Often when we think of skin cancer, we are unsure of what it may look like. Is it a disfiguring growth, a hideous mole, or a painful bump on the skin? Is it itchy, scaly, or a patchy varied colour? Is it on the face, ears, back, arms, legs, hiding in between toes, or on the scalp? Is it invisible or under the skin?
In fact, it is all of these things. There are several different kinds of skin cancer, and knowing what to look for, and when to seek the advice of a medical professional, is crucial to survival of this widespread disease.
Skin cancer is the most common form of cancer, and numbers of diagnoses are rising. In Canada, almost 75,000 new cases of non-melanoma skin cancers are estimated to be diagnosed this year.
Skin cancer results from cells that multiply out of control. As a result, tumours, lumps, or masses can sometimes form on normal skin, and can be either benign (non-cancerous) or malignant (cancerous). Skin cancers are generally categorized as non-melanoma skin cancers (basal cell and squamous cell cancers) and melanoma.
There are three main types of skin cancer found in the outermost layer of skin, the epidermis:
- Basal cell carcinoma (least serious and most common)
- Squamous cell carcinoma (more serious than basal cell carcinoma, but less common)
- Melanoma (most serious and least common)
The difference among the three is the type of cells that the cancer affects. In the case of non-melanoma skin cancers (i.e., basal cell carcinoma and squamous cell carcinoma), the cell affected is the keratinocyte. In human skin, this cell starts out at the basal layer (the lowest layer of the epidermis) and then moves up to the squamous (or middle) layer of our skin. The non-melanoma cancers derive their names from where in the epidermis the affected keratinocyte is located.
Over time the skin accumulates sun damage that may lead to precancerous changes. The most common precancerous conditions of the skin is actinic keratosis. Actinic keratosis is also called solar keratosis, it is found on sun-exposed areas of the skin in people middle-aged or older. Actinic keratosis is often felt before it is seen. It feels like rough patches. With time the lesions become visible as flat red scaling patches. It may be mistaken for eczema. Unlike eczema it is typically not itchy but may be tender and not completely respond to steroid creams. A person with actinic keratosis will often develop more. The number of actinic keratoses often increases with age. Actinic keratoses are considered pre cancerous. Up to 10% of actinic keratoses may develop into squamous cell carcinoma (SCC) if left untreated. Treatment and sun protection is required to minimize the risk of developing skin cancer.
Early detection is key. Skin Cancer is easy to treat when caught early. If you are suspicious of a lesion then seek attention. Assessing a skin lesion takes literally one minute.
It is very important to check your skin regularly in order to detect any new or changing spots. Make sure to look over and under your shoulders, your nails, your neck, your ears and your head. Once you’ve done that you can check out the people around you. If you see something, say something.
95% of skin cancers are Non melanoma cancers. This type of skin cancer is usually skin colored and are often mistaken for common inflammatory conditions like a pimple, scratch or insect bite. But unlike these inflammatory conditions, skin cancers don’t improve with time, they tend to persist and worsen.
5% of skin cancers are Melanomas. 95% of melanomas are pigmented, meaning some shade of brown They may appear as a new lesion or as change to an existing mole or brown spot.
Steps of a Skin Cancer Self-Exam
- Using a mirror in a well-lit room, check the front of your body -face, neck, shoulders, arms, chest, abdomen, thighs and lower legs.
- Turn sideways, raise your arms and look carefully at the right and left sides of your body, including the underarm area.
- With a hand-held mirror, check your upper back, neck and scalp. Next, examine your lower back, buttocks, backs of thighs and calves.
- Examine your forearms, palms, back of the hands, fingernails and in between each finger.
- Finally, check your feet – the tops, soles, toenails, toes and spaces in between.
Canadian Dermatology Association, patient handout “Melanoma Skin Cancer: Know the Signs, Save a Life” 2009.
When checking your own skin or that of your loved ones, keep in mind the “ABCDE’s of skin checks.”
A – Asymmetry. The shape of one half does not match the other half.
B – Border that is irregular. The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
C – Color that is uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
D – Diameter. There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than 6 millimeters wide (about 1/4 inch wide).
E – Evolving. The mole has changed over the past few weeks or months.
F – Firm – is the mole harder than the surrounding skin?
G – Growing – is the mole gradually getting larger?
Early detection of skin cancer can be a real life-saver. Check your skin every month, keep an eye on any abnormalities or problem areas which just do not seem to heal, and always consult with your family doctor about questions or concerns.
Natalie Richardson, mother, writer, melanoma survivor and advocate.