Forms and Instructions
|
 |
With the advent of spring and the promise of summer, the sun rises higher in the southern sky every day, warming the air and greening the foliage, enticing us to get out and enjoy the outdoors that make living in Colorado so enjoyable. Unfortunately, its beckoning could be a siren song leading us to trouble.
It is well accepted that sunlight exposure over the years is the biggest factor in predisposing an individual to the development of skin cancer. Colorado is second only to Arizona in skin cancer incidence, probably due to a combination of our plentiful sunny days, orientation towards outdoor recreation, and altitude (which allows more harmful ultraviolet rays to reach us). The positive news is that with a few precautions, a little knowledge, and some regular self-examinations, skin cancer can be prevented or, at least, caught early enough to be at a stage when treatment is easier and more likely to cure.
As with any disease, prevention is the best medicine. Since sun exposure is the major driving force behind skin cancer, sun avoidance is the best protection. Does this mean that you should take on the lifestyle of Count Dracula? No, just be sensible. Outdoor activities should be done in the late day, if possible, when the sun’s rays are not so intense. Wear clothes that cover the skin, including long pants, long sleeves and hats. (And no, I don’t buy the argument that, “It’s too hot.” In a dry climate, loose clothing that shields the skin from the sun is cooler than being exposed; just ask the Bedouins wandering the deserts of the Mideast!) For times and places that skin is exposed, use a sunscreen to protect your skin from the worst rays. The official recommendation is to use a sunscreen of SPF (Sun Protection Factor) 15 or higher. Again, given the special concerns we have in Colorado, I prefer an SPF around 30. Try to use one that is waterproof, but don’t trust it; reapply after swimming or every 2-3 hours.
Despite our best attempts, sun exposure happens. Over the years, our skin acquires cumulative damage to the point that cells can break free of the normal controls on growth and invade deeper and wider than they are supposed to, thus creating the entity we know as cancer. It is no surprise that in skin cancer, as in most others, early detection leads to easier treatment and higher odds for a cure. While physicians in general, and dermatologists in particular, are trained to recognize signs of skin cancer, it is easy and prudent for every patient to participate in his or her own care by doing routine complete body self exam on a monthly basis, and coming to their physician with any concerns. Such exams can be carried out using a full-length mirror, a hand mirror, and/or a (obviously very close) friend.
There are three types of common skin cancers, and one precancerous growth, that can generally be detected or suspected by observing certain visible characteristics. However I think the most important component of self-examination is developing an ongoing awareness of one’s skin. Get to know the pattern of your spots: their locations, sizes, numbers and colors. Once that pattern is etched into your mind’s eye, even minor changes will be readily detectable as you search. Such changes in skin lesion behavior may be the most important warning to heed. In addition, look for these signs they may indicate one of the following skin cancers.
ACTINIC KERATOSIS: This is precancerous. It is typically small, red, sandpaper rough, sometimes tender, dry patch that peels frequently, only to recur.
BASAL CELL CARCINOMA: This is the most common cancer in humans, and fortunately only very rarely is capable of being fatal. It can however result in destruction of large amounts of skin and thus cause considerable disfigurement. It can appear similar to the above actinic keratosis description, but more commonly is a fleshy to pink raised bump, which frequently bleeds, crusts, heals, and then repeats. It is often described as a “pimple that won’t go away”. Dermatologist note a clear translucence to the lesion, which we refer to as “pearliness”.
SQUAMOUS CELL CARCINOMA: This is the second most common cancer. Although rare, this tumor can occasionally metastasize (spread through the body) and is responsible for about 2,300 deaths per year in the U.S. It is usually present as an enlarging flesh colored nodule with a rough, scaly surface, and occasionally bleeds.
MALIGNANT MELANOMA: This is the rarer of these cancers, but it is the most likely to kill. Around 32,000 Americans will develop it yearly, and an estimated 6,800 will die. Its presentation is totally different from the above cancers, as it is a malignancy of the pigment cells, and therefore, its tumors are usually pigmented. Because these tumors are made up of abnormal cells, the pigment tend to be abnormal as well, and spreading under the surface of the skin. The warning signs are classically described as the “ABCD’s of Melanoma”. ( I tell patients to look for “a spreading coffee stain in a paper towel” effect.)
Asymmetry: One half doesn’t match the other. Border irregularity: The edges are ragged, notched, and blurred. Color irregularity: The “spot” is not all one color, but mixtures of brown, black, blue, white and red. Diameter: Generally, cancers are bigger than 6 mm (about the size of a pencil eraser)
It should be noted that with the proper therapy, the cure rates for Basal Cell and Squamous Cell Carcinoma, and EARLY Melanoma, is over 95%.
Of course the above listing is far from complete, and that is why I encourage any patient to seek a medical opinion if they are concerned about the appearance or behavior of any skin lesion. Most of the time, the spot in question is totally benign and reassurance is the only therapy needed. And by the way don’t feel embarrassed if the spot you are concerned about turns out to be “nothing” — we love to give patients good news.
Dr. Scott Clark is board certified in dermatology. He joined Longmont Clinic in July 1984.
|