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CONDITIONS
51 Things Dermatologists Need You to Know About Skin Cancer
Charlotte Hilton AndersenWe like to pretend otherwise, but skin cancer is the most common cancer there is, period. Learn from dermatologists how to avoid trouble.
It’s way, way more common than you think
Breast cancer gets a lot of press and lung cancer may be the deadliest but when it comes to the sheer number of cases, but nothing comes close to skin cancer. One in five Americans will get some form of skin cancer in their lifetime, according to the Skin Cancer Foundation. “Skin is the most common cancer in the United States,” says Keira Barr, MD, a dual-board certified dermatologist and founder of the Resilient Health Institute. “There are more cases of skin cancer each year than all other cancers combined.”
There is more than one kind of skin cancer
Skin cancer is simply an abnormal growth of skin cells and while they can all hurt your health, most aren’t deadly, according to the American Academy of Dermatology. Melanoma is the one people most often hear about but it’s far more common to get actinic keratoses (AK), basal cell carcinoma (BCC), or squamous cell carcinoma (SCC).
Melanoma is the number one cancer killer in young adults
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Melanoma is the least common type of skin cancer, accounting for just 1 percent of all cases, but it’s got the highest fatality rate. Once it’s spread to other parts of the body it has a 10 to 15 percent survival rate, according to the American Cancer Society. However, the rate of survival increases the earlier you get diagnosed—if it’s caught before it reaches the lymph nodes, the survival rate is over 90 percent—so stay current on your check-ups.
The other types aren’t great for you either
Just because AK, BCC, and SCC aren’t normally deadly, doesn’t mean you shouldn’t worry about them. People with squamous cell carcinoma have a higher risk of death from any cause than the general population, according to the American Academy of Dermatology. About 4,140 people will die from skin cancers other than melanoma in the United States this year, they add.
Your risk of getting it is almost entirely under your control
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Skin cancer is the most preventable and yet the most ignored cancer, Dr. Barr says. In fact, taking a few simple preventive measures can lower your lifetime risk of getting any type of skin cancer by nearly 80 percent, according to the Prevent Cancer Foundation. Find out the 10 sneaky places you can get skin cancer.
That’s because we know the main cause of skin cancer
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Unlike some cancers that seem to come from a variety of nebulous factors, the cause of the vast majority of skin cancers is very clear: The sun. Constant sun exposure over your lifetime allows UV rays to damage the DNA in your skin, causing mutations and cancers, including deadly melanoma, according to Cancer Research UK.
However, the sun isn’t the only cause of skin cancer
Exposure to the sun’s damaging rays over time is the most common cause of skin cancers, accounting for 90 percent, but genetics also play a role, particularly in melanoma. In addition, repeated x-rays, burn scars, some immune diseases, and exposure to certain chemicals can also increase your risk. For more, check out these 9 surprising things that increase your risk of skin cancer.
Sunscreen, sunscreen, sunscreen
Sunscreen may be one of the greatest yet most underrated modern medical advances. Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by about 40 percent and melanoma by 50 percent, says Tsippora Shainhouse, MD, a board-certified dermatologist in Los Angeles, clinical instructor at the University of Southern California, and on the board for Sun Safety for Kids.
You can get it where the sun doesn’t shine
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While BSC and SCC are generally found on body parts that get the most sun exposure, most melanomas are not found on exposed areas, says Paul B. Dean, MD, MPH, dermatologist and founder of SkinResourceMD.com. Melanomas have a genetic component and may be triggered by sun exposure yet develop in places the sun never reaches, like the back of the legs, the bottom of the feet, and even under your fingernails, he says.
But sunscreen won’t help if you’re using it wrong (and most do)
“Sunscreen should be your last line of defense against skin cancer, not your first and certainly not your only,” Dr. Barr says. Why? Because most people only use 25 to 50 percent of the recommended amount of sunscreen which means you’re getting only a small fraction of the protection you need, she explains. It’s just one of 18 sunscreen mistakes you want to avoid.
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Go high-tech with sun-protective clothing
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One of the best ways to protect yourself is by upgrading the clothing you wear every day, says Brittany Buhalog, MD, chief dermatology resident specializing in skin cancer treatment. Companies now make many stylish tops, jackets, hats, and pants with sun-resistant fabric. Look for a tag stating the item has UPF 50 or higher. They may be a bit pricey compared to your plain t-shirts but the cost of the clothes is way cheaper than your health insurance deductible for skin cancer surgery.
No wet t-shirts
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“Denim works great as sun protective clothing but thin cotton does not,” says. So your favorite summery white t-shirt gives only minimal protection from the sun, which is further reduced if the material gets wet. If your clothing isn’t tagged with a UPF label, know that thicker, darker fabrics will provide more sun protection.
