Skin Cancer Awareness
Skin cancer is a lifestyle disease, affecting the young, old and everyone in between. One in 5 Americans will develop skin cancer in his or her lifetime.
An estimated 100,350 new cases of invasive melanoma will be diagnosed in the U.S. in 2020. An estimated 6,850 people will die of melanoma in 2019. Melanoma accounts for less than 1% of skin cancer cases, but the vast majority of skin cancer deaths. The vast majority of melanomas are caused by the sun.
While basal and squamous cell cancers are less likely than melanoma to spread and become life-threatening, they should be identified and treated early. If not, they can grow and invade nearby tissues and organs, causing scarring, deformity or even loss of function.
You can use these tools to learn more.
While anyone can develop skin cancer, you are at greater risk if you have any of these factors:
- Fair skin that freckles easily and burns before tanning
- Light-colored hair and eyes
- Large number of moles or moles of unusual size or shape
- Family and/or personal history of skin cancer
- Personal history of blistering sunburns
- Live or vacation at high altitudes (UV ray strength increases at higher altitudes)
- Spend excessive time outdoors working or playing
- An autoimmune disease, such as lupus
- Had an organ transplant
- A weakened immune system, such as that caused by HIV
- Take medicines that suppress your immune system or make your skin more sensitive to sunlight
Risk increases with age
The incidence of melanoma has been increasing steadily for 30 years. This year alone, approximately 91,270 new cases of melanoma will be diagnosed in the U.S. The risk of melanoma goes up as you age, but melanoma is also diagnosed in those younger than 30.
Find your place in the shade.
For a lifetime of healthy and beautiful skin, avoid a place in the sun and opt for the shade. In addition to preventing skin cancer, follow these recommendations:
- Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day.
- For extended outdoor activity, use a water-resistant, broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
- Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every 2 hours or immediately after swimming or excessive sweating.
- Keep newborns out of the sun. Sunscreens should be used on babies over the age of 6 months.
- Cover your skin with long sleeves, broad-brimmed hats and scarves.
- Examine your skin head-to-toe every month.
- See your physician every year for a professional skin exam.
- Remain in the shade during peak sun hours (10 a.m. to 4 p.m.).
- Wear UV-blocking sunglasses.
- Avoid tanning and never use UV tanning beds.
- Do not burn.
Taking care in Kansas
A recent report from the CDC found that melanoma rates doubled between 1982 and 2011 in the U.S. In Kansas, the malignant melanoma rates increased significantly during the past decade from 16.3 cases per 100,000 people in 2000 to 23.4 cases per 100,000 people in 2011. More than 700 cases of malignant melanoma were diagnosed among Kansans in 2011.
Prevention is key
Speaker 1: Welcome to Bench to Bedside, a weekly series of live conversations about recent advances in cancer from the research bench to treatment at the patient's bedside. And now, your host, and the director of the University of Kansas Cancer Center, Dr Roy Jensen.
Shrikant Anant: Good morning. I'm Dr Shrikant Anant filling in for Dr Roy Jensen, and with me is Dr Daniel Aries, who's a dermatologist at the University of Kansas Health System, and Tim Grimes, who's a melanoma cancer survivor. Welcome. Today we are discussing skin cancer and melanoma. One in five Americans will develop skin cancer in his or her lifetime, and an estimated 91,000 new cases of melanoma will be diagnosed in 2018. The rate of melanoma has been rising for the last 30 years. As few as five sunburns will double a person's risk of developing melanoma, which is an increase in cost of cancer debt in young Americans. So let me start with Dr Aries. Can you please tell us, what are the signs and symptoms of skin cancer?
Daniel Aries: Sure. It's a good question. Particularly for melanomas there are a couple of big things we talk about. One of them is the ABCDs, looking for a legion that is A, asymmetric, so instead of being nice, having the same sides, one side looks different from the other. B is border, so instead of having a nice round border it might have a funny scalloped or [inaudible 00:01:37] border. C is color, you like to see a mole have one color, maybe two, when you start to get to three colors, a mole that has an area that's red and brown and maybe some black, that's very concerning. D is diameter, and they say that a mole bigger than 6 millimeters or about a pencil eraser, that's of concern. And a final factor there is change. And another way of looking at it that's actually even more sensitive is the so-called ugly duckling sign, which is just what it sounds like. So if someone has 20 moles and they all look about the same, and then number 21 looks different, different color, different shape, that's the one to focus on.
