By Robert W. Vera, M.D., F.A.C.O.G.
John Denver had sung a song about sunshine. One of the lines to the song went like this, “Sunshine on my shoulder makes me happy”. The sun shines in El Paso 300 days a year. John Denver could have written another verse, “Sunshine on my skin can cause skin cancer. ” Well, it might have taken away a lot from the beautiful song he wrote and recorded. However, skin cancer is one of the most common of all cancers. If a person lives to age 65, he/she has a 50% chance of getting a skin cancer! Said another way, half of all people age 65 will have a malignant skin lesion. Skin cancer can be cured as it is usually found in its early stages, but because it affects so many people, it is truly a burden on our health care system.
We discussed in other El Paso City Beat issues those risky behaviors we can have that lead to disease and death and being out in the sun too much can eventually lead to skin cancer. Therefore, logically, being careful to cover your skin in the sun can help prevent skin cancer.
Like other cancers, skin cancer has a premalignant stage. These are changes in the skin cells and in the skin that start before a cancer forms. It is called Actinic Keratosis. It is a flakey, crusty, reddened patch of skin that can come off easily with scratching, but it always reforms. Because the skin can be easily examined, the progression to skin cancer can be caught early by your doctor. Because skin cancer is usually found early, it can be cured.
SKIN CANCER TYPES
There are many skin cancer types, however, we are going to discuss the three most common types: Basal Cell Cancer, Squamous Cell Cancer, and Melanoma. Melanoma can be such a devastating disease, that skin cancer is divided into two classes, Melanoma and Non Melanoma. These cancers arise from certain cells found in the skin. Women are less likely to get skin cancer. Skin cancer usually starts in the ages from 40-60. Skin cancer can run in the family as a genetic link.
Basal Cell Carcinoma and Squamous Cell Carcinoma are the most common skin cancers. Basal Cell Skin Cancer makes up some 75% of all skin cancer. Basal Cell Cancer of the skin is slow growing. It can easily be treated with excision and rarely travels to other parts of the body. Squamous Cell Carcinoma still grows slowly, but can be more aggressively growing than Basal Cell Cancer. Squamous Cell Cancer, if found early, is also easily curable, but since it can have more rapid growth, it spreads more readily. Again, both Basal Cell and Squamous Cell Cancer can be cured by surgically removing them.
The dangerous skin cancer is Melanoma. If not caught in its earliest stage, Melanoma is aggressive and can spread to almost any part of the body. If found early, it too can easily be resected and cured. If it grows deeper into the skin, it still can be resected, but the chance that it has gotten into the small blood vessels and lymphatics is high. If this happens, Melanoma spreads easily to other organs and is resistant to most treatment. Melanomas can start in may places besides the skin, like the eye, vagina, anus, and mouth, where it is more difficult to find early. Melanomas can also be found on the soles of the feet and the palms of the hands, odd places for skin cancer. Melanomas are known to occur in non sun exposed areas of the skin. It is a dangerous and deadly cancer if not found early.
Prolonged exposure to ultraviolet light causes skin cancer. Ultraviolet light is part of sunlight. Ultraviolet light damages the DNA, the genetic material of skin cells and when this happens, the cells start to grow uncontrollably and without respect to the natural borders these skin cells normally have. Tanning booths have the same effect and these may be responsible for the spike in skin cancers in young adults. Other agents that are known to cause skin cancer are coal tar exposure, radium exposure, and contact with arsenic containing insecticides.
We have discussed, somewhat, treatment already. Treatment is primarily surgical; the area of skin cancer is removed. It has a propensity for occurring in other parts of the skin, so one must be vigilant of skin changes once one skin cancer is found. There are, however, other treatment modalities other than surgery that can kill or destroy the cancer. Freezing the cancer(called Cryosurgery)can ablate the malignancy. Radiation and Chemotherapy can be reserved for certain cancers of the skin, in particular, melanomas that have spread to other parts of the body. Laser can also destroy early skin cancer. There is some success using the immune system to destroy cancer cells of the skin.
Skin cancer is caused by prolonged sunlight exposure. Most skin cancer is found early. When found early, skin cancer is curable. Melanoma is an aggressive skin cancer and must be removed surgically when it is still in its earliest stages, if not, it easily spreads to other organs, is resistant to treatment that treats metastasis, and is fatal. Examine your skin from head to toe and even the palms of your hands and the soles of your feet. Go see the doctor so that he/she can examine areas that are not that easy to examine, like the anus and the vagina. Get eye exams as melanoma can start there. Treatment for early skin cancer is curative when found early, and, almost all skin cancers should can be found in the earliest stages.
SkinCancer.org has a page called THE MINI SKIN CANCER PREVENTION HANDBOOK. Go to this site for easily understood skin cancer prevention information. Cancer.org/latest-news.html?tag+cancer-types%3Askin-cancer has the latest information on skin cancer from experts in the field, including research developments.