Fighting the most common skin cancers

Heading outside on a sunny day is a bit like going into battle. To protect your skin from harmful ultraviolet (UV) rays, you’ll need armor (sunscreen or sunblock, and sun-protective clothing), tactical strategy (avoiding peak sun hours), and a place to retreat (the shade) — especially during the summer months, when UV intensity is highest.

Mind you, we need a little sunshine on our skin to trigger the production of vitamin D, keep bones strong, and possibly help regulate mood and ward off illness. But unprotected UV exposure can cause skin cancers. The most common of these are non-melanoma skin cancers.

What are they?

To put it simply, non-melanoma skin cancers aren’t melanomas — the aggressive skin cancers that account for just 1% of all skin cancer cases, yet cause the majority of skin cancer deaths in the United States.

Extremely aggressive non-melanoma skin cancers are rare. Instead, the most common types, affecting millions of people per year, are slow-growing. They develop in basal cells (basal cell carcinomas, or BCCs) or squamous cells (squamous cell carcinomas, or SCCs).

These cancers don’t usually spread to other parts of the body, and they aren’t usually life-threatening. But they can be quite dangerous. "Small skin cancers can bleed, hurt, and eat away at your skin. If left untreated, they can erode through important structures like your nose, eyes, bones, or muscles. If they become very large, they can spread, and in rare cases cause death," says Dr. Abigail Waldman, director of the Mohs and Dermatologic Surgery Center at Harvard-affiliated Brigham and Women’s Hospital.

Symptoms

While non-melanoma skin cancers can develop anywhere on the body, they typically show up in areas that have been exposed to the sun, such as the head, face, neck, ears, lips, arms, legs, or hands.

The cancers may look like flat areas that differ only slightly from healthy skin, or they may have distinguishing features. SCCs can be scaly patches, crusty sores, or wart-like bumps. BCCs often have raised edges, a sunken center, and visible blood vessels. They also can look like a pale scar, a sore that won’t heal, a reddish patch, or a bump that might have a number of colors (red, blue, brown, or black).

Melanomas usually have brown, black, or blue pigment of uneven color, jagged edges, and an asymmetrical shape. They can be flat or lumpy. Many people have small brown, black, or blue spots on their skin (lentigos), but their color is even, their edges are smooth, and their shape is symmetrical. Lentigos can turn into melanomas, so pigmented spots that start to change color or shape need to be evaluated.

Diagnosis

BCCs and SCCs are often found early (by you or your doctor), when they are easiest to treat.

To make a diagnosis, your doctor will take a look at a new or changing skin growth under a powerful magnifier. If the area looks suspicious, your doctor might remove a sample of the tissue (a biopsy) and send it to a lab for analysis. If the sample is positive for BCC or SCC, the cancer will need to be removed.

For large tumors, ask your doctor about additional testing. "For SCCs that are bigger than a quarter, my recommendation is to ask your doctor about getting your lymph nodes checked to make sure the cancer hasn’t spread," Dr. Waldman says.

Treatment

Non-melanoma skin cancer treatment depends on a cancer’s specific type and features. "For instance, an in situ [contained and not spreading] SCC on the cheek may be treated with a prescription cream. But an invasive SCC on the cheek would need to be removed with Mohs surgery," Dr. Waldman says.

Mohs micrographic surgery involves removing cancer a little bit at a time, to preserve as much healthy skin as possible. Each piece is checked immediately under a microscope. Once the edges are free of cancer, the surgery is complete.

"Mohs surgery is usually reserved for invasive skin cancers in areas that are cosmetically sensitive — on the face, scalp, neck — or on functional areas like the hands, feet, and genitals, or with very aggressive or large tumors on the trunk or extremities," Dr. Waldman says.

If Mohs surgery isn’t necessary, the skin cancer may be cut or scraped out with surgical tools, frozen, or destroyed with radiation. The encouraging news is that most SCCs and BCCs can be cured when they’re treated early.

Develop your battle plan

The best weapon to fight skin cancer is a strict regimen of prevention and detection. It should include the following steps.

Cover up. Apply sunscreen or sunblock with a sun protection factor (SPF) of 30 to 50 before you go outside. Protect your lips with a sun protection product made for them. If possible, wear a long-sleeved shirt, pants, a wide-brimmed hat, sunglasses, shoes, and socks.

Avoid direct sunlight. Stay out of the sun when it’s strongest (between 10 a.m. and 4 p.m.), and seek the shade as much as possible.

Be vigilant about detection. Schedule annual skin check-ups with your doctor, and conduct your own exams at home each month. Don’t forget your scalp and all the back surfaces of your body. A mirror (or a loved one) can help you check your back and other areas you can’t see well.

Be proactive. Call your doctor if you find any new skin growth that looks suspicious. "We need to see you before tumors grow and become a problem," Dr. Waldman says.

Image: © Jim Bastardo/Getty Images