Shrikant Anant: So do you actually get that 21st mole? You talked about now the number 21, would that 21st mole come up suddenly, or is it an evolution of that 21st mole?
Daniel Aries: That's a great question. About two thirds of melanomas arise de novo, from scratch, from normal skin, and the other third come from a pre-existing mole. So either one could be dangerous.
Shrikant Anant: I see.
Daniel Aries: If there's a mole that's changing, that's concerning, if there's a brand new mole and it's looking funny, different from the other ones, that's also concerning.
Shrikant Anant: So Dr Aries, we talk about skin cancer, we talk about melanoma, how does one progress from skin cancer to melanoma?
Daniel Aries: Okay, well it's a great question. There are a few skin cancers that we see pretty commonly in the US, the most common is basal cell cancer, then squamous cell cancer, which can be deadly, and then the least common of those three is melanoma. Melanoma's by far the deadliest, as you were saying, 10,000 Americans a year are dying of melanoma. I think they say it's one per hour-
Shrikant Anant: Yeah.
Daniel Aries: ... and the rates are going up, up, up. So even though it's relatively rare amongst skin cancers it's still a common, and frankly preventable, cause of death.
Shrikant Anant: Thank you. So let me ask you a question, Tim. You are a survivor, can you share with us how you discovered you had melanoma?
Tim Grimes: Yeah, I was actually going through the checklist in my head and the mole that actually was concerning, it ended up being melanoma. Definitely had all of those symptoms that he mentioned, or traits that he mentioned. I had moles removed when I was younger, dermatologists would want to keep an eye on them or remove it in biopsy, so I was always kind of just like, ah, they're just moles. But this one in particular was pointed out on my back, and, like I said, it had all of those traits. Kept an eye on it for about a year, unfortunately I took my time in getting it checked out, and it definitely got worse. So I just went in and got it removed then biopsied, and it came back about a week later that it was a higher stage of melanoma and I should go see an oncologist. So, like I said, I was definitely one of those that just didn't really worry about it because I had moles removed when I was younger and didn't realize how bad it could get, how serious it could get.
Shrikant Anant: So what do you do about preventing recurrence of melanoma for you now?
Tim Grimes: Right now I definitely am a lot more active in putting on sunscreen, even my friends are good about reminding me, and just kind of covering up more a little bit-
Shrikant Anant: And do you do it all year round, during summer, or just all year round?
Tim Grimes: I am not a very good skin cancer patient in the fact that I probably don't do it as often as I should, but I'm definitely more aware of it now. So, yeah ... I mean, I would say more likely to put sunscreen on in the summer, but there are definitely times when I kind of have to remember that even though it's cloudy you can still get a sunburn and stuff like that. So I am definitely a little bit more cautious, but not as cautious as I should be. So-
Shrikant Anant: I see.
Tim Grimes: ... don't get mad.
Daniel Aries: [crosstalk 00:05:19] good.
Shrikant Anant: So if you're just joining us we are talking about skin cancer and melanoma and the importance of early detection. Alicia Miller is here in the studio to take your questions, remember to share this link with the people you think might benefit from our discussion. Use the hashtag, BenchToBedside. Dr Aries, can I ask you a question? Can we talk about advances that are taking place in terms of prevention and treatment of melanoma, as well as skin cancer? We talked about sunscreen, what else?
Daniel Aries: Okay, well those are two separate areas and they're both great. So on the prevention side there are a lot of very practical things that people can do in their own lives, and I think you mentioned sunburns as being a major factor, that five sunburns can double your risk, and sunscreen certainly helps. One thing that's important with sunburns is to recognize there's a difference between sun and sunburns. Sun is fine. If you're not the kind of person that turns bright pink and peels after walking the dog, walk the dog, not a problem. Go have fun, play in the park. The key is when there's a risk of burning, when it's all day at the pool, when it's the kind of day where you're gonna get a lot of glare, that's when it's really important to be very sun smart, have your sunscreen on, probably even seek out shelter and shade if that's an option, and avoid those burns. Because sun exposure by itself doesn't cause skin cancer, sunburns do.
