By Eva M. Balash, MD, general dermatologist, Boston Family Dermatology at Faulkner Hospital, and Thomas S. Kupper, Chairman, Department of Dermatology, Brigham and Women’s Hospital
While proper skin protection is important all year long, outdoor activities during the warm summer months can make it more challenging for even the most diligent sunscreen user.
Skin cancer is the most common of all cancers – half of all Americans will develop skin cancer at least once and every hour one American dies of the disease. The American Cancer Society estimates that the number of cases of melanoma rises by seven to 11 percent each year – faster than any other cancer in America. Fortunately, skin cancer is also one of the most preventable cancers.
Skin Cancers
The types of skin cancer fall into two categories, nonmelanoma and malignant melanoma. Nonmelanoma skin cancers are the most common cancers of the skin. Basal cell carcinoma and squamous cell carcinoma are the most common of nonmelanomas – developing on areas of the skin that are often exposed to and unprotected from the sun.
Nonmelanoma skin cancers are almost always curable and rarely spread to other parts of the body but, if not diagnosed early, can be severely disfiguring.
- Basal cell carcinoma: Roughly 75 percent of all skin cancers are this type. Developing in the lowest layer of the skin, these cancers are slow-growing and often develop on the neck and head. This cancer is usually not life threatening.
- Squamous cell carcinoma: Developing in the higher levels of the skin, these cancers account for roughly 20 percent of all skin cancers. Faster growing and more aggressive than basal cell carcinomas, these cancers often are found on the face, neck, lips and hands. They are also more likely to spread to the tissue beneath the skin and are slightly more likely to spread to other parts of the body.
Malignant melanoma is the most aggressive form of skin cancer and can be deadly.
- Malignant melanoma: This cancer develops in the pigment-producing skin cells and grows uncontrollably – aggressively invading surrounding tissues. Melanoma may affect only the skin, or it may spread through the blood or lymph system to other organs and bones. It can also arise from pigment producing cells elsewhere, such as the retina, and not appear on the skin at all.
Risk Factors
While sun exposure is the primary and most preventable cause of skin cancer, there are factors that place you at higher risk. These are:
- Skin tone and freckles: Fair skin is particularly vulnerable to harmful effects of the sun. Caucasian people are 10 times more likely to develop skin cancer than people who are African American;
- Age: Skin cancer often develops at a much earlier age than most cancers and the older a person is, the more likely he or she is to develop skin cancer;
- Family History: Malignant melanoma runs in families while nonmelanoma skin cancer probably does not;
- Moles: Although moles are non-cancerous, having at least one mole on an arm or leg doubles the risk of skin cancer. Having many irregular moles increases the risk of melanoma.
Screening and Treatment
You should have a baseline screening at age 18; thereafter, conduct a monthly self-exam of moles and birthmarks to check for changes in shape, texture, or color. This should be done in conjunction with annual screenings by your physician as part of your yearly physical. A physician’s exam usually involves a visual inspection and a closer look at any questionable moles using added lighting with magnification tools.
Treatment of a skin cancer begins with a biopsy to establish what kind of cancer it is – nonmelanoma or melanoma. Once the cancer is defined, treatment can involve chemical or surgical removal depending on the type and its stage of development. If there is a change in your skin, anything that raises a concern, be sure not to ignore it. The earlier a skin cancer is detected, the more effective the treatment.
Skin Cancer Treatment at Dana-Farber/Brigham and Women’s Cancer Center
Dana-Farber/Brigham and Women’s Cancer Center is an integrated center – combining the expertise of Brigham and Women’s Hospital and Dana-Farber Cancer Institute – that treats adults with cancer. The Center for Cutaneous Oncology of Dana-Farber/Brigham and Women’s Cancer Center offers patients access to a team of specialists who focus on all aspects of skin cancer, including research and clinical trials, evaluation, treatment and prevention.
Specialty clinics within the Center include:
- The Mohs Micrographic Surgery and Dermatologic Surgery Center offers specialized and extremely effective outpatient surgical techniques for removing skin cancers. Mohs surgery has a remarkable 99 percent cure rate with new cancers and 95 percent cure rate for skin cancers that come back after treatment.
- Melanoma and Cutaneous Oncology Clinic specialists provide a multidisciplinary approach to treatment for patients with melanoma.
In 2004, the Center received a prestigious Specialized Program of Research Excellence (SPORE) grant in skin cancer funded by the National Cancer Institute – the only one of its kind in the nation. Areas of SPORE research include:
- Testing of possible vaccines for melanoma;
- Learning more about specific risk factors and how they lead to different forms of skin cancer;
- Evaluation of new combination approaches to treatment using chemotherapy and immunotherapies.
Pigmented Lesion Center at Brigham and Women’s Hospital
The Pigmented Lesion Clinic is a comprehensive clinic for managing patients with atypical moles and dark spots that may become precancerous or cancerous. The clinic is staffed by dermatologists with access to oncologists, surgeons and other specialists. The goal of the clinic is to provide information, convey prognosis, future treatment and follow-up, as well as patient education in the areas of sun protection and skin self-exam.
Call for a Skin Check Appointment Today!
To make an appointment for a skin screening with a specialist or PCP of Brigham and Women’s/Faulkner Hospitals, call 1-877-BWF-5773. Also, request “Your Guide to Cancer Prevention and Screenings” for additional information on skin and other cancers.
