Skin Cancer: 11 Things Doctors Want You to Know
- Get to Know the Facts About Skin Cancer“The most common cancer in the United States is skin cancer,” says Mary Stevenson, MD, a dermatologic surgeon at the NYU Langone Medical Center. “A lot of people don’t realize that about 1 in 5 Americans will develop skin cancer.” And there isn’t just one type, by the way—there are three. One thing all dermatologists agree on is there are a lot of misconceptions out there about skin cancer. Here are 11 skin cancer facts practicing dermatologists who treat skin cancer wish you knew.
- 1. “Skin cancer can strike more than once.”“Sometimes patients think if they’ve had one skin cancer, they can’t get another. It would be like lightning striking twice,” says Saira George, MD, a dermatologist at The University of Texas MD Anderson Cancer Center. In fact, you can have different types of cancer as well as different cases. A basal cell carcinoma once doesn’t mean you can’t get squamous cell carcinoma later. “If you’ve had one skin cancer, you should be careful and watch your skin.” She recommends frequent self-skin checks with a full-length and handheld mirror for all patients, not just those who have had skin cancer in the past.
- 2. “Skin cancer can appear just about anywhere.”You can get skin cancer on your arms, legs, feet, hands, face, torso—anywhere the sun hits and some places it doesn’t. “Skin cancers on the bottoms of the feet or under the fingernails are usually worse because they’re not identified until they’re more advanced. You can also get skin cancer in the nose, mouth, anus, or vagina, although those are quite rare,” says Mark Gimbel, MD, a surgical oncologist at Banner MD Anderson Cancer Center. “The rarest ones are in the eye.” Dr. Stevenson’s tip for your dermatologist visit: “If you’re going in for a skin exam, remove your pedicure and manicure and get checked from head to toe.”
- 3. “It doesn’t always look like a dark mole.”“You can get melanomas that are pink,” says Dr. George. “Sometimes patients say they thought their melanomas had to be raised or bleeding or itching. The vast majority of the ones we see are flat and completely asymptomatic.” She adds, “The story I hear all the time about basal cell carcinomas is that they look so innocuous when they start that the patient thinks it’s a pimple or a bug bite. With squamous cell carcinomas, it’s the same thing except typically they’re scalier. I tell people that normal skin and normal cells and normal lesions will heal and go away. If it doesn’t go away or heal, don’t brush that off.”
- 4. “Skin cancer isn’t just for fair-skinned people.”“While darker skin produces more melanin,” says Dr. Stevenson, “all skin tones can be damaged by UV radiation.” Dr. George adds, “The risk of skin cancer is much higher in fair-skinned population, but if you’re darker skinned, it’s a big misconception that your risk hovers around zero. It’s much rarer, but the problem is that people aren’t looking for it.” She notes, for example, that an aggressive form of melanoma called acral lentiginous melanoma is more common in darker-skinned people, and it occurs on the palms and soles—not sun-exposed areas. “Anything that’s an outlier—a warty growth, a spot that looks different, a scaly patch that won’t heal—needs to be evaluated.”
- 5. “Damage starts young.”“A lot of sun damage is done when you’re young, but that doesn’t mean it’s not a good idea to use sunscreen now, because it really does make a difference,” says Dirk Elston, MD, chair of the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina (MUSC). “Cancers are very immunogenic. If you take skin cancer and put it on a mouse, the mouse’s immune system chews it right up. What keeps yours from chewing it up is the constant sun exposure. It suppresses the immune system and basically protects the cancer, so sunscreen plays an important role there.” He urges parents to get children in the habit of wearing sunscreen early.
- 6. “You’re probably not doing sunscreen right.”“Waterproof sunscreen is only waterproof until you towel off and wipe it all off,” says Dr. Gimbel. He recommends a broad-spectrum sunscreen that protects against both UVA and UVB rays. “SPF is a measure of the fraction of sunburn-producing radiation that is going to reach your skin," says Dr. Stevenson. "An SPF of 30 means that 1/30th of the burning radiation is going to reach you." Don’t go for the highest SPF, apply once, and think you're fine—choose SPF 30 or above, apply generously, and reapply several times. Use about a shot glass’s worth of sunscreen for your body and a nickel-size dollop for your face, and don’t forget your ears, back of the neck, or hands.
- 7. “But you don’t have to rely completely on sunscreen.”“I recommend a savvy, well-rounded approach to sun protection,” says Dr. George. “Use sunscreen as a layer, but also wear a hat, cover up, and stay out of the sun during peak hours.” If you’re trying to avoid chemicals, she recommends mineral sunscreen. Dr. Gimbel suggests a rash guard, swim shirt, or even UV-protective clothing if you prefer.
- 8. “There’s no such thing as a protective ‘base tan.’”It’s a misconception that a base tan helps protect you from the sun. “We don’t have a safe way to get a tan,” says Dr. George. “You do get a tiny bit of protection, but way less than people think, like an SPF of 3 or 4. The tan itself is a sign your skin has gotten too much UV radiation—the cells are trying to reorient and putting out more melanin to shield themselves. You always incur damage to get a tan.” Says Dr. Stevenson, “If you’re applying sunscreen and still getting a tan, you’re not applying enough and you’re not reapplying frequently enough.”
- 9. “Even one time in a tanning bed is bad.”“The vast majority of patients I see are older,” says Dr. Gimbel, “but I’m now seeing a higher rate of young women, and that’s because of tanning bed use. I've seen 19-year-olds come in with skin cancer who have a history of tanning bed use." Dr. Stevenson adds, “Using a tanning bed even once raises your risk for melanoma and other skin cancers.”
- 10. “You don’t need as much vitamin D as you think you do.”Some of Dr. Elston’s patients are afraid they won’t get enough vitamin D if they’re using sunscreen. He points to flawed recommendations as the culprit. “Some of the levels of vitamin D touted as normal are not achievable in nature,” he says. “It’s very easy to get your vitamin D requirement without going out in the sun. Going to and from your car is plenty of sun for most people.” He recommends getting your vitamin D through your diet or supplementation.
- 11. “There are lots of treatments available for skin cancer, especially if you catch it early.”Among the options available for treating skin cancer, depending on the type of tumor: topical creams, freezing, IV and oral medications, ultraviolet light, photodynamic therapy, and surgery. “Some of my patients are so afraid they’re going to end up with a big, disfiguring scar that they wait months or years to come in, and by the time they come in, it’s a self-fulfilling prophecy,” says Dr. Elston. “If you get treated promptly, you can get a really good result.”
Skin Cancer Facts | Things Doctors Want You To Know About Skin Cancer