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The month of May means different things to different people. For my kids, it is the beginning of the real countdown to summer. They all know exactly how many days of school they have left, and as usual, they are much more excited about being home all day than I am. For dermatologists, we have declared May as Skin Cancer Awareness Month. For many years, we referred to is as "Melanoma May". Since melanoma isn't the only potentially fatal form of skin cancer, we've decide it's best to be more inclusive to better educate the public.
So what should people be aware of for skin cancer? There are so many important things that I can't summarize them all in one post. I'll try to limit myself to what I think are the most important points for you to take away.
Skin Cancer is Common
In some ways, I think this is the most important point I can make. I see patients every day for a variety of issues: acne, rashes, warts, moles, etc. When patients come in for problems unrelated to skin cancer but have risk factors for developing skin cancer, I try to provide some education. Some take me seriously, but many blow off my comments. The reality is that one in five Americans are expected to develop skin cancer during their lifetime. That means you are much more likely to get skin cancer than any other type of cancer. People consistently get mammograms, colonoscopies, and do all sorts of other things to try to detect cancer. Skin cancer should be no different, especially since it is the one you are most likely to get, and is in some ways the easiest to detect.
Anybody Can Get Skin Cancer
Some think that since they have darker skin, are still relatively young, don't go out in the sun very much, or don't use tanning beds, they aren't really at risk. This thinking is false. Skin cancer affects all races, ages, and people of low and high risk behaviors. Probability of getting skin cancer does change dramatically with factors such as skin type, exposure to the sun and ultraviolet rays, increased age, and other factors, but the reality is it can still affect anyone.
Skin Cancer Can Show Up Anywhere
When I perform a skin cancer screening, patients often look at me strangely when I ask to look at their feet. The common reaction is "I don't get sun there, so why bother looking?" The reality is that skin cancer can show up anywhere on your body, and I mean anywhere. Unfortunately, some of the worst skin cancers I've ever seen have been on the bottom of people's feet or other mostly concealed areas. This is largely because patients, and even sadly their doctors, think that skin cancer doesn't show up in areas that don't get a lot of sun exposure. Skin cancer is certainly much more common in areas where patients have had the most sun exposure, but that doesn't mean we should ignore lower risk areas.
Skin Cancer Can Be Prevented
With this point, I want to be clear that not all skin cancers can be eliminated, but with better behaviors and choices, many can. Exposure to the sun and ultraviolet rays is the biggest modifiable risk factor we have. Studies have shown use of sunscreen can prevent skin cancer. Even better is the use of highly effective sun protective items including shirts, wide-brimmed hats, sunglasses, and umbrellas. Planning your activities so that they are done in times of lower sun exposure is also an effective strategy.
Early Detection of Skin Cancer Saves Lives
While skin cancer can be extremely dangerous and sadly deadly for many thousands of people each year, most of these deaths can be avoided with early detection. Melanoma, the most deadly form of the common skin cancers, has a 99% survival rate when found early. Survival rate drops to 74% when it has spread to the lymph nodes, and is only 35% once it has spread beyond that. If we could just get people to understand the importance of looking at their own skin, knowing what to look for, and seeing a dermatologist for screenings, the amount of deaths occurring from skin cancers would drop significantly.
Detecting Skin Cancer Isn't as Easy as Memorizing the ABCDEs
You have hopefully all heard of the ABCEs of melanoma. These are some of the features people should look for when evaluating their skin that may signify they have a melanoma. They stand for: A - Asymmetry. B - Borders that are irregular. C - Color, meaning spots that are multicolored rather than being one uniform color. D - Diameter, meaning the spot is greater than 6mm in diameter. E - Evolving, meaning the spot is changing in appearance. When I have a patient I feel is of high risk for skin cancer, I'll usually recommend they have a skin cancer screening. They will often decline saying they don't have any spots that look like the ones I showed them on my teaching diagram. My typical reply is that I have found hundreds, if not thousands of skin cancers that patients either had not noticed, or that they had looked right at and not recognized as a skin cancer.
This happens for a few reasons. One, not all skin cancers read the textbook. While most melanomas will have at least some of the ADBDE features, not all do. Also, while the ABCDE features are pretty reliable for detecting more developed melanomas, they aren't as effective for finding melanoma in the absolute earliest stages that would give the highest overall cure rate. Being able to detect melanoma in the earliest stages is sometimes only possible with an extremely observant patient, or by a dermatologist with the proper tools and training to see the necessary features. So while I am 100% in favor of patients examining their own skin, in higher risk individuals I think a regular skin cancer screening with a trained professional is vital.
A Few Facts and Further Resources
I have sighted a relatively small number of facts and statistics in this post on purpose. There are plenty of other places that list those that I will direct you to if you want to know more. I'll leave you with just a few more numbers to think about.
In the two years since we opened our office, we have found over 500 skin cancers. That is more than one skin cancer per business day. As a small office with just a single provider, I am pretty amazed by that number. We actually keep a tally that is displayed on a video screen in our waiting room. When patients see that number, they are pretty surprised, which fortunately prompts many of them to be properly screened.
I'll close this post with one additional number. The number 1. There is only one of you. All it takes is one undetected skin cancer and all that can be ruined. I've seen it in my own family, and have seen it in the lives of patients. Don't ignore the risks. Use all of the preventative strategies you can. Be aware of skin cancer and have a skin cancer screening if you are at risk. Thanks for reading and have a happy May and a wonderful sun-filled, but sun-protected summer.
Additional Resources:
Comprehensive skin cancer statistics: https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/
Information on melanoma: https://www.mymeridianderm.com/melanoma
Information on basal cell carcinoma: https://www.mymeridianderm.com/basal-cell
Information on squamous cell carcinoma: https://www.mymeridianderm.com/squamous-cell
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