Skin Cancer: Diagnosis, Treatment and Prevention
What it's like to find, fight and recover from a malignancy.
You know that crinkle in your forehead is from your daughter announcing she's quitting the debate team to play drums in a garage band. And that bruise on your thigh is from hauling recycling bins out to the curb. But every so often something pops up on your skin that you can't explain. "Most of the time these things are harmless," says Susan Taylor, M.D., of Society Hill Dermatology in Philadelphia, ticking off a long list of common noncancerous conditions from skin tags to age spots. "But if you're not sure what it is, see your doctor." If it's one of the 3.5 million skin cancers diagnosed in the U.S. each year, the sooner you get treated, the better your chance of being cured. Read on to learn about the changes that can happen to your skin — and how to protect it.
Step 1: A Skin Cell Goes Rogue
While genetics and ethnicity can be partly to blame for a skin cell turning cancerous, the major culprit is almost always the sun — real or fake (from a tanning bed). When you're not wearing sunscreen, say while running to the supermarket, ultraviolet rays constantly penetrate your skin. Over many years and many sunburns, these rays can alter the DNA inside your skin cells. They mess with the genes that tell cells when to die off, causing them to grow out of control, explains Ragini Kudchadkar, M.D., a medical oncologist at Moffitt Cancer Center in Tampa, Florida.
People with fair skin — especially redheads — are at higher risk for UV damage, as are individuals with more than 50 normal moles or beauty marks, those with a family history of skin cancer or anyone who has previously had skin cancer. And people with darker skin aren't immune from sun damage. In fact, Dr. Taylor points out that their skin cancer is often detected at a later, less curable stage.
Step 2: X Marks a Spot
Your eyes are the best tool for detecting skin cancer. In fact, many women first notice a change while tweezing their brows or shaving their legs — as well as during monthly checks. Karen Burke, M.D., a New York dermatologist and spokesperson for the Skin Cancer Foundation, says to avoid melanomas, pay particular attention to the ABCDEs: a mole that is asymmetrical, has uneven borders that are scalloped or notched, is a mix of colors rather than just brown, has a diameter larger than a pencil eraser's or has evolved by changing shape, color or size. "And I like to add an F: anything that's funny-looking," she says. (Quick: Quiz yourself right now to see if you remember A through F.)
Dr. Burke points out, though, that as diligent a skin checker as you may be, it's difficult to see some parts of your own body, even with a mirror and some advanced-level yoga poses, so you should also consult your dermatologist for a full-body check. "Every adult should go in for an annual exam by the time she is 18," says Dr. Burke, although she adds that if you missed that deadline, just go ASAP. Depending on your risk level, your doctor might recommend you come back every 3 to 12 months.
Step 3: The Don't-Be-Shy Body Exam
You want your dermatologist to see every inch of your skin, so prepare for an appointment by removing all nail polish, shaving your legs and removing makeup. Your doctor will check you from top to bottom, front to back, in between your toes, on your scalp, even on your breasts and butt. "Some people get embarrassed," says Dr. Taylor. "But I explain that I'm not looking at their body type or whether they need to lose a few pounds. All I notice is skin!" Your M.D. might scan your body with a dermatoscope, which resembles a small magnifying glass and uses polarized light to detect patterns in the skin. Many docs, however, prefer their well-trained eyes. "We may also take some photos of your moles to see if they change over time," Dr. Burke says. A complete exam should only take about 10 minutes.
If your doctor finds a suspicious-looking mole or growth, she'll take a biopsy to determine if it's malignant. After using a needle to inject a small amount of a numbing medicine, she'll remove a sample of the mole by either shaving off a thin layer with a blade or using a small instrument to punch out a tiny core of skin. "If it's on the face, we'll try to take the smallest piece of skin possible so it doesn't leave a scar," says Dr. Burke. Then the sample is sent to a lab for analysis.
