour (every 62 minutes).
- One in 55 people will be diagnosed with melanoma during their lifetime.
- Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
- The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent. The survival rate falls to 15 percent for those with advanced disease.
- The vast majority of mutations found in melanoma are caused by ultraviolet radiation.
- The incidence of many common cancers is falling, but the incidence of melanoma continues to rise at a rate faster than that of any of the seven most common cancers. Between 1992 and 2004, melanoma incidence increased 45 percent, or 3.1 percent annually.
- An estimated 123,590 new cases of melanoma were diagnosed in the US in 2011 — 53,360 noninvasive (in situ) and 70,230 invasive, with nearly 8,790 resulting in death.
- Melanoma accounts for less than five percent of skin cancer cases,20 but it causes more than 75 percent of skin cancer deaths.
- Survival with melanoma increased from 49 percent (1950 - 1954) to 92 percent (1996 - 2003).
- Melanoma is the fifth most common cancer for males and sixth most common for females.
- Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.
- About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.
- One or more blistering sunburns in childhood or adolescence more than double a person's chances of developing melanoma later in life.
- A person's risk for melanoma doubles if he or she has had more than five sunburns at any age.
- Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.
- Ultraviolet radiation (UVR) is a proven human carcinogen. Currently tanning beds are regulated by the FDA as Class I medical devices, the same designation given elastic bandages and tongue depressors.
- Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.
- Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.
- Nearly 30 million people tan indoors in the U.S. every year; 2.3 million of them are teens.
- On an average day, more than one million Americans use tanning salons.
- Seventy-one percent of tanning salon patrons are girls and women aged 16-29.
- Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.
- People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.
- The indoor tanning industry has an annual estimated revenue of $5 billion.
What is melanoma?
Melanoma is a kind of skin cancer. It is not as common as other types of skin cancer, but it is the most serious.
Melanoma can affect your skin only, or it may spread to your organs and bones. As with other cancers, treatment for melanoma works best when the cancer is found early.
This topic is about melanoma that occurs in the skin. It does not cover melanoma that occurs in the eye or in any other part of the body besides the skin.
What causes melanoma?
You can get melanoma by spending too much time in the sun. Too much sun exposure causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.
Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and "pebbly." Having many atypical moles increases your risk of melanoma. Also, it may be a sign that melanoma runs in your family.
What are the symptoms?
The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, size, or color of a mole may be a sign of melanoma.
Melanoma may grow in a mole or birthmark that you already have. But melanomas may grow in unmarked skin. They can be found anywhere on your body. Most of the time, they are on the upper back in men and women and on the legs of women.
Melanoma may look like a flat, brown or black mole that has uneven edges. Melanomas usually have an irregular or asymmetrical shape. This means that one half of the mole doesn't match the other half. Melanoma moles or marks may be any size, but they are usually 6 mm (0.25 in.) or larger.
Unlike a normal mole or mark, a melanoma can:
- Change color, size, or the shape of its border.
- Be lumpy or rounded.
- Become crusty, ooze, or bleed.
How is melanoma diagnosed?
Your doctor will check your skin to look for melanoma. If your doctor thinks you have melanoma, he or she will remove a sample of tissue from the area around the melanoma (biopsy). Another doctor, called a pathologist, will look at the tissue to check for cancer cells.
If your biopsy shows melanoma, you may need to have more tests to find out if it has spread to your lymph nodes.
How is it treated?
The most common treatment is surgery to remove the melanoma. That is all the treatment that you may need for early-stage melanomas that have not spread to other parts of your body.
After surgery, your doctor will set up a schedule of frequent checkups that will happen less often as time goes on. Your doctor will talk with you about how you can lower your chances of having another melanoma.
If your melanoma is very deep or has spread to your lymph nodes, your doctor may talk with you about taking a medicine called interferon. Or your doctor may recommend that you enroll in a clinical trial.
Can you prevent melanoma?
The best way to prevent all kinds of skin cancer, including melanoma, is to protect yourself whenever you are out in the sun. It's important to avoid exposure to the sun's ultraviolet (UV) rays.
- Try to stay out of the sun during the middle of the day (from 10 a.m. to 4 p.m.).
- Wear protective clothes when you are outside, such as a hat that shades your face, a long-sleeved shirt, and long pants.
- Get in the habit of using sunscreen every day. Your sunscreen should have an SPF of least 15. Look for a sunscreen that protects against both types of UV radiation in the sun's rays-UVA and UVB.
- Use a higher SPF when you are at higher elevations.
- Avoid sunbathing and tanning salons.
Check your skin every month for odd marks, moles, or sores that will not heal. Pay extra attention to areas that get a lot of sun, such as your hands, arms, and back. Ask your doctor to check your skin during regular physical exams or at least once a year. Even though the biggest cause of melanoma is spending too much time in the sun, it can be found on parts of your body that never see the sun.
Preventing Skin Cancer
There are many risk factors for developing melanoma. The risk factor you can best control to reduce your risk of melanoma is exposure to ultraviolet (UV) radiation from the sun.
To help prevent skin cancer:
- Protect your skin.
- Stay out of the sun during the midday hours (10 a.m. to 4 p.m.).
- Wear protective clothing. This includes a hat with a brim to shade your ears and neck, a shirt with sleeves to cover your shoulders, and pants. The best fabric for skin protection has a tight weave to keep sunlight out.
- Use a sunscreen every day with an SPF of at least 15. Look for a sunscreen that protects against both types of ultraviolet radiation in the sun's rays-UVA and UVB.
- Use a higher SPF when you are at higher elevations.
- Set a good example for your children by protecting your skin from too much sun.
- Avoid sunbathing and tanning salons. Studies suggest that your risk of melanoma increases by 75% if you start using artificial tanning before you are 30 years old.3
- Examine your skin regularly, and have your doctor check your skin during all other health exams, or at least once a year.
- People who burn rather than tan, especially those who have red hair or blue eyes, also have a high risk and should take extra precautions to prevent melanoma.
Symptoms: Early Signs
The most important warning sign for melanoma is any change in size, shape, or color of a mole or other skin growth, such as a birthmark. Watch for changes that occur over a period of weeks to a month. Use the ABCDE rule to evaluate skin changes, and call your health professional if you have any of the following changes.
- A is for asymmetry. One half of the mole or skin growth doesn't match the other half.
- B is for border irregularity. The edges are ragged, notched, or blurred.
- C is for color. The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Changes in color distribution, especially the spread of color from the edge of a mole into the surrounding skin, also are an early sign of melanoma.
- D is for diameter. The mole or skin growth is larger than 6 mm (0.25 in.) or about the size of a pencil eraser. Any growth of a mole should be of concern.
- E is for evolution. There is a change in the size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or color of a mole.
Signs of melanoma in an existing mole include changes in:
- Elevation, such as thickening or raising of a previously flat mole.
- Surface, such as scaling, erosion, oozing, bleeding, or crusting.
- Surrounding skin, such as redness, swelling, or small new patches of color around a larger lesion (satellite pigmentations).
- Sensation, such as itching, tingling, or burning.
- Consistency, such as softening or small pieces that break off easily (friability).
Melanoma can develop in an existing mole or other mark on the skin, but it often develops in unmarked skin. Although melanoma can grow anywhere on the body, it often occurs on the upper back of men and women and on the legs in women. Less often, it can grow on the soles, palms, nail beds, or mucous membranes that line body cavities such as the mouth, the rectum, and the vagina. On older people, the face is the most common place for melanoma to grow. And in older men, the most common sites are the neck, scalp, and ears.1
Many other skin conditions (such as seborrheic keratosis, warts, and basal cell cancer) have features similar to those of melanoma.