May is the official month to talk about skin cancer, according to the Skin Cancer Foundation, and this makes sense since summer is all about skin being exposed to sunlight.
Your skin is important. It is a big part of the first impression you make, and can undermine your confidence if it doesn’t look good.
Skin is the body’s largest organ. It is a complex and magical organ. Among its least celebrated jobs is keeping the insides on the inside. Not only does that make life easier (you don’t have to carry yourself around in a large bucket), it keeps the insides moist and hospitable. Skin also keeps the core body temperature set where everything works best. Our skin is flexible, tough and self-repairing. Intact skin is germ-proof. We are wired for pressure, temperature and pain, with a huge range of perception. One thing skin doesn’t do is breathe. So it will take more than gold paint to do you in.
For all the wonders of skin, it has an Achilles heel: skin doesn’t tolerate ultraviolet radiation (UV). Approximately 90% of the skin cancers in the world are due to UV exposure. Particularly bad is high levels of UV exposure during childhood – that puts a little different spin on those glorious days as a high school lifeguard.
Skin cancer is divided into three types: basal cell, squamous, and melanoma. To use an analogy, if your skin is healthy grass, then basal cell is a solitary milkweed, squamous is crab grass and melanoma is dandelions, gone to seed, after a breeze.
A basal cell cancer is the least dangerous of the skin cancers. It almost doesn’t deserve to be called a cancer. It is a red, slightly raised lesion that slowly grows and doesn’t heal. The center part may be crusted, looking like a minor injury. Unless you are unlucky enough to have one growing someplace important, a basal cell is easily defeated. Like the milkweed, removing it completely is straightforward and curative.
A squamous cell skin cancer is more aggressive. Unsurprisingly it occurs on sun-exposed areas. It starts as a nodule, and the middle portion breaks down, causing ulceration. This is a pretty scary looking lesion, which doesn’t heal. These spread about 20% of the time, and that opens Pandora’s Box. A cure is much harder to get once the cancer has spread.
Melanoma gets all the press. What makes melanoma scary is that after it spreads, it can grow anywhere. Inside your eye, heart or brain are just a few of the awful areas melanoma can end up. Melanoma, like forest fires, is easily stopped in the beginning. Beware of funny looking moles. Uneven pigment and uneven lesions that are growing, changing, or not healing are all worrisome for melanoma. Catch it early and an excisional biopsy both diagnoses and fixes the problem.
Sunblock is a good thing, it prevents cancer. Apply it 30 minutes before going outside (it has to “soak in”). Apply an ounce (a shot glass full) to do your whole body. Never use less than SPF 15. If you are active, especially in the water, reapply sunscreen every three hours. Remember that high SPFs block a higher fraction of UV (SPF 15 blocks 98%, SPF 50 about 99.4%) but not for any longer time period. Reapply every few hours.
Finally, remember to examine your own skin and occasionally, take some time to get your skin checked. While standing in front of a dermatologist with minimal covering sounds unpleasant, compared to a colonoscopy, it’s a walk in the park.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.