Self-exams aren’t only for breasts
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Early detection can go a long way in preventing and treating skin cancer which is why skin checks are the number one tip Dr. Barr recommends to her patients. And there’s an easy way to remember it: Check your birthday suit every month on the date of your birthday to look for any weird spots, she says. “It only takes five minutes and can save your life,” she adds.
But they don’t replace annual checkups with your doctor
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“If we do not look for skin cancers we cannot detect them,” Dr. Zeichner says. So while your home checks are an essential part of your protection plan, don’t stop there. Make sure to visit a dermatologist annually for a professional skin check as they can see things you can’t or didn’t notice. “Make the appointment right now, don’t put it off,” he adds. “It may be a matter of life and death.”
Enemy #1: Moles
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Most people have at least a few moles on their skin and the vast majority of them are totally fine. However, if you have a mole that looks strange in any way or is changing, it’s time to call your dermatologist, Dr. Barr says. Think ABCDE: Any mole that is Asymmetrical, has an irregular Border, Color that isn’t uniform, a Diameter larger than a pencil eraser, or is Evolving may be a problem and needs to get checked.
Pay attention to other skin spots too
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Moles aren’t the only place skin cancer can show up. Another symptom you should never ignore are sores that don’t heal or come back repeatedly, Dr. Barr says. Any lesion on your skin that seems strange or won’t go away needs to be evaluated by a doctor ASAP. And don’t worry about seeming over-dramatic, your doctor would much rather see you and have it be nothing than miss something important, she adds.
Nude selfies that make sense
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Be honest: How well do you really know your skin? How many moles do you even have? Is that spot a birthmark or did you get it last year? The best way to identify troubling changes on your skin is to document it. Using a mirror or a really close friend, take pictures of your bare skin and save them by date. This will allow you to look for changes over time. (Just don’t send those nudes to anyone else!)
Not all sunburns are equally bad
To be clear: All sunburns damage your skin and all of them increase your risk of getting skin cancer. But when it comes to getting the deadliest type of skin cancer—Melanoma—it’s the kind of bad burn that blisters that you really need to worry about, Dr. Barr says. “One blistering sunburn more than doubles your risk of developing melanoma,” she explains. “Your risk jumps to 80 percent with five or more blistering sunburns.” Here are some surprising things you need to know about skin cancer.
There’s no such thing as a base tan
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There is no such thing as a “protective tan”—you’re just adding more sun damage. More people develop skin cancer due to tanning than lung cancer due to smoking, Dr. Shainhouse says. Here’s exactly how bad tanning is for your health.
Young women are at the highest risk
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Rates of melanoma in women 18 to 39 years old have increased 800 percent from 1970 to 2009, according to the American Academy of Dermatology. Melanoma is the leading cause of cancer-related death in women 25 to 30 years old. Researchers aren’t sure exactly why this is but it means it’s even more important for young women to cover up in the sun, wear sunscreen daily, and avoid tanning beds, Dr. Shainhouse says.
Tans aren’t sexy
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Despite the fact that young women are the most vulnerable to skin cancer, society still encourages them to get a “golden glow,” to look youthful and sexy. This is having dire consequences—70 percent of women ages 18 to 34 aren’t wearing sunscreen regularly and 78 percent of women ages 18 to 24 said they “never” wear sunscreen or only wear it “while at the beach,” according to a RealSelf survey.
Sunscreen in makeup doesn’t count
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Is your foundation or powder labeled with an SPF number? That’s great, but it’s not enough to count. “The average woman doesn’t apply enough foundation to actually obtain the SPF that’s on the bottle,” Dr. Buhalog says. “Look at it as a bonus, but not a primary method of obtaining sun protection for your face.”
Tanning beds are the devil
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Teens, listen up: People who first use a tanning bed before age 35 have a 75 percent higher risk for developing melanoma in the future, Dr. Shainhouse says. And people who have ever used a tanning bed increase their risk of developing non-melanoma cancers by nearly 70 percent, she adds. Embrace your natural skin tone or, if you really want that glow, use fake tanning lotions.
You can’t undo sun damage
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There is a thought that staying out of the sun completely for two years or more may help undo the damage from previous sunburns but while it might help reduce pre-cancerous lesions, there is no evidence that it can undo melanoma risk associated with old sunburns, Dr. Shainhouse says.
It’s never too late to start taking care of your skin
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Think that your fate is sealed thanks to your sun-soaked, sunscreen-free childhood? Only 23 percent of skin exposure happens before 18 years old and taking steps to prevent skin cancer can reduce your lifetime risk no matter how old you are, Dr. Shainhouse says. These 12 surprising things increase your risk of sun damage.
