Common Sense Steps to Prevent Skin Cancer
By Elisabeth Hurliman, MD, PhD, Ridgeview
May is Skin Cancer Awareness Month, and we all look forward to the long summer days ahead with opportunities for a variety of outdoor activities.
As a dermatologist, I have a special interest in skin cancer and as a fellowship-trained Mohs surgeon, I hold advanced training in Mohs surgery, a common skin cancer treatment. But let’s not get ahead of ourselves. Prevention is where I’d like to focus as there are important steps we can take to avoid getting skin cancer. Read below as I address some common questions I hear from patients.
How diligent should I be with sun protection for my family? Which sunscreen types are best?
It is important to wear sunscreen daily, and choose one with an SPF of at least 30 with broad spectrum coverage, so you are at least 95 percent protected against all UV rays. I like to tell my patients, “It is the daylight, not the sunshine,” that’s dangerous to your skin over time.
Even sitting by a window, driving your car or popping out briefly to go to the store, can expose you to dangerous rays.
It’s also important to reapply sunscreen every two to three hours, and each time you go swimming or sweat. Remember to use a generous amount to get the coverage you need. The best sunscreen type is the one you like best and will use regularly.
What other sun protection measures are important?
No sunscreen offers complete protection and, particularly during peak hours (10 a.m. – 4 p.m.), it’s important to take additional precautions to protect your skin. Cover up with protective clothing made of special microfibers with UPF (ultraviolet protection factor, the clothing equivalent of SPF). Wear hats to protect your scalp, and ones that also cover your ears and neck. Try to catch a bit of shade between outdoor activities. Remember to wear your sunglasses, as sun damage can easily happen around the eyes and harm them directly as well. For children younger than six months old, don’t use sunscreen—practice other sun protection and avoid direct exposure to the sun.
I am a person who tans easily and rarely burns. Is skin cancer less of a concern for me?
Unfortunately, no one is protected from skin cancer. A tan is actually a sign that your skin is trying to defend itself from harmful UV rays and is getting damaged. You should still use sunscreen. There is no such thing as a safe tan (unless it is a spray tan), and tanning beds do not offer a “protective base,” but are actually linked to skin cancer.
I am a person who has a lot of moles. When should I be concerned?
People with many moles or abnormal moles (dysplastic nevi) can have an increased risk of skin cancer. Monthly self-exams are very helpful, particularly in identifying new or changing moles. In general, we look for the ABCDEs to detect melanoma: asymmetry, borders, color, diameter and evolving.
Self-exams can easily be done with a full length mirror and a handheld mirror. Talk to your dermatologist for guidance. Document any new or unusual moles with a photo so you can easily identify a change and can share the images with your dermatologist. It is important to be familiar with your skin, and it’s prudent to schedule a baseline total body skin exam with a board-certified dermatologist.
If skin cancer is detected, how dangerous is it?
Skin cancer is the most common type of cancer in the United States. There are three main types: basal cell carcinoma, squamous cell carcinoma and melanoma. Basal cell is most common, grows slowly and rarely spreads to other organs. If left untreated, it can get quite large and grow into underlying tissues. It most commonly occurs on sun-exposed areas of the face and body. Squamous cell carcinoma is the second most common type, also commonly found on sun-exposed areas, but grows more quickly than basal cell and is more likely to spread elsewhere (metastasize).
Melanoma can develop anywhere, in normal skin or in an existing mole, on sun-exposed or sun-protected areas. Melanoma has the highest risk for metastasis and therefore is consider the most dangerous. Melanoma that spreads can be difficult to treat, but if it is caught early, it is often curable. In general, skin cancers are very curable if detected and treated early.
What skin cancer treatments are commonly used?
Some skin cancers, if superficial, can be treated with a topical treatment or destruction with heat. Most skin cancers require excision or surgical removal. Skin cancers on the face or other sensitive areas—such as the hands—are commonly treated with Mohs surgery.
Mohs surgery is a unique treatment that preserves as much healthy tissue as possible while examining tissue margins to ensure the highest cure rate—all while patients are awake but comfortable under local anesthesia. Mohs surgeons function as both surgeon to remove the skin cancer as well as pathologists to read the tissue for any cancer cells under the microscope. Reconstruction of the surgical site can also happen with the Mohs surgeon on the same day or with a plastic surgeon.
When should I make an appointment with my dermatologist? What can I expect?
It is always valuable to schedule a baseline total body skin exam with a board-certified dermatologist. Depending on your personal or family history of risk factors, your dermatologist may recommend a repeat skin check every three to 12 months. If you are already doing monthly self-exams, let your dermatologist know as soon as you notice a change. The earlier we diagnose a skin cancer, the better is the chance for a complete cure.
Dr. Elisabeth Hurliman is a board-certified dermatologist and fellowship-trained Mohs surgeon practicing at Ridgeview in Waconia. She also has experience with lasers for scar revision and rejuvenation, and cosmetic dermatology.