Article for July, 2006

Skin Cancer: Promising Prevention Strategies on the Horizon

By Joan Liebmann-Smith, Ph.D.
Strang Cancer Prevention Center, New York*

Skin cancer is the most prevalent cancer in the U.S. today, with over 1 million new cases each year. One in six Americans will develop some form of skin cancer. The good news is that the majority of skin cancers, including melanoma, are curable when detected and treated early. According to Richard Granstein, MD, chief of the dermatology service at New York Weill Cornell Medical Center: “They are largely preventable, especially so for non-melanoma skin cancer. However, Americans are not doing what they can to prevent this disease. Many are, in fact, actively engaging in behaviors that cause it: sunbathing and skin tanning. The result is that the incidence of skin cancer — including melanoma — the deadliest form, is rising at an alarming rate."

There are many types of skin cancer, but the most common types are: basal cell carcinoma (BCC), squamous cellcarcinoma (SCC), and melanoma.

Basal cell skin cancer — BCC is the most common form of cancer in the world. Eighty percent of skin cancers in the U.S. are BCCs. It is easily treatable when detected early, and it rarely metastasizes (spreads). However, death can occur if it's left untreated.

Squamous cell skin cancer — About 17 percent of skin cancers in the U.S. are SCCs, making SCC the second most common form. Unless treated early, SCC can metastasize and cause death.

Melanoma — This is the most lethal of all of the skin cancers, accounting for about 4 percent of skin cancers in the U.S. According to the American Cancer Society (ACS), between 1973 and 1997, the incidence of this deadly disease almost tripled among white males and more than doubled among white females and the mortality rate among whites increased by 50 percent during this time. The ACS predicts that in 2006, there will be more than 60,000 new cases of melanoma and close to 8,000 deaths from this disease; that's almost one person each hour of each day. However, if detected and treated very early, 95 percent of cases of melanoma are curable. But once melanoma metastasizes, the prognosis is extremely poor.

Causes and Risk Factors

Excessive exposure to ultraviolet (UVA and UVB) rays from either the sun or artificial tanning devices is the primary cause of all three forms of skin cancer. Genetics, however, does play a significant role: about 5 to 10 percent of cases of melanoma are genetic; that is, people can inherit a gene that puts them at higher risk of developing melanoma.

Those who are at high risk have a close relative with skin cancer or have fair skin, blue or green eyes, blond or red hair, and the tendency freckle or burn easily. Having had severe sunburn in childhood or adulthood is another significant risk factor, but because the carcinogenic effects of the sun are cumulative, it's possible to get skin cancer without having had major sunburn. Older adults, especially males, are at increased risk. Indeed, older Caucasian men have the highest rates of both developing and dying from melanoma.

Prevention

Skin cancer is the most preventable form of cancer. It's relatively easy to prevent by taking the following measures:

Screening for Skin Cancer

Early detection is the key to successful treatment. Periodic — ideally, monthly — self-examination of one's skin and the skin of family members is a simple but extremely important measure. The most common sites for skin cancer are the areas that get the most sun exposure — the face, neck, scalp, hands and feet. But melanoma often occurs in less likely places such as on the eyelids, on the bottom of the feet, under the arms, under the breasts and even on the genitals.

The most significant sign of skin cancer is a change in size, shape and color or a mole or growth. The following can also be indications of skin cancer. Anyone who has these signs should consult a dermatologist or skin oncologist as soon as possible.

In addition to self exams, the ACS recommends that a total body skin examination be performed annually by a health care provider for those over 40 and every three years for those younger than 40. A dermascope, a handheld device, is often used to aid in the examination of moles. If a suspicious growth is found, a biopsy is necessary to rule out, or confirm skin cancer.

* The Strang Cancer Prevention Center is affiliated with NewYork Weill Cornell Medical Center in New York City. The oldest cancer prevention institute in continuous operation in the US – Strang is dedicated to research to prevent and promote cure through early detection.

More Information:

Current as of July 2006