Slather on the Sunscreen and Burns Beware

Skin cancer is the most common cancer in adults. While it is not very common in children, it is vitally important to protect children from the sun. Why? Because the greatest amount of skin damage occurs before you turn 18—and the majority of that  before the age of five, says Charles McDonald, MD, chief of dermatology at Rhode Island Hospital. Skin cancer and other skin damage may not show up for 15 to 20 years after initial sun exposure or sunburn, but the damage has been done.

Anyone can develop skin cancer. Although those with lighter skin have a higher risk, everyone should protect themselves.

Types
The three types of skin cancer are squamous cell, basal cell and melanoma. Squamous cell is nearly always caused by sunburn, but may occur where the skin or body has been exposed to repeated trauma. Basal cell does not always occur in sun-exposed skin and is more likely to be hereditary. Melanoma is less common, but more deadly. Melanoma, like squamous cell carcinoma, can spread throughout the body and can cause death.

Two to three million Americans are diagnosed with skin cancer each year, according to McDonald, and the incidence of skin cancer in America increases annually. The most serious type of skin cancer, melanoma, is the most common of all cancers in women 18 to 35. McDonald attributes this in part to the fact that Americans are in the sun more than ever before. Much of this exposure occurs through outdoor recreational activities. This is particularly true of those who are able to spend the winters in warmer locales, such as Florida.

How to examine yourself for skin cancer

Prevention
Living in coastal areas, where the so many of us of enjoy boating, fishing and going to beach, it’s especially important that we protect our skin.

McDonald recommends a broad-spectrum sunscreen that will protect you from both UVA and UVB light rays.  UVA rays are longer rays of light that penetrate the skin deeper and probably are more likely to initiatie the cancer. UVB rays are shorter rays, McDonald says, but still cause considerable damage.

It’s best to avoid the sun between 10 and 3 because the sun’s rays are most intense during these times. However, if you are going to be out, sunscreen should be applied every hour and a half to two hours. McDonald also recommends a wide-brimmed visor or hat and other protective clothing if possible.

More information on preventing skin cancer

Several medications and treatments may be helpful in preventing skin cancer, although their long-term effectiveness is still being tested.

• Retinol can reduce the number of pre-cancerous lesions if it is used daily and over a long period of time. This medication also dramatically increases your sensitivity to the sun.
• Laser therapy may help rejuvenate the skin and cause it to revert to a more normal and youthful physical appearance. It is not known how long this treatment lasts, and if it is able to delay the onset of skin cancer.
• Cancer chemoprevention uses a derivative of retinol. It is presently recommended for those who develop multiple skins cancers. It is effective if used over a long period of time.

Treatment
The good news about skin cancer is that if it’s caught early, it’s almost always curable.

Photodynamic therapy is a new treatment being used at Rhode Island Hospital for squamous cell carcinoma. Photodynamic therapy uses a light sensitive chemical that is painted on the affected skin. The skin is then exposed to a special type of light that activates the chemical to attack the precancerous areas and kills the cancer cells. McDonald compares it to topical chemotherapy.

Cryotherapy can also be used to treat precancerous skin lesions. In this method, a measured amount of liquid nitrogen is applied to the area. Electrodesiccation and curettage uses an electric cautery to literally burn the pre-cancerous lesion, which is then scraped off the skin. This method is least preferred, as it may cause scarring.

Basal cells can also be treated with cryotherapy and electrodesiccation; however, the best method for treating both basal cell and melanoma is to surgically excise the cancer. Both squamous cell and melanoma are very difficult to eradicate if they have already metastasized.

Yet another type of treatment for basal cell and squamous cell skin cancer is Mohs surgery. It is a very specialized method used for removing the cancer while preserving normal tissue.

Mohs Surgery
Rhode Island Hospital’s Mohs micrographic surgery unit, within the department of dermatology, will complete over 1600 procedures this year. It is one of the busiest units in the country. This procedure is used to identify and remove skin cancer from cosmetically or functionally critical areas of the body, such as the face or neck. It is also used on recurring cancers or infiltrating, aggressive or large cancers. This technique allows surgeons to remove as little skin as possible because they are able to map the tissue by immediately examining it under a microscope. Surgeons preserve the tissue by removing only small sections of skin to examine, rather than removing skin that does not contain the tumor. Raymond Dufresne, MD, director of the Mohs unit, suggests that on average, Mohs surgery removes half of what is taken during a regular cancer excision.

Dufresne says that the number of procedures continues to grow each year as he sees younger and younger patients with skin cancer. He says it’s not unusual to see three generations in one year who come in for treatment. Fortunately Mohs surgery offers the highest cure rate of any skin cancer treatment.

More about Mohs surgery

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