Shrikant Anant: I see. I believe we have a question. Alicia?
Alicia Miller: We do, we have four questions, actually. First one is, is there a genetic link to skin cancer or melanoma?
Shrikant Anant: Fantastic question. Is there a genetic link?
Daniel Aries: Yeah. No, and there absolutely is, and there's probably more than one genetic link. So there are some so-called cancer genes that can increase the risk of various cancers, like breast cancer and melanoma can go together, thyroid cancer and melanoma can go together. So there are in fact genetic markers, and that's one of the reasons why having melanoma, or really any skin cancer in the family, is a sign that someone needs to be a little bit more careful. Now it's not a death sentence, it doesn't say, give up hope, in fact it says the opposite. It says, fine, there's a genetic predisposition, there's an increased risk, but that's the reason to be very smart about it-
Shrikant Anant: Yeah.
Daniel Aries: ... and to really look out for those sunburns, avoid tanning. Women under 30 are six times more likely to get melanoma if they've ever done indoor tanning.
Shrikant Anant: So let me ask you a question about the letters of a patient who's had melanoma. Do they just go talk to their physicians, their primary care, and tell them, hey, I do have a family member, a very close, a brother, sister, mother, father, who's had this, and so should you just let them know, so they keep an eye out for this? Is that the way to get going?
Daniel Aries: I think that's a great way to start. Talk to your primary provider and say, look, I just found out my mom got diagnosed with melanoma, my sister got diagnosed with melanoma, I think I'm at higher risk. And you want a good skin exam. If there's anything concerning I think it's worthwhile to seek out an expert, go ahead and go to a dermatology office and get looked at.
Shrikant Anant: Tim, has your family members done this, is that something that has been practiced in your family? Tim Grimes: Absolutely, yeah. It's definitely something that has made it ... it was not anything to be worried about before, but now I think-
Shrikant Anant: Now you are recognizing.
Tim Grimes: Yeah, everybody's kind of keeping an eye on it. And as Dr Aries said, I think if it's anything concerning people should get it checked out. I get pictures of moles from my friends and they're like, hey, should I get this checked out? And for me it's always like if you're worried, yes, go
Shrikant Anant: I do want to come back to asking you about your clinical trial, but Alicia has another question. Can you tell us-
Alicia Miller: Yes.
Shrikant Anant: ... the next question? Alicia Miller: Yes. The next question is, are spray sunscreens safe to use on children? What are the most important things to look for in terms of finding safe, effective sunscreens to use on children?
Shrikant Anant: Children and sunscreen.
Daniel Aries: Okay. Again, another wonderful question. So I want to take this ... again, it's a multi-part answer to a pretty simple question. The first thing is, the best sunscreen's the one you'll actually use. So I don't want to say, oh, sprays aren't that good, don't use any sunscreen. That said, I would say sprays are not that good. The coverage is poor, it can go into the eyes and the mouth and other places it really doesn't belong. The best sunscreens for children, and really the best sunscreens for anyone, are sunscreens that contain ingredients like zinc and titanium. Zinc is not only a really excellent protector, it's a little layer of metal between you and the burning rays, but it's also very safe. It's a nutrient. If you look at certain vitamin pills you'll see zinc is something we all need. By the same token I recommend lip blockers, if your kids will tolerate them, because sunburns on the lips happen and are very dangerous as well, in some ways more dangerous. So ... am I allowed to mention the product, or is that not a good idea?
Shrikant Anant: Not a good idea.
Daniel Aries: I won't mention the product. I'll tell you guys, go out there, go on the internet, find products that contain zinc-
Shrikant Anant: That's right.
