As Memorial Day approaches and the days become longer and warmer, most of us look forward to getting outside and catching some rays. After all, sunshine provides vitamin D, warmth and often happiness. However, May’s designation as Skin Cancer Awareness Month serves as a reminder to practice safe sun.
“The main risk factor for skin cancer is sunburns rather than chronic exposure,” said Douglas Kress, MD, of UPMC Children’s Dermatology Services. “The goal is to limit burns to the greatest extent.”
Avoiding the Burn
Skin cancer’s most preventable risk factor is unprotected UV exposure. “Use a sunscreen with a minimum of 30 SPF applied every 90 minutes to two hours from Memorial Day to Labor Day,” advised Dr. Kress. “SPF 30 is sufficient in western Pennsylvania for most people unless they’re blond-haired and blue-eyed or red-haired and green-eyed. Those with more fair skin should look for SPF 50 or higher.”
The key is to reapply sunscreen often. “Even sport or active sunscreens which are supposedly waterproof are only guaranteed for 80 minutes,” cautioned Dr. Kress.
Risk can be further reduced by seeking shade when the sun’s rays are the strongest between 10 a.m. and 2 p.m., and wearing sun-protective clothing such as wide-brimmed hats and sunglasses with UV protection and possibly a lightweight, long-sleeved shirt.
Remember that sunburns don’t just happen at the Jersey Shore or on the shores of Lake Erie—by some estimates, 80 percent of sun exposure happens while doing everyday activities like walking the dog or running errands.
Types of Skin Cancer
There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Of these, basal cell is the most common and melanoma is the most serious. All are treatable with early detection.
Basal cell carcinoma often appears as a slightly transparent bump on the skin, though it can take other forms. Squamous lesions typically appear hard, well-defined and occasionally crusty. However, some appear soft and fleshy. Self-exams and regular visits to the dermatologist aid in identifying and treating these skin cancers early.
To aid in identifying the warning signs of melanoma, look to the first five letters of the alphabet—ABCDE—as a guide.
A = Asymmetry: Most melanomas are asymmetrical. Drawing a line through the middle of the lesion reveals the two halves don’t match. This differs from a round to oval and symmetrical common mole.
B = Border: In contrast to the smoother, even borders of common moles, melanoma borders tend have scalloped or notched uneven edges.
C = Color: Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colors red, white or blue may also appear.
D = Diameter or Dark: Detecting melanoma when it’s small is ideal. Finding a lesion the size of a pencil eraser (about ¼ inch in diameter) or larger is a red flag.
E = Evolving: Changes in size, shape, color or elevation or new symptoms such as crusting, itching or bleeding may be a warning sign of melanoma.
“Change is really what you’re looking for,” explained Dr. Kress. “Suppose you have multiple moles of pencil eraser size that resemble the color of Hershey’s milk chocolate or coffee with milk. If one of those turns black, see a dermatologist immediately.”
Skin Cancer Treatment
Treatment for all types of skin cancer requires sampling, according to Dr. Kress. “While we can look at a lesion and think that it’s basal cell carcinoma, for example, sampling confirms our diagnosis,” he explained.
Complete surgical excision is the initial treatment for most types of all three skin cancers. Dr. Kress adds that some subtypes of basal cell carcinoma, especially those on the face, may require a special type of surgery known as Mohs, while some thicker melanomas may need to have lymph nodes evaluated and require more aggressive systemic therapy, including chemotherapy.
A recently developed test helps simplify the detection of melanoma. “The equivalent of a tape stripping, the new test allows us to pull a few cells off the surface, do a genetic analysis of those cells and determine with pretty high likelihood whether it’s melanoma or not,” said Dr. Kress.
Skin Cancer and Children
Thankfully, skin cancer in young children is rare and is typically not sun induced. "However, skin cancer in high school and college students may be sun induced, especially in those with a history of significant sun exposure,” said Dr. Kress.
“Every now and then we’ll see a young child with melanoma cancer,” he added. “In these cases, family history and the number of moles is significant.”
Annual exams aid in identifying moles that may present future problems. It also helps in developing positive habits.
“If we see the kids every year, it becomes almost like going to the dentist,” said Dr. Kress. “Our hope for this generation is that skin cancer incidents will be lower than it was for our generation.”