On the lookout for skin cancer

IT DOESN’T ALWAYS LOOK LIKE WHAT YOU’D THINK

By Kasha Stoll

Itwas right under my nose. Well, actually, just to the left of it, but close enough. This round patch of dry, flaky skin just showed up on my face and refused to leave.

Given my fair skin and history of sunburns, I wondered briefly if it could be cancer. However, the spot didn’t have any of the well-publicized markers of melanoma and didn’t look like any of the warning photos I had ever seen. In a state of blissful ignorance, I decided it was nothing to worry about.

One large warrior scar later, I am singing a different tune.

According to the Centers for Disease Control and Prevention, Minnesota has one of the highest rates of skin cancer in general and melanoma in particular per capita in the country.

“That is not a surprise to me,” said Hilary Reich, a dermatologist at Essentia Health. “Minnesotans spend a lot of time indoors in the winter. As soon as it gets warm, everyone rushes outside to enjoy our beautiful sun and lakes. They rush out and immediately fry.”

WHO IS AT RISK?

Who is at risk? The simple answer is: everyone. Sun damage is cumulative, and about one in five Americans will develop skin cancer by age 70.

However, certain groups are at a higher risk.

“Minnesota is a mainly white state with a population derived in large part from northern Europeans,” Reich said. “We are at a very high risk for sunburns.”

People with lighter skin are more susceptible to sunburns because they lack the pigment that provides some measure of protection. According to the American Cancer Society, melanoma is 20 times more common in Caucasians than in black people.

However, Reich said people of color also develop skin cancer. When they do, she said it is typically diagnosed later and at a higher stage of disease progression. This results in a worse prognosis.

People who spend a lot of time at or near a lake are also at increased risk. They are exposed to the sun’s direct rays, as well as rays that reflect off the water.

“We get the sun from above and 100 percent reflectance from below,” Reich said. “I see so many patients who are boaters and fisherman. They have chronic exposure from above and below, and they have a much higher incidence of skin cancer.”

Reich said everyone, regardless of their skin type or history of sun damage, should protect their skin and regularly check for any growths or abnormalities.

What To Look For

Perhaps, like me, you have heard of the ABCDEs of skin cancer:

A – Asymmetrical shape

B – Borders that are uneven, scalloped or notched

C – Colors, multiple as opposed to just one

D – Diameter of quarter-inch or more

E – Evolving or changing in size, shape, color, elevation or any other way

Those are indicators of melanoma, so absolutely check for them. But don’t stop there.

“Melanoma is really scary, but it is about five percent of all skin cancers,” Reich said. “If the only thing you are looking for is a flat, black spot, you are going to miss 95 percent.”

Reich said basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) account for about 60 percent and 35 percent of all skin cancers, respectively.

BCC is the least dangerous. It rarely spreads to other parts of the body or becomes life threatening. However, Reich said it is “a relentless grower. (The lesions) will grow bigger and deeper, and they can destroy the structure of what they are growing on top of. They can grow all the way through your nose, ear or cheek.”

SCCs are not usually life threatening, although it is possible if the cancer is allowed to grow. They can also be disfiguring.

Reich said people should watch for four signs of possible skin cancer:

• Pink or red spots that won’t heal up and go away

• Spots that occasionally bleed, even when they are not touched

• Spots that are disproportionately tender

• A “pimple” that lasts for months

How To Stay Safe

Reich recommends that everyone apply sunscreen or a moisturizer with SPF 30 or higher to their head and neck every morning.

“That is baseline,” she said. “If you are outside and are active or playing, you need to add another level of protection. You should apply sunscreen every two hours, or as appropriate if you are sweating or swimming.”

Reich also recommended wearing a broad-brimmed hat that covers your ears and rash guard shirts to protect your skin while swimming.

Reich said her take-home message is simple: “I want everyone to go out and play, and enjoy our natural environment. But I want everyone to be careful and protect themselves. I tell my patients, ‘Never burn, never intentionally tan and just do your best.’” D