Caitlin Gallagher
May 29, 2019 12:41 pm
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With warm weather finally hitting most of the country, it’s almost time to soak up those sweet summertime rays. But before you step outside, refresh your memory on the signs of skin cancer to look out for this season, and remember to slather on that SPF. Your skin will thank you.

Skin cancer is one of the least discriminating cancers of all. It’s the most common type of cancer in the U.S., and celebs like Hugh Jackman and Khloé Kardashian have had their own skin cancer scares. There’s even a lion in South Africa currently being treated for skin cancer.

Skin cancer can be devastating, so we talked with two specialists to find out exactly what can cause it, how to check for it, and what to do to prevent it.

Below, Arizona-based oncologist Dr. Govardhanan Nagaiah and New York City dermatologist Dr. Whitney Bowe share some of the most important things to know about skin cancer so that you can step out into the sun with confidence.

Here’s what you need to know about the signs of skin cancer—and not just during the summer, but any time of year:

What is skin cancer?

Dr. Nagaiah: Skin cancer is the most common type of cancer in the U.S. It begins on the outer layer of skin, called the epidermis, and is most often caused by exposure to ultraviolet (UV) light, including sunlight and artificial UV light from tanning beds. However, skin cancer can appear anywhere on your body even if it wasn’t exposed heavily to UV light.

What are the different types of skin cancer?

Dr. Nagaiah: There are two primary categories of skin cancer.

Melanoma: Melanoma starts in cells in the skin called melanocytes, which are the cells found between the dermis and epidermis. These cancerous growths develop when UV radiation triggers genetic defects to skin cells that lead to rapid multiplication of skin cells that form malignant (cancerous) tumors. Melanomas often look like moles and some actually start out as moles. While the majority of melanomas are black or brown, some may be skin-colored, pink, red, purple, blue, or white. Melanomas can develop anywhere on the skin, but they are more likely to develop on the trunk (chest and back) in men and on the legs in women. The neck and face are other common areas.

Non-melanoma skin cancers: Basal cell cancer and squamous cell cancer are the two most common types of skin cancer. These cancers often form on the head, face, neck, hands, and arms—areas that are often exposed to the sun.

What are the symptoms and signs of skin cancer?

Dr. Bowe: You can develop skin cancer on areas of your body that are not frequently in the sun and even under your nails or on your lip. Non-melanoma skin cancers can look like pearly red bumps, red scaly patches, or even scars that appear without any history of trauma in the area.

When it comes to melanoma, the most deadly form of skin cancer, I remind my patients to remember the “ABCDEs of Melanoma,” which includes evaluating the following characteristics of a mole:

• Asymmetry
• Border irregularity
• Color of the area
• Diameter of the mole
• Evolving size of the area in question

What are some risk factors for skin cancer?

Dr. Nagaiah: Risk factors vary for different types of skin cancer, but there are some general risk factors that include:

• Physical traits such as fair skin, freckling, blue or green eyes, and blonde or red hair.
• Family history of skin cancer. Around 10% of people with melanoma have a close relative with the disease. This may be because the family tends to spend more time in the sun, because family members have fair skin, or both.
• Personal history of skin cancer. People who have already had melanoma have a higher risk of getting it again.
• Excessive exposure to UV light, including a history of sunburns, and/or a history of indoor tanning.
• Skin that reddens, burns, or freckles easily in the sun.
• Skin that becomes painful in the sun.
• Age. Chances of being diagnosed with skin cancer increase as a person gets older due to more sun exposure, but skin cancer is also found in young people.
• Smoking tobacco.
• Severe or long-term skin inflammation.
• Certain types and/or a large number of moles increase a person’s chance of developing melanoma.
• Being male. Men have a higher risk than women.
• Exposure to chemicals or radiation.
• Weakened immune system. People who have been treated with medicines that suppress the immune system have an increased chance of developing melanoma.
• Taking medications that can make it easier to get sunburned.

How can you tell if a skin mole or patch might be skin cancer?

Dr. Bowe: When it comes to a mole, the concern is for melanoma. I recommend that my patients have an annual skin check and to watch for what I call an “ugly duckling,” which means a mole or freckle that stands out to you, seems to be changing, itches, bleeds, or essentially seems to differ from the other freckles/moles on your skin. And, of course, look out for the ABCDEs.

When it comes to non-melanoma skin cancer, if something new appears on the skin and doesn’t resolve, or if you have a spot that bleeds or scabs, it’s worth getting it checked out. Some non-melanoma skin cancers can even look just like a pimple or a scab! But that pimple doesn’t go away, and that scab never quite heals.

Dr. Nagaiah: Some additional signs include:

• Dome-shaped growth
• Scaly patch
• Non-healing sore or sore that heals and returns
• Brown or black streak under a nail
• Skin spots that differ from others

What should you do if you find a potential sign of skin cancer?

Dr. Nagaiah: Talk to your primary doctor or make an appointment to see a dermatologist.

How can you check your own body for skin cancer?

Dr. Nagaiah: Checking your skin means taking note of all the spots on your body. Spots typically include freckles, moles, birthmarks, age spots, bumps, sores, scabs, open wounds that bleed, and scaly patches.

