Skin Cancer

Skin Cancer: Screening Beyond Sunscreen

If you have skin, you’re at risk for skin cancer — no matter your race, gender or age.

In the United States, more people are diagnosed with skin cancer each year than all other cancers combined.

And the number of diagnosed cases of skin cancer is rising.

But when caught early, skin cancer is highly treatable. 

And that’s why both screening by qualified health professionals and self-screening by you are critical strategies when it comes to winning the race to beat skin cancer.

A Pit Stop with William A. Wooden, MD

Educating his fellow Hoosiers about the prevention and detection of skin cancer is a passion of Dr. William A. Wooden. As the James E. Bennett Professor of Plastic Surgery at the Indiana University School of Medicine and a highly respected plastic surgeon who practices at IU Health, Dr. Wooden teaches future healthcare providers how to care for those with skin cancer and also educates his own patients about the benefits of regular skin cancer screenings. When it comes to the early detection of skin cancer, Dr. Wooden is going full throttle.

People need to realize that skin cancer is a cancer — not just some nuisance. So, it needs to be taken very seriously. There are a variety of different types of cells in our skin and any of them can turn into skin cancer.

Basal cell carcinoma starts in the basal cells, which are at the base of the skin and are responsible for producing new skin cells that replace old ones. This form of skin cancer can appear in a number of ways — including red patches, shiny bumps, pink growths, and others. Basal cell carcinoma is the most common type of skin cancer.

Squamous cell carcinoma begins in the squamous cells, which make up the top layer of our skin. Like basal cell carcinoma, this form of skin cancer takes multiple forms — including scaly red patches, open sores, wart-like growths, and others.

Melanoma is a very serious form of skin cancer and begins in the melanocyte cells of the skin. It’s these cells that give color to our skin. We all have the same number of them, but they work differently depending on our heritage. When they become cancerous, they can do a lot of damage. Melanoma can be difficult to recognize because it might appear within an existing mole or freckle. That’s why it’s so important to notice anything that’s new or changing on your skin and to also know the warning signs for melanoma — which are referred to as the ABCDE’s of melanoma.

Merkel cell carcinoma is a very rare form of skin cancer but can also be extremely aggressive. It grows quickly and can spread to other parts of the body. This is the type of skin cancer Jimmy Buffet was diagnosed with and eventually died from. It tends to look like a shiny reddish, purplish, or bluish-red bump on the skin that expands quite rapidly.

A visual representation of the ABCDE's of Melanoma

The most effective way to detect skin cancer early — when it’s most curable — is to have an annual full body scan conducted by a health care professional trained in skin cancer. If they suspect you’ve developed a skin cancer, they’ll conduct a biopsy of the suspicious spot or growth.

Skin cancer is sometimes detected by patients themselves. They happen to see something that looks different on their skin and this raises concerns. If you see an area on your skin that’s new, increases in size, changes colors, itches or feels unusual — get it checked out by a healthcare professional. Don’t wait. The earlier skin cancer is detected, the less has to be done to treat it.

It's important to educate yourself and your family about skin cancer — including what it looks like. You can find images of the various forms of skin cancer online. Be sure to keep check on your own skin — looking at exposed areas, as well as your back, under fingernail polish, and the bottoms of your feet. Also, be aware of any changes you see on the skin of friends and loved ones.

We should never take our skin for granted.

There are several primary risk factors for skin cancer — and most of us have at least one. They include indoor tanning, sunburns (5 or more during your lifetime double the risk for melanoma), skin type, lack of sun protection, genetics, atypical moles, organ transplantation and red hair.

Also, age is a factor. While people of any age can get skin cancer, the older we are the longer our skin has been exposed to all of the environmental threats around us. Skin eventually wears out.

We never need to get a sunburn — and we don’t want to get one. Just like you wear a bike helmet or a life jacket, you need to protect yourself against sun exposure.

