Summer means sunshine, and sunshine means tanned skin. What people don’t realize is that skin cancer is the most commonly diagnosed cancer in the world, and although it affects all ages, it’s most commonly found in the older community. Exposure to the sun heightens our risks of skin cancer, but how do we know if our skin or skin of a loved one is already harmed? There are plenty of warning signs to skin cancer and things we can do to prevent it from getting worse.
The three most common forms of skin cancer are melanoma, basal cell, and squamous.
Melanoma
Melanoma is a skin cancer that starts in the melanocytes— a cell that’s located in the bottom layer of the skin’s epidermis. These cells are what allow our skin to tan, and they are what give suspicious moles their brown coloring. Although less common than the other types of skin cancer, melanoma is more likely to grow and spread throughout the body. Those with consistent exposure to sun are at higher risk for developing melanoma, which can take form in these darker spots or moles. However, they can still develop even without sunlight. According to the American Cancer Society, the neck and face are common sites of the visible marks of skin cancer. Although melanomas can develop anywhere on the skin, they are more likely to start on the chest and back in men and on the legs in women. The National Cancer Institute provides a good checklist for checking our bodies with, by considering “ABCDE.”
-Asymmetry: The shape of one half does not match the other half.
-Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
-Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
-Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
-Evolving: The mole has changed over the past few weeks or months.
Basal Cell
Basal cell carcinoma is a type of skin cancer that forms in the basal cells— the cell that reproduces new skin cells as old ones die off. When our DNA cells undergo a mutation, a rapid production of these cells takes place, eventually accumulating in the shape of an abnormality or lesion on the skin. It is the most common form of skin cancer and type of cancer overall, while having the tendency to stay benign throughout its appearance. The following information is provided by the Mayo Clinic’s research on basal cell skin cancer; these changes in the skin, or lesions, usually have one of the following characteristics:
-A pearly white, skin-colored or pink bump that is translucent, meaning you can see a bit through the surface. Tiny blood vessels are often visible. In people with darker skin tones, the lesion would be darker but still somewhat translucent. The most common type of basal cell carcinoma appears on the face, ears, or neck. The lesion may rupture, bleed and scab over.
-A brown, black or blue lesion — or a lesion with dark spots — with a slightly raised, translucent border.
-A flat, scaly, reddish patch with a raised edge is more common on the back or chest. Over time, these patches can grow quite large.
A- white, waxy, scar-like lesion without a clearly defined border, called morpheaform basal cell carcinoma, is the least common. This lesion is easy to overlook, but it may be a sign of a particularly invasive and disfiguring cancer.
Squamous
Squamous cell carcinoma is skin cancer produced by an abnormal accumulation of squamous cells, which make up the bulk of our upper layers of skin. More than 1 million cases of squamous cell carcinoma are diagnosed each year in the U.S., and) as many as 8,800 people die from the disease. Squamous cancer cells often look red, scaly, and patchy, and can have similar characteristics overall to the ones listed above for basal cell carcinoma. This type of skin cancer can cause disfiguring sores and can occur on all areas of the body. Sun exposure is a major contributing factor to this skin cancer, like most, and is commonly found on the ears, lips, balding scalp, arms and legs.
An article on MedScape by Stephanie R. Johnson, MSN GNP-BC and Melissa A. Taylor, MSN, CRNP says the older community runs high risks of developing different types of skin cancer—
“The majority of skin cancers, including basal cell carcinoma and squamous cell carcinoma, occur among older adults. The incidence of malignant melanoma is 10 times higher for older adults than for adults younger than 40.” Older adults have darkened skin and age spots regardless, which means they’re less able to identify new or differing skin lesions and chronic diseases. This inability to differentiate can be harmful, leading the geriatric population into later- stage lesions with poorer prognoses and higher mortality.
Caution with Treatment
We all want to protect our loved ones from pain, and being that skin cancer is the most widely diagnosed cancer, some argue the low-risk cases can be treated too aggressively. Dr. Eleni Linos, a dermatologist at the University of California San Francisco, had been treating one of her 95-year old patients with multiple surgeries to remove these basal cell and squamous cell cancers, even though these kinds of skin cancers are usually asymptomatic. The patient died the following year from pneumonia.“In the last year of this man’s life, we put him through so much,” she said.
Treating skin cancer can be done in different ways— outpatient surgery with local anesthesia, minor excisions to scrape or cut out the visible lesion or choosing to simply do nothing and see what happens. American medicine would argue against the last option, but given the current state of health and stage of the skin cancer patient, it could save time, money, and recovery.
Dr. Linos stated, “for someone active and healthy, going through a little skin cancer surgery to get rid of it is something we wouldn’t think much about,” and since non-melanoma cancers can eventually grow, it makes sense to remove them from patients likely to live long enough to worry about it. It’s the population of much older, weaker, and sicker patients that need to be considered more sensitively. Even minor procedures can have complications and because some cases of skin cancers grow so slowly, they won’t be an issue in the patients’ remaining years.
The safest way to protect yourself from various skin cancers is by making sure you stay covered in the sun either with protective clothing or sunscreen. If you or a loved one has observed a change in color or size or felt discomfort from a mole or lesion, please contact your local dermatologist to get it checked out.