As summer comes to a close, many people think about putting away the sunblock. But sun exposure occurs year-round, and too much sun is one of the leading causes of skin cancer.
According to the Centers for Disease Control and Prevention (CDC), skin cancer is one of the most common forms of cancer in the U.S.1 Among veterans, nonmelanoma skin cancer (NMSC) is the most frequently diagnosed2 cancer.
Sun Safety
The best way to prevent skin cancer is to limit sun exposure. If you're in the sun, cover up and use sunscreen on exposed skin. However, if you're a sun lover, are active, or work outdoors, these tips3 can help you stay sun safe:
- Limit exposure to the sun between 10AM and 4PM, when the sun's rays are strongest.
- Keep covered up. Use SPF-rated clothing, wear a wide-brimmed hat, and use wrap-around sunglasses that block UVA and UVB rays.
- Wear a UVA/UVB blocking sunscreen or sunblock. Look for products that contain both chemical and physical blocking agents.
- If you swim, surf, sail, or are otherwise in or on the water, reapply sunblock frequently. Give yourself 15 to 20 minutes for sunblock to sink in before exposure to the sun.
Risk Factors
In addition to taking preventive measures, knowing your risk factors for skin cancer can also help. Risk factors include4:
- Pale or fair skin
- Blue or green eyes
- Blond or red hair
- Family or personal history of skin cancer
- Prolonged regular daily exposure to the sun
- A history of sunburns in childhood
- Skin that burns, freckles, or becomes painful in the sun
If you're more likely to develop skin cancer, you can take extra care by using a higher SPF, staying covered up, and having regular skin cancer exams. If you have significant risk factors, work with your doctor to have regular skin checks.
Types of Skin Cancer
There are three types of skin cancer5: basal cell, squamous cell, and malignant melanoma.
Basal cell carcinoma (BCC): The most common cancer in humans, most BCCs appear on areas of the body that are regularly exposed to the sun (face, ears, scalp, upper body). While BCCs tend to grow very slowly, and rarely spread to other parts of the body, early diagnosis and treatment can prevent additional damage to surrounding tissue. 6
Squamous cell carcinoma (SCC): About 200,000 cases of SCC are diagnosed every year. SCC tends to develop in fair-skinned, middle-aged, and elderly people who have had long-term sun exposure. SCC usually appears on sun-exposed areas of the body, but it can develop anywhere. SCC can spread to other areas of the body, which is why early detection and treatment are critical. 7
Melanoma: Melanoma has been coined "the most lethal form of skin cancer" because it can rapidly spread to the lymph system and internal organs. Melanoma often begins in a pre-existing mole, or a skin growth that might resemble a mole. However, with early detection and proper treatment, the cure rate for melanoma is about 95%. Learning to look for the signs of melanoma can help with early treatment. 8
Detection and Treatment
With an average cure rate of 95% when detected and treated early, skin cancer is one of the most treatable forms of cancer; even melanoma, when limited to the outermost layers of the skin, has a 95% cure rate. That's why early detection and treatment are so important.
Learning to perform regular skin self-examinations and understanding what to look for are keys to early detection. Talk with your doctor if you have concerns about your risk, new skin growths, or about whether you should see a dermatologist.
VA HSR&D Research on Skin Cancer
VA HSR&D is working to improve prevention and treatment for veterans with skin cancer. Several recent studies look at telemedicine and long-term outcomes for veterans with skin cancer.
Recurrence after Treatments of Nonmelanoma Skin Cancer
Nonmelanoma skin cancer (NMSC) is the most frequent cancer reported in veterans, and in this ongoing study, researchers are trying to determine which treatment may best prevent recurrence. Investigators will conduct a prospective longitudinal study of patients newly diagnosed with NMSC. The study will review medical records to compare tumor recurrence at least five years post-surgery with the objective of determining the effectiveness of different treatments. The study will conclude in June of 2009, and it is hoped that given the high prevalence of NMSC in older veterans, an effective and appropriate basis for treatment planning will result. 9
Comprehensive Outcomes of Nonmelanoma Skin Cancer
In this study, investigators compared treatments for nonmelanoma skin cancer (NMSC) in VA with those in private practice. The most common treatments for NMSC are excisional surgery, where the tumor is cut from the skin; electrodessication/curettage, where the tumor is cut from the skin with a curette, or sharp tool, and a needle-shaped electrode treats the area with an electric current; and Mohs surgery, where the tumor is cut in thin layers; each layer is then examined through a microscope until all cancer cells are gone. This prospective longitudinal, observational study compares outcomes of different treatments for non-melanoma skin cancer for 1,500 patients being treated at either a VA Dermatology Clinic in San Francisco or at the Dermatology Department of the University of California at San Francisco. Results show that there were substantial variations in the performance rates of non-melanoma skin cancers between VA and the private site, and this variation exists for both primary tumors and recurrent tumors. For example, patients with low-risk tumors cared for at the private site were much more likely to be treated with Mohs surgery than patients treated at the VA. The study impact is significant in that veterans have a high prevalence of NMSC, and the study will serve to inform clinical decisions and patients' participation in those decisions regarding the most appropriate therapies. 10
Evaluating Teledermatology for Skin Neoplasm
In this recently completed study (the first of its kind), investigators determined the diagnostic accuracy of a store-forward imaging system for skin growths. Researchers obtained obtain digital photographs and a standardized patient history that were electronically forwarded to one of four dermatologists, whose diagnostic accuracy was then compared to the accuracy of clinic dermatologists who had examined the patients. Outcome measures assessed the appropriateness of treatment plans and determined that both in-clinic and teledermatology treatment plans were equivalent. These findings may have wide impact on VA's approach to treatment plans for veterans with skin neoplasms. 11
References
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1, 3, 4 Centers for Disease Control and Prevention website. "Cancer-Basic Information About Skin Cancer."
- 2, 9 Chren, Mary-Margaret, MD. Recurrence after Treatments of Nonmelanoma Skin Cancer. VA Medical Center, San Francisco, CA. (01/2006 - 06/2009).
- 5, 6, 7, 8 American Academy of Dermatology website "What is skin cancer?"
- 10 Chren MM, Sahay, AP, Sands LP. Variation in performance rates of therapies for non-melanoma skin cancers [abstract]. Society of Investigative Dermatology Annual Meeting, Chicago, IL 2000; Journal of Investigative Dermatology 114:744.
- 11 Warshaw, Erin. MD, MS. Evaluation of Store-Forward Teledermatology for Skin Neoplasms. VA Medical Center, Minneapolis, MN (7/2002 - 5/2006).