Get a good sunscreen and wear it every day. You don’t need more than a 15 or 30 SPF. Anything above 30 SPF doesn’t add additional protection. These days, you can get sunscreen in a variety of forms, including makeup, lotions, sprays and sticks. Use whichever form works best for you.

For your face, it’s often advisable to use a stick form of sunscreen because it doesn’t run and get into your eyes. In addition to putting it on your face, be sure to put it behind and on top of your ears, as well as on your neck.

The key to using sunscreen effectively is to apply a lot of it. Most people don’t put on enough. If you’re using lotion, put it on until you can see it on your skin and then let it soak in. If it’s in spray form, use it until your skin looks shiny and wet. Be sure to put any sunscreen on before you go outside. For example, don’t try to apply it once you get out to the beach. The wind and sand will make it difficult — if not impossible — to apply correctly. Also, reapply sunscreen throughout the day.

Another way to help reduce the risk of getting skin cancer is to wear sun protective clothing. There are a lot of different styles and affordable options available now. And they’re easy to find.

If you want a tan, get a spray tan or a self-bronzer. Those are safe.

The earlier skin cancer is detected, the more likely it can be cured. This is even the case for the more dangerous forms of skin cancer, such as melanoma.

There are a variety of reasons people don’t get screened regularly for skin cancer and/or don’t come in to be seen if they’ve detected a change on their skin.

One of the most common misconceptions is that people think, “Hey. I wear sunscreen. That means I won’t get skin cancer.” That’s simply not true. While sunscreen certainly can help lessen the risk of skin cancer, it doesn’t completely eliminate it. Also, some skin cancers occur as a result of sun exposure we had when we were kids. So, using sunscreen now doesn’t negate that.

Some believe that tanning beds are a safe option because they’re not the sun. This isn’t the case. Tanning beds are not safe and no one should use them.

Others see a change on their skin and dismiss it as being an age spot or something else. This can lead to a delay in diagnosis and adversely impact treatment options.

Also, some people don’t want to come in for a screening because they’re afraid the doctor will do “bad things” to them — like take a biopsy or use a needle. The thing is, the sooner you come in, the less I’ll have to do when it comes to treating any skin cancer we happen to find.

Shaping the Future of Skin Cancer

In the not-so-distant past, the prognosis after being diagnosed with melanoma was poor. There weren’t drugs or treatments that could successfully attack this form of skin cancer. However, there are now treatments that are working well and improving outcomes. These include immunotherapy therapies that essentially turn a patient’s immune system on so that it will fight melanoma.

The Indiana University Melvin and Bren Simon Comprehensive Cancer Center is staying at the forefront of skin cancer screening and detection by ensuring patients benefit from the latest in screening technologies. These include the Vectra WB360 3D imaging system that analyzes all of a patient’s skin surface in a single scan. Additionally, physicians at the center use dermascopes to conduct an enhanced evaluation of specific spots and growths on a patient’s skin.

When it comes to detecting and treating skin cancer, our multidisciplinary team of surgeons, oncologists, dermatologists, and others is at the top of the leader board.

Racing Highlights

Skin Cancer Research at IU

  • In the largest genetic-focused study to explore squamous cell carcinoma, researchers at IU discovered eight new locations on a person’s genome that could increase their risk of squamous cell skin cancer. These are in addition to the 14 that researchers had already discovered.
  • Exploring the evolution of how skin cancer develops — particularly melanoma — is a focus of IU researchers. The information gained through having a better understanding of how normal cells transform into skin cancer can be used to develop more advanced and effective targeted treatment therapies.

According to the National Cancer Institute:

  • Approximately 2.2% of individuals will be diagnosed with melanoma of the skin at some point during their lifetime.
  • When melanoma of the skin is caught early and hasn’t spread to other areas of the body, the five-year-survival rate is 99.6%.
  • Skin cancer of any kind can occur anywhere on the body. However, most skin cancers occur on areas that are regularly exposed to sunlight.

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