When the weather warms up, many of us eagerly anticipate the weather and the sunshine it promises. It’s important to remember, however, that too much sunshine without proper protection can come at a price. Incidences of skin cancer in the United States are up and continue to grow annually – meaning skin cancer prevention is the best medicine.
We talked with Mercy Health physician and dermatologist Emily Moosbrugger, MD, about prevention, skin cancer types and everything under the sun when it comes to skin cancer.
What to know about skin cancer prevention
How to prevent skin cancer
“Prevention remains the best strategy,” says Mercy Health physician and dermatologist Emily Moosbrugger, MD. “Use a sunscreen with an SPF (sun protection factor) of at least 30. Fifty is better. Reapply it every hour if you are swimming and every one to two hours to keep up with the protection level on the bottle. You have to get a good enough layer on to benefit from sunscreen, so don’t spread it too thin.”
What sunscreen to use
Some people are allergic to certain types of or specific ingredients in sunscreen, especially if they already have pre-existing skin conditions, such as eczema. However, it’s more likely that you are using a sunscreen that doesn’t agree with your skin type.
There are two types of sunscreens:
- Physical or mineral: This sunscreen uses ingredients that physically block the sun’s ultraviolet (UV) rays from entering your skin.
- Chemical sunscreen: This kind contains ingredients that are absorbed by your skin and create a chemical reaction when it encounters UV light, which converts it into heat that is evaporated from the skin.
Special sunscreens are also available for the face that minimize breakouts. Look for ones that are oil-free and non-comedogenic, meaning they won’t clog your pores. Water-resistant options are best if you are swimming or taking part in activities that make you sweat.
Sun protection clothing, such as hats, long-sleeved shirts and pants, is also on the market, which can also help protect your skin from the sun similar to sunscreen.
Who is more at risk?
“People with fair skin, light eyes and light hair tend to burn easily and have more melanoma risk factors, as do people with a higher number of moles,” Dr. Moosbrugger says. “If this describes you, it’s even more important that you use sunscreen and use it properly.”
Often, people with a family history are at higher risk of skin cancer, whether that’s a result of a shared lifestyle of being out in the sun a lot, similar complexions and skin types or specific gene mutations that are inherited.
Early detection is the next line of defense for skin cancer prevention.
“Even if you are a low-risk individual who doesn’t have too many moles, I recommend scheduling a baseline visit with your dermatologist for a skin check,” Dr. Moosbrugger says. “Your dermatologist can work with you to determine a regular screening schedule that makes sense based on your risk level.”
Common types of skin cancer conditions
Actinic keratosis
The most common skin cancer condition that Dr. Moosbrugger sees is actinic keratosis, which is actually pre-cancerous lesions.
“Some of these lesions, which resemble rough, scaly pink or red patches, never develop into anything serious, but some can become squamous and basal cell carcinomas. That’s why we treat them,” Dr. Moosbrugger says.
Treatment options include:
- Freezing the lesions with liquid nitrogen in the dermatologist’s office
- Prescribing chemotherapy cream that the patient takes home and applies on the lesion for a couple of weeks
- Painting the lesion with medication and having the patient sit under a special light that activates the medication
All of the treatment options cause the lesion to peel, inflame and then heal.
Basal cell carcinoma
Dr. Moosbrugger also commonly sees basal cell carcinoma and squamous cell carcinomas, both of which are the next level up in severity from actinic keratosis.
“Basal cell carcinomas are small pink or white patches or bumps, similar to a pimple except that they don’t go away,” Dr. Moosbrugger says. “Once a biopsy confirms what it is, treatment options include curettage, or scraping, for superficial lesions located near the top layer of the skin. We treat bigger basal cell carcinomas with a scalpel, cutting around it before closing the wound with stitches. A pathologist confirms the edges are clear on what we’ve removed.”
However, where the basal cell carcinoma is located on your body may determine your type of treatment.
“If the basal cell carcinoma is on the head, neck, face or hands, we are likely to recommend that you see a Mohs surgeon, a dermatologist who’s completed a specialized fellowship in this type of microsurgery. With a Mohs procedure, the surgeon processes the tissue in the office as the procedure progresses, taking small layers of the carcinoma until it comes back clear before stitching you up. Mohs surgery has the highest cure rate, and it spares tissue, providing a better cosmetic outcome,” she adds.
Left untreated, basal cell carcinomas will continue to grow or ulcerate down into the skin. In rare cases, they can even lead to death.
Squamous cell carcinoma
“Squamous cell carcinomas are not as common, but they have more potential to spread. While they tend to be slow-growing, there is a subset that can grow quickly. If caught early, they are low risk,” Dr. Moosbrugger says. “These appear as pink, scaly patches or bumps and tend to come up on areas with sun exposure. Again, we will biopsy the tissue to confirm what it is and treatment options are very similar to that for basal cell carcinomas.”
While treatment for basal cell carcinoma depends more on the location, squamous cell carcinoma treatment relies more on the size.
“Bigger or infiltrating squamous cell carcinomas sometimes call for Mohs surgery on parts of the body beyond the face. Radiation therapy is an option for advanced skin cancer or for an older patient who can’t tolerate surgery that a larger lesion would require,” she adds.
Melanoma
Melanoma is the most dangerous form of skin cancer, and Dr. Moosbrugger sees more of them each year, in line with national trends.
“Melanomas can itch or bleed, appear in various colors and often evolve over time. It’s important to check your skin regularly for anything that looks new and different. If you have a mole or other patch on your body that is asymmetric, has an irregular border, changes color, grows or evolves in any way, please get it checked,” she says.
The thickness of the melanoma determines the stage of the disease. Stage zero melanomas are those caught in the top layer of the skin.
“If the melanoma is less than one millimeter thick in biopsy, we will excise it in the office. It goes to pathology to ensure the surrounding tissue is clear, and if it is, the patient needs only to schedule continued screenings with a dermatologist,” Dr. Moosbrugger says. “If it measures more than one millimeter, we typically recommend a sentinel lymph node biopsy. This is a surgical procedure that is performed in the operating room. A surgical oncologist cuts out the melanoma as well as the lymph node to which it would drain to ensure the cancer hasn’t spread. If the lymph node is clear, the patient usually only needs continued frequent skin screenings. If not, the patient is referred to an oncologist for additional care.”
When to check your skin
“If you have had a melanoma, check your skin monthly. Initially, you might see your dermatologist every three months and then build out to once or twice yearly as you remain cancer-free. We recommend seeing most patients with other skin cancers every six to twelve months depending on the number and frequency of their skin cancers,” Dr. Moosbrugger says.
And while skin cancer is most likely to develop in areas of your body that receive sun exposure, that’s not always the case.
“While we find some skin cancers where the sun doesn’t shine, the majority of them occur in sun-exposed areas,” Dr. Moosbrugger adds. “The sun damages cells cumulatively over time, but luckily, it’s an environmental factor over which we can have some control.”
Learn about the dermatology and skin cancer services we offer at Mercy Health.
