Self-examination is a simple, inexpensive and effective way to detect skin cancers when they can still be successfully treated.
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When you’re young enough to take serious preventive measures, you’re usually too busy cavorting in the sun to worry about skin cancer. After age 40, when various spots, freckles, bumps and growths begin to show up on the skin, it’s normal to feel anxiety...and still not too late to do something about it.
Skin cancer is the most common cancer, affecting one of five Americans at some time in their lives and about 50 percent of those over age 65. Exposure to sunlight is the major risk factor, and doctors believe the critical period for prevention is during the first 20 years of life. For most of us, that means the damage may already have been done.
The good news is that the vast majority of skin cancers are not life threatening. And, if found early enough, virtually 100 percent are treatable.
Many of the unusual spots and growths that appear on the skin are harmless; others are either cancerous or have the potential of becoming cancerous. Only a doctor can distinguish between the two, of course, and the diagnosis usually requires a biopsy. It’s your job, however, to be the detective and report suspicious lesions to your doctor while they can still be treated.
The American Cancer Society recommends a thorough self-examination once a month. Start with your scalp and face; 70 percent of skin cancers are located from the neck up. Be sure to check your nose, lips, mouth and ears and under your hair. Use a mirror to examine the back of your scalp and behind your ears.
As you check your hands and arms, look closely under your nails and between your fingers and use a hand mirror for the upper arms, elbows and underarms.
On your torso, use mirrors as necessary and be sure to thoroughly examine your back, your genital and anal areas and under your pubic hair. Finish by checking your legs and feet, focusing on the hidden areas such as between your toes, under your toenails and the soles of your feet. Cancer can be hiding anywhere.
What To Look For
What you’re looking for are suspicious changes in the color or texture of the skin or the size and shape of moles. Be on the lookout for any open, oozing or bleeding sore that doesn’t heal or a mole with an uneven color or texture.
Skin cancer comes in three basic types:
Basal cell carcinoma, by far the most common, accounting for 75 percent of all skin cancers, is also the least harmful. It rarely spreads to distant parts of the body and is nearly always curable. If ignored, however, it can eventually cause severe damage to underlying skin and bone.
Basal cell cancers typically start showing up after age 40, usually on the face, behind the ears or on the neck–areas likely to get heavy exposure to the sun. They are usually waxy or pearly bumps or flat, pink growths similar to scar tissue. A depression in the center is often an ominous sign.
Squamous cell carcinoma, accounting for about 20 percent of non-melanoma skin cancers, can spread to other organs but rarely does and is nearly always treatable if discovered early.
These cancers may be firm, red bumps or flat, scaly, crusty growths, usually on the face, neck, hands or forearms. They may develop from previously existing, but non-cancerous, spots or growths on the skin, and they typically have edges that are indistinct.
Melanoma can occur anywhere on the body, in various shapes and at any age, so constant vigilance is necessary.
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Melanoma is the most dangerous skin cancer and must ideally be detected before it has spread to other organs. Once it has spread, the five-year survival rate is less than 10 percent.
Named because the cancer develops in pigment cells or melanocytes, melanoma often occurs in a pre-existing mole or a new one. It can occur at any age, in various shapes and anywhere on the body, so constant vigilance is important.
Cumulative sun exposure is not believed to play a direct role, but one or more severe sunburns in early life may be a factor. Other risk factors include genetics, fair skin, a weakened immune system and having numerous moles (more than 50), atypical moles or one giant mole somewhere on the body.
Identifying possible melanomas requires knowing your ABCDs:
An actinic keratosis is frequently a precursor or, some believe, the earliest stage of squamous cell cancer.
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A is for asymmetry–the shape is irregular with one side different from the other.
B is for border–typically notched or scalloped, like an island with many inlets.
C is for color. A melanoma is usually dark–blue, black, red or brown–but tends to have more than one shade or color.
D is for diameter. A growth measuring six millimeters or more, about the diameter of a pencil eraser, merits concern.
You could also add E for elevation. A melanoma usually starts out flat but gradually becomes thicker and raised.
There are many harmless growths, of course, that to the untrained eye may appear to be cancerous.
The flat freckle-like spots that start showing up after age 40 are age spots or liver spots and no cause for concern.
A seborrheic keratosis, often found on the back or chest, can grow quickly from a flat, brown spot to a rather thick lesion with a variety of colors and a waxy, “stuck on” appearance. It looks dangerous but is harmless.
An actinic keratosis, on the other hand, is frequently a precursor or, some believe, the earliest stage of squamous cell cancer. These tend to be ill defined areas of reddish-brown, grayish-black or skin-color with a dry, scaly appearance–sometimes easier to feel than see.
Most skin cancers can be treated by removal–through surgery, freezing with liquid nitrogen or curettage and electrodessication–scraping with a circular blade and then burning with an electric needle. For larger or difficult-to-treat skin cancers, Mohs micrographic surgery may be used. This involves cutting away the growth in layers until no abnormal cells remain. When melanoma has spread, other cancer treatments such as chemotherapy, radiation and immunotherapy are usually required.
Topical creams are used to treat actinic keratoses and, in the near future, may play an increasingly important role in the treatment of basal and squamous cell carcinoma..
Most skin cancers can be successfully treated, and self-examination is a simple, inexpensive and effective way of spotting cancers at an early and treatable stage. One study found that 56 percent of patients successfully identified their own skin cancers, and there was no significant difference in survival between the self-diagnosed cancers and those diagnosed by a doctor.
REFERENCES:
“Attorney General’s Skin Surgery Highlights Need for Prevention, Early Detection,” Health & Medicine Week, March 4, 2002.
Robert P. Blereau and Joe Monroe, “Melanoma–Or Mimic?” Consultant, March, 2001.
Sherry Boschert, “Concentrate on Major Melanoma Risk Factors,” Pediatric News, November, 2001.
Jeffrey Peter Larson, “Skin Cancer, Non-Melanoma,” Gale Encyclopedia of Medicine, Edition 1, 1999.
Norman Levine, “Flat, Pearl-Colored Plaque: Consider Various Carcinomas in a Patient with a History of Skin Cancers,” Geriatrics, January, 2002.
“New Treatment Options Available for Actinic Keratoses,” Health & Medicine Week, December 3, 2001.
Dorothy L. Pennachio, “New Therapies, New Thinking,” Patient Care, October 15, 2001.
Carol S. Saunders, “Clinical Gallery: Skin Cancer; Test Your Ability To Differentiate Benign from Malignant Skin Lesions,” Patient Care, August, 2002.
“Skin Cancer: Catch It Early,” Mayo Clinic Health Letter, September, 2002.
“Skin Cancer: Shedding Light on Melanoma,” Harvard Women’s Health Watch, September, 2001.
“Skin Care: Keeping Your Skin Healthy at Any Age,” Mayo Clinic Health Letter Medical Essay, June, 1998.
Mary Wills, “Skin Cancer Screening,” Physical Therapy, December, 2002.
Sharon Worcester, “Self-Exams for Skin Cancer Are Effective,” Skin & Allergy News, July, 2001.
Sharon Worcester, “Unusual Presentations Can Mimic Skin Cancer,” Skin & Allergy News, June, 2002.
