Experts say that healthcare professionals throughout a facility can be vital in the effort to help patients understand and mitigate skin cancer risks.
The coronavirus pandemic has brought with it a host of precautions to take when going outside.
Now, with summer in full swing and the sun’s ultraviolet rays at full strength, you should be packing sunscreen along with your facemask, hand sanitizer and so on.
Skin cancer is the most common of all cancers. And while melanomas account for just 1 percent of all skin cancers, they cause a majority of skin cancer-related deaths, according to the American Cancer Society.
The ACS also estimates that more than 100,000 new melanomas—around 60,000 in men and approximately 40,000 in women—will be diagnosed in 2020.
Typically developing on areas of sun-exposed skin—the scalp, face, lips, ears, neck, chest, arms and hands, for instance—skin cancer can also form on other parts of the body that aren’t necessarily as visible to the sun, such as the palms or under one’s fingernails or toenails. It also affects individuals of all skin tones, including those with darker complexions.
Some patients are more likely to develop skin cancer simply by virtue of their family history or color of their hair, for example. Exposure to ultraviolet light is the single biggest risk factor for skin cancer, of course. Patients can limit the amount of time they spend in the sun, and can take steps designed to mitigate other more risks as well. Experts say that healthcare professionals should help educate patients on sun protection and other behaviors that will help improve their chances of avoiding the most common type of cancer.
Weighing the risk factors
There are risk factors for skin cancer over which patients have little or no control.
Some of them have to do with heredity: a family history of melanoma, for example. Others are simple physical features, such as moles, fair skin, freckling or light hair, for instance.
“If you are fair-skinned with light-colored eyes and red or blond hair, and tend to burn easily in the sun, you are even more sensitive to UV radiation,” says Susan Chon, MD, dermatologist at The University of Texas MD Anderson Cancer Center.
“Also, if there is a family history of skin cancer, you might be more genetically susceptible to skin cancer.”
Tanya Nino, MD, dermatologist with the Center for Cancer Prevention and Treatment at St. Joseph Hospital in Orange County, Calif, notes that many skin cancer patients she’s seen have had a large amount of unprotected sun exposure in their lifetimes, or have had a history of blistering sunburns.
“Factor in the sun exposure you had during childhood and your youth, [and] it all adds up and leads to accumulated damage in your skin cells, which can lead to skin cancer,” says Nino, noting that exposure to certain chemicals such as arsenic, industrial tar, coal, paraffin and certain types of oil, or smoking cigarettes can also increase skin cancer risk.
Patient education is key to prevention
Sun exposure might be the most significant risk factor for melanoma and non-melanoma skin cancer. But it’s also the most modifiable risk factor, says Vadim Gushchin, MD, FACS, director of the Skin Malignancy Center at the Institute for Cancer Care at Mercy in Baltimore, Md.
“If it comes to melanoma, it is related to the number of sunburns a person accumulated before they are age 15. Therefore, patient education is key,” says Gushchin, adding that tanning using artificial sources is risky as well.
“Physicians could explain [risks] in a non-threatening manner to have a long-lasting effect on skin health,” he continues.
“For example, teaching young adults that sun damage leads to unhealthy looking and wrinkled skin is more likely to change their behavior than scaring them with abstract numbers of melanoma-related mortality. Also, screening of healthy people with risk factors—sunburns in childhood, multiple abnormal-looking pigmented lesions, family history of skin cancers—may be beneficial.”
One unique aspect of skin cancer “is that it can be noticed by anyone,” says Chon.
“What’s helpful to patients is if all providers, even those not in dermatology, take notice of any lesion that looks atypical during their routine exams or follow-throughs on a patient complaint about a lesion.”
Other healthcare providers can refer patients to a dermatologist for further investigation, of course. And healthcare professionals should initiate conversations with patients around skin cancer prevention strategies such as smoking cessation, increased exercise and sun avoidance, says Chon.
‘Increased awareness and education regarding sun protection will enable patients to actually modify behavior.”
Physicians and other healthcare providers should also encourage patients to protect their skin from the sun, seek shade and wear sunscreen on protected skin, adds Nino.
“We can educate our patients on the harmful effects of UV radiation and tanning bed use. And most importantly, we can keep a careful watch over our patients by doing skin exams in order to identify skin cancer early,” she says. “Remember, most skin cancer is curable if found and treated early.”
- American Cancer Society, 2020. Accessed May 19, 2020.
Spotting the Signs and Symptoms
One in five Americans will develop skin cancer by the age of 70, and more 9,500 people are diagnosed with skin cancer every day in the United States, according to the Skin Cancer Foundation.
The better news is that the five-year survival rate for melanoma—when detected early—is 99 percent.
Learning to see the warning signs of melanoma is crucial to early detection and, subsequently, successful treatment.
The American Cancer Society details some of the important signs to monitor for, such as a new spot on the skin, a spot that is changing in size, shape or color, or a spot that looks different from all the other spots on one’s skin. (Known as the “ugly duckling sign,” the ACS points out.)
The ACS also provides a guide to identifying the usual signs of melanoma, using the ABCDE rule:
Asymmetry. One half of a mole or birthmark does not match the other.
Border. The edges are irregular, ragged, notched or blurred.
Color. The color is not the same all over and might include different shades of brown or black, or sometimes with patches of pink, red, white or blue.
Diameter. The spot is larger than 6 millimeters across (about one-quarter inch, or the size of a pencil eraser), although melanomas can sometimes be smaller.
Evolving. The mole is changing in size, shape or color.
- Skin Cancer Foundation, 2020. Accessed May 21, 2020.
2. American Cancer Society, 2020. Accessed May 22, 2020.