Protect the Skin You're In

Stop and think before you head out into the sun. Monthly self-exams and yearly skin exams by a family doctor, internist or dermatologist are beneficial in early detection. After a long, hard winter, many of us can't wait to get out and enjoy the sunshine. Mary Toporcer, MD, Doylestown Hospital dermatologist, shares the basics about skin cancer and ways to protect yourself.

What age should people start checking their skin for unusual moles?

Unusual moles can occur at any age, but the incidence of melanoma is highest in adults over the age of 40 (1 in 50 adults will grow an invasive melanoma). Children can likewise develop melanoma, but the incidence is much lower, 1.6 cases in 100,000 between the ages of 10-19 years. Because early detection is the key to survival, everyone should have their skin screened on a yearly basis in the same way that a routine examination of the heart, lungs and dentition is beneficial.

What about those with a family history of melanoma?

A family history of malignant melanoma is indeed a contributing factor in a person's risk for developing melanoma, along with fair skin, light hair and eyes, a high mole count and sunburns. The literature states that a person's risk for developing melanoma, if you have a family history of melanoma, is two-fold higher than if there is no family history of melanoma.

What should people look for when they check their skin?

With regards to atypical nevi and melanoma, the American Academy of Dermatology touts the ABCDE's of melanoma:

• Asymmetry: One half does not match the other half.
• Border irregularity: The edges are ragged, notched or blurred.
• Color: The pigmentation is not uniform. Different shades of tan, brown or black are often present. Dashes of red, white, and blue can add to the mottled appearance, though melanomas may be pink or amelanotic (without color).
• Diameter: While melanomas are usually greater than 6mm in diameter when diagnosed, they can be smaller.
• Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

What about moles that look different than other moles?

Remember the "ugly duckling theory" or, to quote Sesame Street, "One of these things is not like the other." I explain to my patients that it makes perfect sense that an individual's DNA is programmed to produce a certain pattern(s) of moles. If a mole deviates significantly from its prototype, then it's worth calling it to a doctor's attention. I try to give my patients "their prototype" when I examine their moles. I also explain to patients that moles do indeed change with age; they usually lighten or "gray" just like your hair and they often grow outwardly or undergo "fatty degeneration". These are attributes of a mature mole and are normal.

In addition to melanoma, what are other types of skin cancer?

The other most common types of skin cancers are Basal Cell Carcinoma and Squamous Cell Carcinoma. These affect 1 in 5 Americans during their lifetime and are able to be fully treated if caught early. My patients have taught me that basal cells usually present like "pimples that don't want to heal over a few months". They are usually pink, shiny and may ulcerate or bleed if they are allowed to grow untreated. Squamous cell skin cancers often look like "pink warts". They are usually scalier than basal cells and likewise will thicken, crust and bleed over time. In comparison to basal cell carcinoma, squamous cell carcinoma has a higher risk of spreading to lymph nodes if left untreated.

What are the best ways to prevent skin cancer and keep skin healthy year-round?

Prevention and early detection are paramount in dealing with skin cancer and melanoma. Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. You can have fun in the sun and reduce your risk of skin cancer. In 2010, new research found that daily sunscreen use cut the incidence of melanoma, the deadliest form of skin cancer, in half.

Tips to Prevent Skin Cancer

• Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. "Broad-spectrum" provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.
• Use extra caution near water, snow and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.

Alarming Melanoma Facts

• On average, one American dies from melanoma every hour.
• Approximately 75 percent of skin cancer deaths are from melanoma.
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.
• Melanoma is increasing faster in females 15-29 years old than males in the same age group.
• Melanoma in Caucasian women under the age of 44 has increased 6.1 percent annually, which may reflect recent trends in indoor tanning.

"Pale is the new tan!" – Mary Toporcer, MD