Daniel Aries: ... and the other nice thing about zinc is it lasts longer, and some of the chemicals in fact can degrade into byproducts that make the sun more dangerous. So, again, zinc sunscreen and the other thing to add to that, maybe it [inaudible 00:10:32] for all this, but the other thing to add to that is hats are wonderful. Not so much for kids, but for anyone who will wear them sunglasses are great too. So hats, sunglasses, lip block, and a zinc sunscreen and your dermatologist will bless that particular approach.
Shrikant Anant: Thank you. Alicia? Next question? Alicia Miller: Yes. The next question is, is there an age range that is at higher risk?
Daniel Aries: Another excellent question. So the answer is, younger. Sunburns early in life are especially dangerous, and in fact sunburns before age 15 are considered to be far more dangerous than sunburns after age 15. So I'm not saying, oh, you're 17, go out and burn. I'm not saying that, but I am saying, to parents especially, when your kids are smaller they're at much higher risk, so it's really, really important to get that sunscreen on if they're at risk of burning. And this doesn't apply to everyday life, if they're gonna go out and play at recess and they're not gonna get a burn, if they're not that red-haired child who's gonna burn every time and they're fine going in the sun, they can go in the sun. But, you're taking that trip south, you're going to Texas? Pack the sunscreen.
Shrikant Anant: Thank you. Alicia?
Alicia Miller: Mm-hmm (affirmative). Here's one more question. I've heard that melanomas can often appear in areas that aren't even exposed to the sun, can you explain why or how that happens?
Daniel Aries: Okay. Another really interesting question, and this does have a practical application as well. So most melanomas, 85%, are considered to be ultraviolet radiation-induced, meaning sunburn accounts for 85% of melanomas, or indoor tanning. The other 15%, it's something else that causes that, and it may just be random. A fair amount of cancers are random, or so-called stochastic, which is a fancy way of saying random. So the other 15%, they can occur anywhere, and that's why if you're changing a kid's diaper and you see a really weird-looking mole it's something that's worth checking out. And the same applies to individuals who maybe are not red-haired, and not fair-skinned, and think, oh, I won't get a melanoma, I can't burn, look at my wonderful darker skin, they can still get melanomas off of what are called acral lentiginous melanoma, meaning on the hands, on the feet. In our clinic we found a melanoma on the foot of a lady in her fifties who came in for a harmless spot on her arm, and we said, should we look at you since you're here? And she had a blueberry on her foot, and didn't think anything of it because there was no skin cancer in her family, but in fact it was a melanoma. And it was successfully removed.
Shrikant Anant: Nice. So, Tim, I want to really get back to the clinical trials-
Tim Grimes: Sure.
Shrikant Anant: ... and your experience with the clinical trial.
Tim Grimes: Yeah, when I was first diagnosed my chances were not good. I wasn't given a very good prognosis, so it was definitely, let's do whatever we can and be aggressive. So I started on a clinical trial. I've ended up doing different drugs since then, but I was excited to be a part of the clinical trial just because I know how important they are in advancing treatment. So even if it didn't work for me I was excited to be able to help future patients, or at least help the study of it. But I did end up doing about five different treatments, and a lot of them are right, fresh off the clinical trial phase, so that meant a lot to me for people that went through it. I actually know a couple of people who were on my drugs in the clinical trial phase, so just for them to go through it and kind of take that risk, it's definitely not as ... I guess not as safe or as studied as something that's not in clinical trials. So for people to go through that and be able to help advance the medicine, that was something that I really liked hearing about. And to be able to be a part of that was definitely exciting as well, like I said, because a lot of the drugs that saved my life, they were fresh off clinical trials. So it's definitely important to get involved and-
Shrikant Anant: So let me ask you this question because when you were faced with this choice, that you have to go to a clinical trial, did it really worry you that you had to go into clinical trial, or a drug that you didn't really know how safe it was?
Tim Grimes: Not really.
Shrikant Anant: Did you ask the doctor a lot of questions?
Tim Grimes: I did, yeah. He definitely put me at ease, and he made everything very clear and answered all of my questions, and that was definitely important. As much as I was ready to take it on and be aggressive I obviously still had concerns, but he put me at ease. And even ... one of the drugs I was on I had a bad reaction to, but he was able to get it under control and-
Shrikant Anant: Fantastic.
