For most of us, there are are a few things we can do to minimize the risk of developing skin cancer but a great deal of the risk has already been determined for us.
By this, I mean that most of the risk of developing skin cancer happens before we are 25 years old, and a lot of the rest of the risk is determined by our genetics. Thus, short of going back in time and selecting darker-skinned parents who won’t take us to the beach as babies, we need to be prudent about what we can do now.
The most significant intervention is to be aware of any changes in our skin. Since May is skin cancer awareness and protection month, there are some simple things we can do that can really make a difference.
First, have a reasonable strategy to deal with the sun. Since most of us don’t live in a cave, we all get some sun. This is not entirely bad as we require ultraviolet light to make vitamin D and many studies show that significant numbers of Americans are Vitamin D deficient (it is an easy test that can be performed at any doctor).
However, to minimize the chances of developing skin cancer, it is a good idea to avoid sunburns and (as with many things in life) remember that moderation is key. Here’s a rule of thumb for moderation: 15-20 minutes per day (less if you are fair skinned and more if you are dark).
When you are going to be out for longer than this, use high number sunscreens that have UVA protection in them in addition to the UVB protection measured by the SPF rating.
Next, see a board-certified dermatologist annually. This is getting harder to do for a few reasons. The first is that dermatologists are in short supply. The second reason is that many non dermatologists have taken to labeling themselves as dermatologists and are practicing as such without the benefit of training or board certification by the American Board of Dermatology.
Since many states do not regulate what physicians call themselves, this is legal and if you simply pick up the phone book in many areas you will find that several of the people listed in the dermatology section are not.
To help ensure that you are getting seen by those who have been trained, check their credentials online and if they are hazy about what they did their residency in, ask some questions or check with the State Board of Medicine (usually available online).
You are the keeper of your skin, so know the skin you’re in.
Since most skin cancers get noticed by the patient before the physician, it is a great idea to look at yourself once a month and look for anything new or different. Sometimes you can find small areas that bleed or don’t heal (usually basal cell carcinomas). Occasionally you may note moles that are changing size, shape or color (melanomas or dysplastic nevi/ moles).
Other types of lesions that are potential problems may get scaly and red (squamous cell carcinomas) or simply form scabs that itch or bleed. Whatever the case, if you notice something changing on your skin, have a biopsy performed and find out what the issue is. Since many of these lesions are curable when discovered early, it is prudent to get them treated at an early stage.
It is a great idea to get looked at annually by a dermatologist. This means head to toe with nothing on — no makeup or socks etc. If you are shy, wearing something is better than not going at all but less is more in terms of skin examinations.
Dermatologists prefer to see you in a bathing suit than not seeing you at all so go with what works for you. Realize that many insurance companies and Medicare don’t pay for routine skin cancer screenings and do yourself a favor and get one anyway.
Don’t try to squeeze a full exam into a visit that you scheduled to look at some acne just because the insurance will pay for that visit.
Treatment of skin cancers has changed over the years. However, the best treatment for most skin cancers remains surgical.
Fortunately, most of these procedures can be performed by a dermatologist in an office. Alternatives for some types of skin cancer may include topical medications (Aldara is one), freezing, light treatments, or radiation.
However, since surgery allows the physician to determine the extent of the cancer, this is the modality that I prefer. One type of surgery (Mohs) is performed using special pathology so that the borders of the cancer may be found while the patient waits in the office. As with every type of surgery, the outcome depends on the training and experience of the physician performing the procedure.
Some dermatologists have done fellowship training in Mohs or are certified in dermatopathology (the interpretation of skin under the microscope) while others have no training at all. Mohs is usually reserved for basal cell or squamous cell carcinomas on the face or hands but in some instances may be used on other types of skin cancers including those that are large (greater than 2 centimeters), invasive, that were not cured with previous surgeries or that are recurrent.
It is not appropriate for Mohs to be used on many other types of skin cancers and its overuse by some physicians is part of what is straining healthcare.
There are many excellent resources available to educate yourself about skincare and skin cancer. Some of the Web sites that have information include www.aad.org and www.asds.net.
I recommend that you learn about your skin and visit your dermatologist to have an exam annually. If you have a family history of skin cancer or have had one yourself, more frequent visits may be appropriate.
The great news about skin cancer is that it is curable when found early and that there are new treatments being developed all the time.
Dr. Kenneth R. Beer, M.D., is a board-certified dermatologist and dermatopathologist. He is one of a few cosmetic and surgical dermatologists to be credentialed in both specialties. Visit www.idealskin.com.
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