Assistant Professor of Surgery and Dermatology
Leader, Melanoma Management Team
Stony Brook University Cancer Center
Skin cancer — including melanoma and basal and squamous cell carcinomas — is the most common of all cancer types. The American Cancer Society estimates that in the United States this year there will be about 91,270 new cases of melanoma, the most dangerous form of skin cancer, and 9,320 deaths from it. The rates of melanoma have been rising for the last 30 years. The number of cases of the more frequent skin cancers, basal cell carcinoma and squamous cell carcinoma, has been increasing for many years. According to one estimate, about 3.5 million cases of them are diagnosed annually (80% are basal cell). Most of these three types of skin cancer are caused by exposure to ultraviolet (UV) light primarily from the sun. However, only a little over half of American adults use sun-protection measures. The good news is that if diagnosed and treated early, skin cancer can often be cured. But if the disease is allowed to progress, it can result in disfigurement and possibly death.
Here, Tara L. Huston, MD, assistant professor of surgery and dermatology, and leader of Stony Brook's Melanoma Management Team, explains what can be done to help prevent skin cancer and how to detect its early signs.
What should people know about protecting themselves against skin cancer?
Skin cancer is usually the result of sun exposure and blistering sunburns that occur in childhood and also cumulative sun exposure. The most important thing we can do is to protect our children from early sun exposure, although it's never too late to reduce your own risk for skin cancer. Eliminating ongoing sun damage is very important. The good news is that most people with skin cancer are going to be fine. The majority of skin cancers are either basal cell or squamous cell carcinomas. Only 4% of all skin cancers are melanoma, the most serious type of skin cancer.
Besides early sun exposure, what are some other risk factors for skin cancer?
Skin type has a lot to do with it. Fair skin, light hair, and light eyes are risk factors for melanoma. Sun exposure is by far the most common risk factor. The use of tanning salons is also a risk factor. Self-tanning lotions do not pose a risk.
What are the symptoms of skin cancer, and what should people look for?
ABCDE is the key. This applies to new or changing moles. A is for asymmetry; B is for irregular borders; C is for color variation; D is for a diameter greater than 6 millimeters (about the size of a pencil eraser); and E is for evolution, or any change in a mole, including itching or bleeding. Any new lesion that bleeds or scabs and does not go away over four weeks should be brought to your physician's attention.
How often should people do self-body checks for changing moles, and how often should they get clinical checkups?
People should be aware of their skin and look for any changing moles on a daily basis. People who don't have any history of skin cancer should have a complete skin examination annually by a physician. Those with a history of skin cancer, especially melanoma, should be evaluated at least twice a year by a dermatologist and do skin self-checks monthly. It's a lifetime of follow-up evaluations with your doctor, not just because of possible melanoma recurrence, but because of the possibility of other skin cancers as well.
How can people protect themselves against the UVA and UVB rays of the sun?
Plan your outdoor activities before 10 am and after 4 pm. Use a broad-spectrum sunscreen with SPF of 30 or higher, and apply over all exposed skin about ten minutes before going out, and reapply every two hours, or sooner if swimming. There is also clothing that now has UV protection in them, including bathing suits for kids. And be sure to wear a hat to protect the scalp and ears. Sun-exposed areas such as the nose and ears are very common spots where skin cancer can develop.
How is skin cancer treated?
If you have a lesion that you're worried about, the first step is to see your dermatologist, who will remove it if it looks suspicious. Most of the basal and squamous cell cancers are handled with local removal by a dermatologist or plastic surgeon, and that's all the treatment needed. If there is a diagnosis of melanoma, a melanoma surgeon will become involved, and the treatment depends on the depth of the melanoma. If it's what we call a thin melanoma, which is less than one millimeter deep (1/25 of an inch), the treatment is removal of some normal skin around the melanoma. Once the melanoma is more than one millimeter deep or demonstrates concerning features on pathology exam, in addition to removing normal skin around the melanoma, we also sample the lymph node, because the deeper the melanoma, the greater the chance of lymph node involvement.
What distinguishes Stony Brook from other centers in treating skin cancer?
Stony Brook provides comprehensive, multidisciplinary care to patients with melanoma. We offer screening, surgery, and the option to participate in local and national clinical trials. In addition, we conduct basic science and translational research, and also provide community education. While clinical trials are not for everyone and participation in them is strictly voluntary, the availability of these trials serves as a hallmark of our ability to offer leading-edge treatment. For many patients, this is the only opportunity available in Suffolk County to benefit from such studies. Several trials are currently underway at Stony Brook. We recently participated in the Multicenter Selective Lymphadenectomy Trial (MSLT 2) that evaluated the role of completion lymph node surgery in melanoma, in order to determine the optimum care for patients (see Dr. Huston's blog about it). Our dedicated team of pathologists, dermatologists, medical oncologists, and melanoma surgeons meets once a month to review each melanoma case, and thus ensures that our patients receive the benefits of multidisciplinary care.
Editor's note: Dr. Huston and Alexander B. Dagum, MD, her departmental colleague and fellow melanoma surgical specialist, bring years of experience and excellent outcomes to the management of skin cancer. Christopher S. Bellber, MD, is a new and experienced member of the melanoma surgical team.