Tim Grimes: ... kind of sidestep that and get back on the right path. So, yeah, I mean it was definitely kind of an easy choice once I'd looked at the other choices and was explained how everything worked. It was for me kind of a-
Shrikant Anant: And it was-
Tim Grimes: ... no-brainer.
Shrikant Anant: And it was not just the physician, right? So you had the support staff as well in the hospital were also-
Tim Grimes: Absolutely. Yeah.
Shrikant Anant: And you had constant communications with them, so you never, ever felt like you were left alone after being given the drug?
Tim Grimes: Oh, absolutely. Yeah. No, they checked up on me all the time. I think I had probably close to weekly visits just monitoring my blood levels and things like that-
Shrikant Anant: Fantastic.
Tim Grimes: And I think the way that my oncologist heard about it was through another cancer center, so he was kind of working with some other people outside of his hospital as well. So that was nice because there was definitely different eyes on my status and keeping an eye on me.
Shrikant Anant: Thank you so much for sharing that experience.
Tim Grimes: Sure.
Shrikant Anant: Alicia? Another question?
Alicia Miller: Yes. Dr Aries mentioned that tanning beds are not safe and that sunburns are what causes skin cancer. If an individual does not burn from a tanning bed are they still okay to use?
Daniel Aries: That's an excellent question, and it raises a really good point, that these are statistics, and so they're kind of looking at groups. And if there is an individual person who is tanning in a really, really mild way, let's say just a minute two or three times a week, so their goal is not really to make their skin tone change, they're not trying to get dark, they're doing it for another reason. For instance, we have patients for whom we recommend tanning for things like psoriasis or certain kinds of lymphoma, but they're not really doing it with the goal of changing their appearance. They're doing it with the very different goal of controlling a symptom where ultraviolet light, in a very low dose, will help. Now, the thing is that the kids, and it's mostly kids who are doing the tanning, most of them don't really have a real mature approach, and many of them are doing it instead to change their skin. And the dermatology view of this is all skin is beautiful, love the skin you're in. If you're pale, be pale, don't try to make yourself into someone you're not because that tends to be unsafe.
Shrikant Anant: And you also mentioned that melanoma is a bigger problem with children, younger ages, right?
Daniel Aries: That's correct. It's that early exposure. So maybe a 16-year-old thinks, oh, I won't burn, I'll just walk that fine line between making myself a little bit darker and not ever burning. But if they fail, they step off that line once or twice, or five times, they've doubled their lifetime risk of melanoma. So they've doubled their risk of a deadly skin cancer for the purpose of something cosmetic.
Shrikant Anant: Yeah, it's really not worth it.
Daniel Aries: No.
Shrikant Anant: Yeah. Alicia?
Alicia Miller: There is another question here. Should individuals see a dermatologist annually for a mole check?
Daniel Aries: Again, a really good question, there's a lot of controversy around it. Someone who has never had sunburns, there's no skin cancer in the family, there's probably not a reason to get an annual check from a dermatologist. It's good enough just to talk to the doctor about it during an annual physical, and also maybe do a self-exam, and I tend to say, four times a year because that'll tell if things are changing. It's kind of like puppies. If you look at your puppy every day you don't notice your puppy's gotten bigger. If you look, let's say, Christmas, St. Patrick's Day, July Fourth, and Halloween, that's four times a year, and you'll notice, hey, that puppy got bigger. And so I think that is worthwhile for everyone, just do a skin check for yourself. But people who are at risk, someone who's had a melanoma, yeah, they need to be followed. Someone who's had some sunburns and maybe has a grandmother who's had a basal cell cancer, that person needs to be looked at.
Shrikant Anant: But then you generally start with the primary care physician anyway- Daniel Aries: Correct.
Shrikant Anant: ... and then they will refer you to a dermatologist.
Daniel Aries: That's correct.
Shrikant Anant: And then they will decide whether you need to do it every year-
Daniel Aries: That's correct.