Baseball caps don’t count as sun hats
Wearing a hat is one of the best and easiest ways to reduce your sun exposure—but only if it’s actually shading all your skin, Dr. Shainhouse says. “A baseball cap will cover your scalp and forehead and most of your nose, but will not protect the sides of your face, ears or back of the neck,” she explains. “Look for a hat with at least a 3-inch wide brim that goes all the way around.”
Go for those giant Jackie O shades
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Forget the tiny sunglasses that are trendy this year! To avoid getting skin cancer in your eyes (oh yes, that’s a thing), cataracts, and premature wrinkles, wear large, UV-protective, dark-tinted sunglasses any time you’re outdoors, Dr. Shainhouse says.
Teach your kids young
It may be too late to save yourself from all those sunburns and tanning beds you experienced as a kid but it’s not too late to protect your children, says Jeffrey Benabio, MD, Dermatology Chief of Service, Kaiser Permanente San Diego. One of the best things you can do as a parent is to model good sun behavior by carrying sunscreen with you, applying it before going outdoors, reapplying as necessary, wearing sun-protective hats and clothing and then encouraging your kids to do the same, he says.
The SPF number isn’t how many minutes your sunscreen will last
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A sunscreen’s SPF—sun protection factor—is a confusing thing. But since the rating gauges the ability of the sunscreen to shield UVB rays from damaging the skin, it’s important to know, Dr. Shainhouse says. “An SPF 50 means that 1/50 (2 percent) can get through the sunscreen and reach the skin,” she explains. This is only true, however, if you’re applying it as directed, she adds. Here are some other critical spots you shouldn’t forget to put sunscreen.
The higher the SPF, the better
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There’s a common myth that any sunscreen over, say, SPF 30, doesn’t provide significant extra protection and it’s just a marketing ploy for companies to get more money. Not true, says Joshua Zeichner, MD, Director of Cosmetic and Clinical Research in Dermatology at the Mount Sinai Hospital in NYC. “In a recent study, an SPF 100+ sunscreen was shown to give statistically superior protection as compared to an SPF 50 product,” he says. “For that reason, I recommend patients use the highest level of protection possible.”
Put on more sunscreen—and then add some more
How much sunscreen do you need to get full coverage? More than you think. A lot more. “You need a shot glass or golf ball size amount for your entire body,” Dr. Shainhouse explains. But if you are just treating your face, ears, neck, chest, and scalp, you only need a dollop the size of a quarter, she adds. Check out these 30 sunscreen do’s and don’ts you’ll wish you knew sooner.
Mineral sunscreens work but only with one important caveat
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Mineral sunscreens made with ingredients like zinc oxide and titanium dioxide are becoming increasingly popular as people look for more natural protection. They do work well but there’s one thing you must know: They wipe off very easily. So be careful when toweling off after getting out of the water or wiping the sweat off your brow, Dr. Shainhouse cautions. When in doubt, reapply.
Chemical sunscreens dissolve
Chemical sunscreens have been getting a lot of flack recently as some ingredients have been shown to damage coral reefs and may be carcinogenic. Yet when it comes to ease of use and efficacy, they’re hard to beat. Just remember that UVA chemical sunscreens begin to break down and lose efficacy after two to three hours, Dr. Shainhouse says. Re-apply your sunscreen if you will be outside longer, if you are swimming or sweating a lot, or if you decide to head outside of the office for a lunch break. Check out these 13 sunburn myths that are damaging your skin even more.
Think beyond basic sunscreen formulations
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One of the most common complaints that dermatologists hear is that sunscreen is too thick, sticky, turns the skin white, or causes breakouts. While these are valid concerns, there are a ton of new products on the market that solve these problems, Dr. Buhalog says. Look for setting sprays, powders, gels, and foams that make reapplication less goopy and cumbersome. These are the best sunscreens for every skin type.
Any sunscreen still needs to be combined with other protections
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“Sunscreen alone cannot prevent skin cancer as sunscreen formulations do not protect against all wavelengths of sunlight that can cause skin cancer,” says Fayne L. Frey, MD, a dermatologist and surgeon specializing in skin cancer treatment. “Even broad-spectrum sunscreen cannot prevent all skin cancer.”
Sunscreen can sometimes do more harm than good
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Wearing sunscreen is mandatory, Dr. Frey says, but some people get a false sense of security, letting their guard down in the sun just because their skin isn’t burning. If wearing sunscreen causes you to spend even more time in the sun then more harm than good is done, she says. Do your best to avoid the sun during peak hours and wearing protective clothing and hats.
