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SKIN CANCER

Over one million cases of skin cancer will be diagnosed in the United States this year. Visiting your dermatologist at least annually for a total body skin examination will help you identify skin cancer early, when treatment is often curative. There are several types of skin cancer, each beginning in a specific cell type within the skin. The two most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma, which usually develop on the head, face, neck, hands and arms. These are areas commonly exposed to the sun, but skin cancer can occur anywhere on the body. Another common type of skin cancer is melanoma, a potentially fatal form of skin cancer. Melanoma is now the number one cause of cancer death in people 25-40 years of age.

Basal Cell Carcinoma

Basal cell carcinoma is a slow-growing form of skin cancer that usually occurs on areas of the skin that have been in the sun, most commonly the face. Basal cell cancer rarely spreads to other parts of the body, and is usually treated by surgical excision. When a tumor is large (over 2 cm in diameter on the body), or is located on a cosmetically-sensitive area on the face (such as the eyelid, lip, nose), a special type of treatment called Mohs' Surgery, is indicated. Dr. Andrew Menkes is highly skilled in using Mohs' surgery to treat skin cancer and will help determine the appropriate course of treatment for each patient who is diagnosed with skin cancer.

Squamous Cell Carcinoma

Like basal cell carcinoma, squamous cell skin cancer occurs on parts of the skin that have been in the sun, but can also develop in areas that have been protected from sunlight. It sometimes spreads to lymph nodes and organs inside the body. When detected early, this form of skin cancer is usually completely curable. As with basal cell skin cancers, squamous cell carcinoma is usually treated surgically. Mohs' surgery is performed for skin cancers that are large or those that involve a cosmetically-sensitive area on the face such as the nose, eyelid or lip. Appropriate therapy is determined by our dermatologists after a consultation with the patient to thoroughly discuss each treatment option.

Melanoma

Melanoma occurs when melanocytes (pigment cells) become malignant. Most pigment cells are in the skin; when melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in the eye (ocular melanoma or intraocular melanoma). Rarely, melanoma may arise in the meninges, the digestive tract, lymph nodes, or other areas where melanocytes are normally found in the body.

Melanoma is one of the most common cancers. The chance of developing it increases with age, but this disease affects people of all ages. It can occur on any skin surface. In men, melanoma is often found on the trunk (the area between the shoulders and the hips) or the head and neck. In women, it often develops on the lower legs. Melanoma is rare in black people and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails, or on the palms or soles.

When melanoma spreads, cancer cells may show up in nearby lymph nodes. Groups of lymph nodes are found throughout the body. Lymph nodes trap bacteria, cancer cells, or other harmful substances that may be in the lymphatic system. If the cancer has reached the lymph nodes, it may mean that cancer cells have spread or "metastasized" to other parts of the body such as the liver, lungs, or brain. In such cases, the cancer cells in the other areas are still melanoma cells, and the disease is called metastatic melanoma, not liver, lung, or brain cancer.

No one knows the exact causes of melanoma. Doctors can seldom explain why one person gets melanoma and another does not. However, research has shown that people with certain risk factors are more likely than others to develop melanoma. A risk factor is anything that increases a person's chance of developing a disease. Still, many who do get this disease have no known risk factors. People who are concerned about developing melanoma should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's personal and family history, medical history, and other risk factors.

Who's at Risk for Melanoma?

Studies have found the following risk factors for melanoma:

• Dysplastic nevi: Dysplastic nevi are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles. The risk of melanoma is greatest for people who have a large number of dysplastic nevi. The risk is especially high for people with a family history of both dysplastic nevi and melanoma.
• Many (more than 50) ordinary moles: Having many moles increases the risk of developing melanoma.
• Fair skin: Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes) than in people with dark skin.
• Personal history of melanoma or skin cancer: People who have been treated for melanoma have a high risk of a second melanoma. Some people develop more than two melanomas. People who had one or more of the common skin cancers (basal cell carcinoma or squamous cell carcinoma) are at increased risk of melanoma.
• Family history of melanoma: Melanoma sometimes runs in families. Having two or more close relatives who have had this disease is a risk factor. About 10 percent of all patients with melanoma have a family member with this disease. When melanoma runs in a family, all family members should be checked regularly by a doctor.
• Personal history of melanoma or skin cancer: People who have been treated for melanoma have a high risk of a second melanoma. Some people develop more than two melanomas. People who had one or more of the common skin cancers (basal cell carcinoma or squamous cell carcinoma) are at increased risk of melanoma.
• Weakened immune system: People whose immune system is weakened by certain cancers, by drugs given following organ transplantation, or by HIV are at increased risk of developing melanoma.
• Severe, blistering sunburns: People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. Because of this, doctors advise that parents protect children's skin from the sun. Such protection may reduce the risk of melanoma later in life. Sunburns in adulthood are also a risk factor for melanoma.
• Ultraviolet (UV) radiation: Experts believe that much of the worldwide increase in melanoma is related to an increase in the amount of time people spend in the sun. This disease is also more common in people who live in areas that get large amounts of UV radiation from the sun. In the United States, for example, melanoma is more common in Texas than in Minnesota, where the sun is not as strong. UV radiation from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can cause skin damage and increase the risk of melanoma. Doctors encourage people to limit their exposure to natural UV radiation and to avoid artificial sources.

Recommendations?

• Avoid exposure to the midday sun (from 10 a.m. to 4 p.m.) whenever possible.
• If you must be outside, wear long sleeves, long pants, and a hat with a wide brim.
• Protect yourself from UV radiation reflected by sand, water, snow, and ice.
• Help protect your skin by using a lotion, cream, or gel that contains sunscreen SPF 15 or higher to provide the most protection against sunburn.
• Wear sunglasses that have UV-absorbing lenses that block at least 99 percent of UVA and UVB rays. This protects both the eyes and the delicate skin around the eyes from the damaging effects of the sun.

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