Melanoma and Skin Cancer Toolkit

Skin cancer is highly preventable, yet, according to the American Cancer Society, it is the most commonly diagnosed cancer in the United States. Excessive exposure to ultraviolet (UV) radiation from the sun or other sources, like tanning beds, is the greatest risk factor for developing skin cancer. Overall, skin cancers affect more people than lung, breast, colon and prostate cancers combined. The two most common forms are basal cell and squamous cell carcinoma. Melanoma accounts for less than two percent of skin cancer cases.

The Skin Cancer Foundation defines basal cell carcinoma (BCC) as uncontrolled growth or lesions in the deepest level of the epidermis, the outer layer of skin. BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads beyond the original tumor site.

Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. SCC is mainly caused by cumulative UV exposure over the course of a lifetime. It can become disfiguring and sometimes deadly if allowed to grow.

The number of BCC and SCC skin cancers is difficult to estimate because these cases are not required to be reported to the Indiana State Cancer Registry. According to one report, in 2006, an estimated 3.5 million cases of NMSC occurred among U.S. residents.

Melanoma is a serious form of skin cancer that starts in the pigment-producing skin cells called melanocytes. These cells become abnormal, grow uncontrollably, and aggressively invade surrounding tissues. Unlike BCC or SCC skin cancers, melanoma can spread to other organs, tissues and bones. While melanoma only accounts for a small percentage of skin cancer diagnoses, it causes the most skin cancer deaths.

Melanoma can develop in an existing mole or other mark on the skin, but it may form in unmarked skin. Any change in the shape, size, or color of a mole may be an early sign of melanoma. Melanoma usually looks like a flat, brown or black mole that has irregular, uneven borders and is not symmetrical. Melanoma lesions may be any size, but are usually 6 mm (0.25 in.) or larger. A melanoma may be lumpy or rounded, change color, become crusty, ooze, or bleed. Treatment for melanoma works best when the cancer is caught and treated in its early stages when it affects only the skin. Overall, the lifetime risk of getting melanoma is about one in 50 for whites, one in 1,000 for African-Americans and one in 200 for Hispanics.

Who gets Melanoma/Skin Cancer Most Often?

People of all ages, races and ethnicities are subject to developing skin cancer. Some risk factors for developing skin cancer include:

  • Age. During 2008-2012, over 74 percent of melanoma cases occurred among Indiana residents ages 50 and older. However, nationally, melanoma is on the rise among younger people.
  • Sex. Overall, during 2008-2012, the incidence rate for melanoma among Indiana males was 30 percent higher than among females. However, before the age of 50, the incidence rate among females was 64 percent higher than among males. Then, among people ages 55 and older, males had more than twice the risk that females did.
  • Race. During 2008-2012, the risk of melanoma was 15 times higher for Indiana whites than for African-Americans; however, anyone can develop the disease.
  • Fair to light skinned complexion. Freckles are an indicator of sun sensitivity and sun damage.
  • Hair and eye color. People with natural blonde or red hair, or blue or green eyes, are more susceptible to developing skin cancer.
  • Multiple or atypical nevi (moles). People who have a large number of moles (more than 50) often have a higher risk of developing melanoma.
  • Family history. The risk for developing melanoma is greater for someone who has had one or more close relatives diagnosed with the disease.
  • Excessive exposure to UV radiation from the sun and tanning beds. The U.S. Department of Health and Human Services and the International Agency of Research on Cancer panel has found that exposure to sunlamps or tanning beds is known to be a human carcinogen.
  • History of sunburns. Sunburn at an early age can increase a person’s risk for developing melanoma and other skin cancers as they age.
  • Diseases that suppress the immune system. People who have a weakened immune system, or who are being treated with immune-suppressing medicines, have an increased risk for melanoma.
  • Past history of basal cell or squamous cell skin cancers.
  • Occupational exposure to coal tar, pitch, creosote, arsenic compounds, radium or some pesticides.

Common Signs and Symptoms of Melanoma/Skin Cancer

A simple ABCDE rule outlines some warning signs of skin cancer. It is important to remember that melanoma might appear differently than what is described in the ABCDE rule, so discuss any changes to existing moles or new growths on the skin with your health care provider. The ABCDE rule is as follows:

A = Asymmetry: One half of the mole (or lesion) does not match the other half.

B = Border: Border irregularity; the edges are ragged, notched or blurred.

C = Color: The pigmentation is not uniform, with variable degrees of tan, brown, or black.

D = Diameter: The diameter of a mole or skin lesion is greater than 6 millimeters (or the size of a pencil eraser). Any sudden increase in size of an existing mole should be checked.

E = Evolution. When existing moles change in shape, size or color.

Take Charge! Reduce Your Risk

  • Limit or avoid exposure to the sun during peak hours (10 a.m. to 4 p.m.).
  • Wear sunscreen with a Sun Protection Factor (SPF) of 30 or more that protects you from both UVA and UVB rays. These are called “brad spectrum” sunscreens.
  • Wear clothing that has built-in SPF in the fabric, or wear protective clothing such as long sleeves and long pants (tightly woven dark fabrics protect your skin better than lightly colored, loosely woven fabrics).
  • Wear a hat that protects your scalp and shades your face, neck, and ears.
  • Avoid use of tanning beds and sun lamps.
  • Wear sunglasses to protect your eyes from ocular melanoma (melanoma of the eye).
  • ALWAYS protect your skin. Your skin is still exposed to UV rays on cloudy days and during the winter months. Use extra caution around water, snow, and sand as they reflect the sun’s ultraviolet rays.

Early Detection

The best way to detect skin cancer early is to recognize changes in skin growths or the appearance of new growths. Adults should thoroughly examine their skin regularly, preferably once a month. New or unusual lesions or a progressive change in a lesion’s appearance (size, shape, or color, for example) should be evaluated promptly by a health care provider.

Melanomas often start as small, mole-like growths that increase in size and might change color. BCC cancers might appear as growths that are flat or as small raised ping or red, translucent, shiny areas that might bleed following minor injury. SCC cancer might appear as growing lumps, often with a rough surface, or as flat, reddish patches that grow slowly.

Most BCCs and SCCs can be cured, especially if the cancer is detected and treated early. Early stage BCC and SCC can be removed in most cases by one of several methods including surgical excision, electrodesiccation and curettage (tissue destruction by electric current and removed by scraping with a curette), or cryosurgery (tissue destruction by freezing). Radiation therapy and certain topical medications may be used in some cases.

Melanoma is also highly curable if detected in its earliest stages and treated properly. Treatment involves removing the primary growth and surrounding normal tissue. Sometimes, a sentinel lymph node is biopsied to determine stage. Additional, extensive lymph node surgery may be needed if lymph node metastases are present. Treatment for advanced cases of melanoma includes palliative surgery, newer targeted or immunotherapy drugs, and sometimes chemotherapy and/or radiation therapy. The treatment of advanced melanoma has changed with the U.S. Food and Drug Administration’s approval of certain targeted drugs.

Melanoma is more likely than other skin cancers to spread to other parts of the body (i.e. legs, pelvis, spine, bones, liver, and brain). The five-year survival rate for people with melanoma is 91 percent. For localized melanoma (48.5 percent of cases diagnosed in Indiana), the five-year survival rate is 62 percent. In Indiana, during 2008-2012, 3.5 percent of cases were diagnosed in the distant stage. For those diagnosed during this stage, the five-year survival rate declines to just 16 percent.


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