It’s not a trade-off between cancer and low vitamin D levels
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Vitamin D is a vital nutrient made by the body when your skin is exposed to sunlight. This fact is a popular reason many people give when rationalizing their tan but it’s not an either/or situation, Dr. Dean says. It only takes about 15 minutes of sun to get your vitamin D needs for the day and you have the option of taking supplements, he says. Talk to your doctor about the right balance of sunshine and sunscreen for your body. Here are signs that could mean you’re short on vitamin D.
Early treatment is everything
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Any skin cancers start as pre-cancerous spots, called actinic keratoses, Dr. Dean says. These can be treated by either freezing them or removing them from the surface of your skin. “Early treatment can eliminate these areas from becoming skin cancer, so be sure to check in with your dermatologist when any suspicious spots are noticed,” he advises. These are the skin cancer risk factors you might not know about.
It’s a myth that black people can’t get skin cancer
Don’t be fooled, people who have darker skin tones are not immune to sunburns or skin cancer, Dr. Benabio says. While the incidence of melanoma is higher in fair-skinned people, melanoma can be more deadly in people of color because it’s often diagnosed in its later stages, he adds. These are the skin cancer myths you need to stop believing.
Do not underestimate just how damaging the sun really is
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Fact: Sunshine is a beautiful, warm life essential. Also a fact: The World Health Organization includes ultraviolet radiation, including sunshine, in its Group 1 list of agents that cause cancer—alongside cigarette smoking and other known dangers, Dr. Frey says.
Melanomas aren’t always colored
The stereotypical melanoma is an ominously dark brown or purple mole but some melanomas aren’t colored at all (or are simply skin colored), Dr. Frey cautions. Get anysuspicious bump checked out by your dermatologist. Here are some other places you may be ignoring when you check for skin cancer symptoms.
The more moles you have, the higher your risk
Most of us have a smattering of moles across our bodies but some people are covered in dozens or even hundreds of the brown, raised spots. It’s not just a cosmetic issue—the more moles you have the higher your risk of skin cancer, says Joel Schlessinger, MD, a dermatologist and RealSelf contributor. “Anyone who has 50 or more moles, large moles, or unusual looking moles is at risk,” he says. Ask your doctor how often you need to get checked out based on your moles. Find out what happened when one woman underwent mole mapping.
Watch your screen time
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Spending hours on your phone or tablet has been linked with many health problems and now you can add skin cancer to that list. “There are reports of increased UV damage from the reflection from cellphones and tablet screens on sunny days, so make sure you are protecting yourself using these devices,” says Elizabeth Farhat, MD, a dermatologist with Allina Health in the Twin Cities.
Tinted windows won’t protect you
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Many people think their windshields and car windows provide sufficient protection from harmful rays but you can still get sun through window glass and that means sun damage, Dr. Farhat says. Tinting your car windows does not block UVA rays so wear sunscreen while driving or riding in a car.
Tanned skin is damaged, precancerous skin
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A common myth is that a tan is a sign of good health or that getting a base tan will protect your skin against further sun damage. The reality is that any change in the color of your skin is a sign of sun damage and can set you up for skin cancer down the road, Dr. Schlessinger says. There is simply no such thing as a safe or healthy tan. This is the worst skin care advicedermatologists have ever heard.
Skin cancer doesn’t “feel” like anything
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Skin cancer doesn’t typically hurt, Dr. Schlessinger says. “Most people think that something horrible will cause them pain, but that doesn’t happen with skin cancer,” he says. “These are painless and deadly and if you have any questions about a mole you should see a board-certified dermatologist as it could save your life.”
If it’s bleeding, call your doctor yesterday
Bleeding and/or “pearly” moles are one of the biggest signs of melanoma and should never be ignored, Dr. Schlessinger says. “People don’t notice their mole silently growing but by the time it’s turned black and started bleeding it is well past the point of no return and likely has spread,” he explains.
Watch your hands and feet especially
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Be very aware of any moles on your feet and hands, particularly those that are darker in color, as they can be worse actors in general, Dr. Schlessinger says. Also be on the lookout for dark lines over your finger- or toe-nails or dark spots underneath the nail as those can be signs of melanoma. Note: The UV light in gel manicures can contribute to skin cancer so put sunscreen on before that mani-pedi. Here are some places you can get skin cancer that aren’t on your skin.
Skin cancer sets you up for more skin cancer
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Once you have had skin cancer, you need to follow up closely with your dermatologist because you are at risk for more skin cancers in the future, says Dr. Farhat. Next, find out the 7 hopeful cancer statistics everyone should know.
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