Step 4: A Diagnosis Is Made
After a week or two, your doctor will call you with the biopsy results. In the best-case scenario the spot is benign, and you breathe a sigh of relief, stock up on SPF 30 sunscreen and throw away that Groupon for a tanning salon visit. You could also be told you have an atypical mole (dysplastic nevus) that ups your chances of a melanoma later on or a precancerous growth (actinic keratosis). Both require removal or extra vigilance. Finally, there's a chance you'll be told you have cancer. As you recover from the shock, remember that most skin cancers are completely curable. They generally fall into three categories:
- Basal Cell Carcinoma: About 80% of skin cancers are basal, developing in the deepest layer of the epidermis. They're likely to appear on the parts of your body that see the most sun, such as your face, shoulders and neck. Since basal cell carcinoma can show up as a dry red patch or a pink translucent bump, it's sometimes mistaken for a pimple or callus that won't go away. This cancer rarely spreads to other parts of the body, but left untreated, it can damage surrounding tissue and become disfiguring.
- Squamous Cell Carcinoma: The second most common skin cancer, squamous cell carcinoma usually develops on the outer layer of the skin on sun-exposed parts like hands, lips and ears. It tends to travel a bit more than basal cell cancer but is rarely fatal. Squamous cell carcinoma can appear as crusty or bleeding growths, scaly red patches, open sores or warts.
- Melanoma: While melanomas account for less than 5% of all skin cancer cases, they are the most deadly and will kill approximately 9,500 Americans this year. Melanomas, which develop in the cells responsible for pigment, can pop up anywhere on your body, even places that rarely see the sun. They often look like an out-of-control mole — a black, brown or multicolor spot, flat or raised, with a jagged border. If the cancer is detected before it spreads, the five-year survival rate is about 98%. But once malignant cells reach the lymph nodes, the survival rate decreases to 62%; it drops to 15% if the cancer spreads to other organs.
Step 5: Planning Treatment
Doctors have a range of options to consider — everything from lasers to creams to radiation to surgery — and even more promising new techniques are being tested every day. The critical goal is to get rid of the tumor and find any rogue cancer cells that have broken off and traveled to other parts of your skin or body. You and your doctor will choose a method based on several factors, including the type of cancer, the size and depth of the spot, the location and whether or not it has spread. There are three common surgical treatments:
- Curettage and Electrodesiccation: If you have a small, non-melanoma cancer, your doctor will probably remove it in her office by scraping off the growth with a sharp, ring-shaped instrument called a curette and then using an electric needle to burn off any remaining cells. (You'll receive a shot of local anesthetic first.) It may take multiple visits to get all the cancer cells, but this technique can be as effective as more invasive types of surgery.
- Mohs Micrographic Surgery: "This skin-saving procedure was created as a way to excise all the cancerous cells while removing the least amount of healthy tissue surrounding them," explains Dr. Kudchadkar. It's only for non-melanoma cancers and is recommended for sensitive spots, such as near the eyes or on the nose or hands. A dermatological surgeon uses a scalpel to remove malignant skin. The sample is biopsied in the office while you wait — you may be there an hour or an entire day — and if there's even a trace of cancer found around the edges, a little more skin is removed. The process is repeated until all the cancer has been cut out.
- Simple Excision: Melanomas are treated more aggressively with this standard excisional surgery. The doctor cuts out the melanoma plus a wide margin (from .5 to 2 centimeters) around it. The surgery will leave more of a scar, but it could also save your life. "If it's a very thin melanoma, the surgery may be performed in the office," says Dr. Kudchadkar. "But if it is thicker than 1 millimeter, we prefer the operating room, so we can do a lymph-node biopsy at the same time to see if the cancer has spread." Depending on the location and size of the melanoma, you may need a skin graft or some other type of reconstructive surgery afterward.
Step 6: Avoiding a Recurrence
Once your doctor gives you the good news that you're cancer-free, your next step should be figuring out how to best protect your skin in the future. "Use a broad-spectrum sunscreen that blocks both UVA and UVB rays, and reapply it every two hours whenever you're outside," advises Dr. Taylor. After you've had one skin cancer, you're at greater risk for another. If you've had a melanoma, you should typically circle back with your doctor every 3 to 12 months for several years. If you've had a basal cell cancer, you should likely circle back every 6 to 12 months, and with squamous cell cancer every 3 to 6 months, for the first few years. "I tell my patients, 'We're partners in this,' " explains Dr. Taylor. "Your job is to check yourself and come in to see me. My job is to examine you and detect anything as soon as possible so we can cure it."
Originally published in the June 2013 issue of Family Circle magazine.
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