For your self-exam, you’ll need a full-length mirror, a hand mirror, bright lighting, and a place to record your findings. When possible, ask someone to help check hard-to-see places. Here are the steps for a self-exam:

1. Examine your body, front and back, in the mirror, then look at the right and left sides with your arms raised. Women should lift breasts to view the undersides.

2. Bend elbows and look carefully at forearms, underarms, and palms. Also, check between fingers and under fingernails.

3. Look at the backs of your legs and feet, between your toes, and the soles of your feet.

4. Check the back of your neck and scalp with a hand mirror. Part the hair to get a closer look. A hair dryer may be helpful in raising up your hair so it’s easier to see.

5. Examine your back and buttocks with a hand mirror.

Sun exposure isn’t the only risk factor when it comes to developing skin cancer. That is why it’s important to examine all of your skin, including places that aren’t often (or ever) exposed to the sun or UV rays.

After the exam, it’s important to take note of your findings. An easy and effective way to do this is by downloading a Body Map to track new spots or changes in existing spots. On a printed diagram of the body, you simply make marks that correspond to the marks on your skin, then draw lines out to the margin to record approximate size, color, and date. Use the same map to record your findings and compare them each month. There is also this Body Mole Map from the American Academy of Dermatology.

Smartphone apps like SkinVision and MySkinPal can also be used to track and take pictures of spots. It is important to remember, though, that these apps should never be used for diagnosis.

With each self-exam, you’ll become more familiar with what is normal for you, so anything unusual will draw your attention quickly and you can have it checked out by your primary care physician or dermatologist, if you have one.

Do any other health issues accompany skin cancer?

Dr. Nagaiah: Typically, patients with skin cancer feel otherwise well, i.e., they do not feel sick. There are multiple other conditions that might present with skin changes, though. Some examples would be dermatomyositis [a muscle inflammation disease marked by a skin rash], systemic lupus erythematosus [the full name for the autoimmune disease lupus], and porphyria cutanea tarda [a blood condition that causes photosensitivity].

How is skin cancer diagnosed?

Dr. Nagaiah: In most cases, skin cancer is identified first by a doctor as an abnormal area on the skin. However, they won’t know if it’s cancerous or not until it’s removed and tested. This is a biopsy. A biopsy is the only sure way to diagnose skin cancer. You may have the skin cancer biopsy in a dermatologist’s office or as an outpatient in a clinic or hospital. Where it is done depends on the size and place of the abnormal area on your skin. You probably will have local anesthesia.

There are four common types of skin biopsies:

Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area.

Incisional biopsy: The doctor uses a scalpel to remove part of the growth.

Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it.

Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth.

The dermatologist will never “shave off” or cauterize a growth that might be melanoma. An excisional biopsy will be performed, or, if the growth is too large to be removed entirely, a tissue sample will be taken.

Who is typically diagnosed with skin cancer?

Dr. Bowe: More people are diagnosed with skin cancer each year in the U.S. than all other cancers combined. In fact, one in five Americans will develop skin cancer before the age of 70, and many are diagnosed in their 30s and 40s. I can’t tell you how many times a young woman (yes, skin cancer impacts young women too) asks me casually about a little “pimple” that isn’t going away and it turns out being a skin cancer that requires extensive surgery and changes her life forever. Unfortunately, some of my patients don’t actually start practicing sun-safe behaviors until they get that dreaded phone call.

What are some common ways that skin cancer is treated?

Dr. Nagaiah: Skin cancer is typically treated by surgery and radiation. Immunotherapy is used for advanced skin cancer that cannot be treated surgically or with radiation.

What are some simple ways to help prevent skin cancer?

Dr. Nagaiah: It is important to protect yourself from ultraviolet radiation all year round, not just during the summer. Even on cloudy or hazy days, UV rays can reach your skin. UV rays also reflect off surfaces, including water, cement, sand, and snow.

Being extra cautious between 10 a.m. and 4 p.m. may also be beneficial, as these are the most hazardous hours of the day for UV exposure. In North America, UV rays from sunlight are the most intense during late spring and early summer.

Some easy options for protection against UV radiation include:

• Seeking shade or bringing shade with you, i.e. a canopy or an umbrella
• Covering your arms and legs
• Wearing a wide-brimmed hat
• Wearing sunglasses that block both UVA and UVB rays
• Using sunscreen with a sun protection factor (SPF) of 30 or higher
• Planning outdoor activities early in the day or the evening
• Avoiding indoor tanning—it is very important to avoid indoor tanning since even a single exposure, especially at a young age, can increase the risk of melanoma

What are some misconceptions about skin cancer that you’d like to clear up?

Dr. Bowe: There is a common misconception that if you have dark skin, you do not have to wear sunscreen and you cannot get skin cancer. This is not true. Anyone can develop skin cancer, and in darker skin, it is frequently not detected until very late stages when it is more likely to be fatal. So, I recommend to my patients of every skin tone to wear sunscreen, to consider taking a Heliocare supplement, to incorporate UPF clothing and swimwear into their summer wardrobe, to wear a sun protective hat, and to seek shade between the hours of 11 a.m. and 2 p.m. Also, you can have skin cancer and not feel sick. You will not necessarily be in pain or even discomfort initially. Therefore, I recommend an annual skin cancer check at your dermatologist’s office and, you will want to see your derm more frequently if you have already been diagnosed with skin cancer.

These interviews have been edited and condensed.

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