Skin cancers are the exception to the collective wisdom that all cancers are statistically more prevalent with increasing age. Unfortunately the most updated oncology statistics reinforce this data. Skin cancer is a young persons disease that is divisible in to three broad categories of basal cell, squamous cell and melanoma. In adolescents and early twenties melanoma is the second commonest of all the cancers and in the mid twenties to early thirties it is the most common cancer. For all age groups, there is a slightly greater prevalence in males with the obvious factor of excessive sun exposure being the primary cause. The earlier the age at which our sun worshipping practices begin the earlier it is a contributing factor.
It’s November and most of us are psyching in to winter mental mode so is this really the appropriate time to discuss a subject that is so clearly sun related? The answer is an emphatic YES! For some very logical reasons. Most skin cancer begins with a subtle change in the surface skin cells known as actinic keratosis that resemble rough red area, sometimes itchy, that appear most commonly on the backs of hands, exposed scalp, face, forearms and ear lobes. This is a process that can be months to years in its evolution. If the cutaneous changes follow a basal cell path, the lesion becomes fragile, may bleed easily, scab over, then repeat the sloughing off with just minor irritation. Squamous cell carcinoma has a similar early evolution but can develop a much larger base and eventually invade underlying tissues then metastasize to deeper or more distant organs. Melanoma follows a different path beginning in the melanocyte cells in the skin where the body is producing the protective pigment known as melanin. The other major characteristic of melanoma is its ability to mask itself as a mole, even develop within the structure of an existing mole and, most disturbing, has the predilection for early and accelerated metastasis both locally and in to distant organs.
I have deliberately avoided including a visual of a typical melanoma because there is no stereotypical melanoma. I refer to them as the snowflakes of cancers because I have never seen any two with exactly the same characteristics. It would be a mistake to GOOGLE melanoma and decide what you are looking at is not the same as the pictorial reference offered. So what should YOU be looking for? An easy rule to follow is what dermatologists refer to as the alphabet of melanoma:
- Asymmetry. The majority of benign moles are oval or round. Melanoma lesions
Demonstrate unbalanced growth
- Border. Melanoma has a irregular even frayed edging
- Colour. Melanoma can range from black to brown to red even white and sometimes
A rainbow of colouring
- Diameter. Melanomas grown quickly with a typically expanding border. Moles don’t.
- Evolution. Melanomas change colour, size, shape and thickness.
Some will bleed without irritation and some even become painful.
We’re in that solstice sandwich between our summer indiscretions and the coming snowbird migration so this is definitely the ideal time to take stock of your skin lesion status. Ask yourself two questions. What is there now that wasn’t there before and what has changed? For the latter, I usually tell predisposed patients with excess exposure or personal or family cancer histories to document on a piece of graph paper front and back descriptions of any skin asymmetries. If there are no changes then put the graph pepper in the drawer and get it out for future reference after the next sun season. For new lesions the definitive management is a dermatology consult with a biopsy, usually an office procedure, early rather than later. Successful management and survival is absolutely linked to early discovery and intervention.
A few final caveats. Avoid tanning beds. I detest them for the risk factor they generate. Use SP 30 protection for both UVA and UVB exposures and apply frequently.
And finally, enjoy your outdoor events whatever the season. Just don’t allow yourself to become a part of a growing statistic.
Written by Dr. David Carll