HEALTH WATCH | Skin cancer’s cumulative risk
March 2, 2010
Of the many afflictions affecting human skin, skin cancer is probably the most onerous. Skin cancer affects more than 50 percent of Caucasian people and to a somewhat lesser extent people of color. The risk of developing a skin cancer is a function of a person’s genetic predisposition to these diseases modified by their environmental exposure. There is no question exposure to the sun’s radiant energy increases an individual’s risk of skin cancer. The risk is cumulative, in that the more exposure to solar radiation that one experiences during their lifetime, the higher the risk of developing a skin cancer. The problem is no one knows when any given individual hits his or her “tipping point,” so, your biggest weapon in preventing cancer of the skin is to minimize your lifetime sun exposure. That said, we cannot reasonably live underground. Instead, science has developed a large number of readily available ointments that can prevent the amount of radiation that penetrates the skin. The use of these products is “cheap insurance!”
Living at altitude decreases the amount of the earth’s atmosphere the sun’s radiation has to penetrate before striking your skin. Hence a general rule would be individuals living at elevation are at more risk for the development of skin cancer than are their cousins living at sea level. Common sense preventative measures therefore would be to limit sun exposure and to make use of commercially available sunblocks whenever you are anticipating exposure to the sun.
There are basically three common forms of human skin cancer. Of increasingly serious concern, these diseases are; basal cell skin cancer, squamous cell skin cancer and malignant melanoma.
Basal cell skin cancer is by far the most common form of this disease. While this is a “cancer” by definition, basal cell cancers are usually quite benign in nature. They tend to grow slowly and they can destroy skin structures locally, but they do not tend to spread (metastasize) to other areas of the body. Treatment therefore consists of the local removal of these lesions.
Squamous cell skin cancers are more aggressive. If left untreated squamous cell cancer can spread to local lymph nodes and beyond. Hence, the local treatment needs to be a bit more aggressive and the patient needs to be monitored for signs of tumor spread beyond the primary lesion. Thankfully, squamous cell skin cancers occur much less frequently than do basal cell skin cancers.
The skin cancer variant that is of most concern to physicians is malignant melanoma. This tumor is generally pigmented to various degrees. While malignant melanoma is far less common than either basal cell cancer or squamous cell skin cancer, it is far more serious and potentially deadly. Malignant melanoma tends to spread not only to regional lymph nodes, but also to other organ systems. Malignant melanoma needs to be aggressively treated by surgical removal and may need chemotherapy as well.
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Prevention is the key to this family of common diseases. Along with the exposure prevention discussed above, an annual physical examination done by your family physician should include an examination of the skin, especially areas that are exposed. Areas of concern might well warrant a biopsy for confirmation and/or a surgical remedy. Any “sore” that persists or enlarges and is not the result of injury deserves evaluation. Any colored “mole” that appears after childhood or changes in appearance deserves a surgical biopsy.
– Dr. Jellinek is a board certified plastic surgeon practicing in Truckee with more than three decades of experience in treating skin cancer.