Shrikant Anant: ... or not, right?
Daniel Aries: That's correct.
Shrikant Anant: So ... Alicia?
Alicia Miller: Are self-tanning products such as lotions safe?
Daniel Aries: Okay. The answer on that is they generally are safe. The self-tanners are the right way to go about it. If you want to change your look for some reason or other and you want to make your skin a little darker use a self-tanner. In terms of the spray-on self-tanners I'd be careful not to breathe it because the things that make the skin darker bind to proteins called keratins, don't worry, this will be over quick, but the lung has the same kind of proteins so you don't want to be tanning the inside of your lung. So hold your breath if you're gonna spray it on, if you're just rubbing it on that's fine.
Shrikant Anant: Thank you. Tim, so you've gone through your clinical trial and you've finished your clinical trial, since then what kind of care are you getting, and do you need it? And ...
Tim Grimes: Yeah, I actually was able to stop treatment in January, I had my last treatment, which was definitely a big milestone. Not only was I cancer-free after a long battle, but I was under the impression I had to do some type of treatment the rest of my life, so that was a big, big milestone for me. But yeah, now it's just kind of every three months-ish I go in and make sure it's still not coming back, hasn't spread anymore, anything like that, and also skin checks. And I've definitely overall been more aware of my health, trying to eat better, definitely ... like I said, I slack a little bit on the sun protection, but it's definitely more than it would have been a couple years ago. So yeah, I mean I think I just overall, I try to take a healthier approach to my life in general, and that was definitely a big eye-opener for me. It was just a lot of little things that you can do throughout your routine can make a big difference in the long run too.
Shrikant Anant: I guess after hearing Dr Aries today you're gonna definitely be using more sunscreen-
Tim Grimes: Oh, yeah.
Shrikant Anant: ... on a regular basis, especially-
Tim Grimes: I don't want to get in trouble.
Shrikant Anant: ... since you don't even have hair. Tim Grimes: Oh, yeah. No, this thing has been burnt many times, that's for sure. It sneaks up on you when you don't have any hair.
Shrikant Anant: That's true. If you're just joining us we're talking with Dr Daniel Aries, who's a dermatologist, about the importance of early detection with skin cancer, and a melanoma survivor, Tim Grimes, who's been telling us all his stories about how he has gone through it. Alicia Miller is here in the studio to take any questions. Any final questions, Alicia?
Alicia Miller: There are no final questions, but we will be continuing the conversation on Facebook. So if you still have questions let us know and we will get those answered for you.
Shrikant Anant: Thank you, Tim. Thank you, Dr Aries. Let's give them a big hand for helping us think through the skin cancer and melanoma. Join us next Wednesday at 10:00 AM for Bench to Bedside as we discuss what patients should know about advances in radiation therapy. Thank you for watching, and we will see you next Wednesday at 10:00 AM. Thank you.
Your role in early detection
By examining your skin, you can catch potentially dangerous conditions while they are still treatable.
Basal and squamous cell carcinomas may begin as:
- A small, white or pink nodule or bump with a smooth and shiny, waxy or pitted surface
- A red spot that is rough, dry or scaly
- A firm, red lump that may form a crusted group of nodules
- A sore that bleeds and does not heal after two to four weeks
- A white patch that looks like scar tissue
Melanoma warning signs
Melanoma is usually signaled by a change in the size, shape or color of an existing mole or as a new growth. Watch for the ABCDE warning signs:
- A is for Asymmetry
One half of a mole or birthmark does not match the other.
- B is for Border
Edges are irregular, ragged, notched or blurred.
- C is for Color
Color is not the same all over and may include shades of brown or black, or sometimes with patches of pink, red, white or blue.
- D is for Diameter
Spot is larger than 6 millimeters across (about ¼ inch – the size of a pencil eraser), although melanomas can sometimes be smaller than this.
- E is for Evolution
Mole is changing in size, shape, color or border.
If you have these warning signs, have your skin checked by your doctor.
By knowing your risk factors and having regular screenings, you can avoid skin cancer. If you have questions or want to request a skin cancer screening, please call 913-588-1227.