For many of us, the past year has been one in which health has been on the forefront of our minds like never before. The novel coronavirus pandemic that has swept across the globe has made it difficult to think about little else, and avoiding catching the virus is something that requires daily vigilance. However, although Covid-19 is a serious global health threat and we should all be doing our part to stop the spread, it is important to not forget that there are other ways in which our health can be jeopardized besides the virus. Skin cancer remains the most common form of cancer found both in the United States and worldwide, and more than two people die of skin cancer in the United States every hour. Although there is no data yet on how Covid-19 has affected skin cancer screenings in particular, overall cancer screenings have seen a large dip, with findings released in May of 2020 by the Epic Health Research Network showing a drop between 86 percent and 94 percent in preventative cancer screenings nationwide when compared with equivalent weeks from 2017, 2018, and 2019.
Timing is a crucial factor in the treatment of skin cancer. For example, melanoma is known as one of the more dangerous forms of skin cancer because of its ability to spread to other organs more rapidly if it is not treated at an early stage, but when it is detected early the five-year survival rate is 99 percent. Although during a pandemic the last place you may want to go is a doctor's office, telehealth services have evolved at a rapid pace since the onset of Covid-19, and are particularly useful for skin cancer screenings where cancerous tissue is visible and identifiable more often than not.
For Tim Ioannides, M.D., he believes that arming yourself with knowledge is one of the best ways you can be proactive when it comes to skin cancer prevention. He has spent much of his career not only treating those with skin cancer, but also ensuring each of his patients were well educated on the causes, prevention tactics, and early signs of the disease. Beginning his career at a practice that performed cosmetic procedures in addition to offering services for medical dermatology, he soon left to found his own practice in the Florida county of Saint Lucie, which has the second-highest rate of skin cancer in the United States. At his practice, Dr. Ioannides now focuses exclusively on the prevention and treatment of skin cancer and skin health, and works to emphasize to each patient that while skin cancer is the most common type of cancer diagnosed to Americans in the United States, it is also the most preventable.
Below, we explore the causes of skin cancer, how it is best prevented, and the three most common types to look out for.
How Skin Cancer Occurs
Although other factors exist such as age, a compromised immune system, and a family history of skin cancer and other hereditary variables, the main cause of skin cancer is caused by exposure to ultraviolet (UV) light. The sun emits three types of UV rays, but only two - UVA and UVB - are able to reach the earth's surface. Of the two, UVA rays have longer wavelengths, penetrating deeper into the skin and damaging the fibers in the skin called elastin. You may think that dark spots, wrinkles, and sagging skin are all just a normal part of the aging process, but they are actually caused by the damage done to the elastin in your skin by UVA rays. It is because of this damage that your skin loses its elasticity, sags, stretches, bruises and tears more easily, and takes longer to heal. UVB rays on the other hand, are the primary cause of your skin reddening and eventually turning to a sunburn. Just as UVA rays damage elastin, UVB rays damage the DNA in your skin's cells, and to help with the healing process your body floods the damaged area with blood, resulting in the characteristic red skin and painful inflammation that we call a sunburn.
UV radiation is a proven human carcinogen. Both UVA and UVB rays damage the DNA within your skin cells, which in addition to causing sunburn and aging can also allow it to mutate so that it can't properly control skin cell growth, leading to an abnormal growth of skin tissue that we call a cancerous tumor. It is also important to realize that while the sun is the primary source of UV exposure, it isn't the only one. Indoor tanning devices can emit UV radiation in amounts 10 to 15 times higher than the sun at its peak intensity, and the World Health Organization's International Agency for Research on Cancer lists them in Group 1, along with plutonium, cigarettes, and solar UV radiation. In fact, more people develop skin cancer because of indoor tanning than develop lung cancer because of smoking.
Prevention Best Practices
As Dr. Ioannides previously stated, skin cancer is one of the most preventable types of cancer. Although sunscreen is an incredibly important factor in preventing skin cancer, the most effective way is to avoid sun exposure (and therefore UV radiation) in the first place. Clothing has the ability to prevent UV rays from ever reaching your skin, and it offers a more uniform coverage than sunscreen, which can often be unevenly applied and requires reapplication on a consistent basis. It can be difficult to imagine covering up in the summer when the heat is sweltering and you are spending time at places like the pool or the beach, but many fabrics today have been specially engineered to be both breathable and UV-resistant, making them an ideal choice during the summer. Additionally, accessories such as a wide-brimmed hat and UV-blocking sunglasses offer great protection for your face which can be one of the areas most sensitive to sun damage.
Although clothing provides good protection from solar UV radiation, it isn't a realistic expectation for everybody to cover every single part of their body all day every day. Instead, remaining aware of your surroundings can help keep your skin protected. The sun is most intense between the hours of 10AM and 4PM, so during these times look for shade to remain under. Although shade doesn't provide a perfect barrier from UV radiation it does make a difference, and walking on the shaded side of the street, under trees, or even using an umbrella are easy ways in which you can minimize the amount of time your skin is exposed to the sun. Just be aware that indirect sources of light also emit UV radiation, such as the sun reflecting off of water, snow, sand, or glass, as well as through the leaves and branches of trees.
Speaking of glass, don't think that just because your windows are tinted on your car or even in your house that you are being fully protected from UV radiation. While glass blocks the shorter UVB rays fairly well, UVA rays are still able to pass through them. Your car's front windshield is usually treated to protect the driver and front passenger from UVA rays, but more often than not the side windows, rear windows, and sunroof are not. While you can have a UV-protective film applied to both these windows and those that are in your home, don't forget the windows of trains, buses, and airplanes. In fact, at a higher altitude such as when you are in a plane you are even more susceptible to sun damage.
90 percent of nonmelanoma skin cancers come from solar UV radiation, but if you make the choice to use an indoor tanning bed, you greatly increase your risk at developing one of the three most common types of skin cancer. Using an indoor tanning device just once increases your risk of developing squamous cell carcinoma by 83 percent and your risk of developing basal cell carcinoma by 29 percent. Additionally, using a tanning bed before the age of 35 increases your melanoma risk by 75 percent. Basically, just say no to tanning beds.
All other prevention methods aside, regular and consistent application of sunscreen has been proven to be effective in preventing the development of skin cancer. Those who use sunscreen with an SPF 15 or higher daily have a 40 percent reduced risk of developing squamous cell carcinoma and a 50 percent reduced risk of developing melanoma. They even age better, showing 24 percent less skin aging than those who do not use sunscreen daily. Sunscreen works by either blocking or absorbing the UV rays before they are able to penetrate your skin, and contrary to popular belief, SPF numbers do not indicate how strong a sunscreen is. SPF stands for "sun protection factor" and tells you the multiplier by which you would compare how long the suns' UVB rays would take to redden your skin if you apply the sunscreen exactly as directed, compared with the same amount of time without sunscreen. For example, if you apply sunscreen with an SPF of 30, you would burn 30 times quicker if you didn't use any sunscreen at all. Notice that SPF has nothing to do with UVA rays, which receive a separate rating. Ideally, your sunscreen would also have a UVA rating of four or five stars.
An SPF 15 sunscreen should be adequate protection for daily use if your typical day is spent indoors for the most part, but the more time that will be spent outdoors, the higher SPF that you will likely need in order to remain properly protected. When it comes to the application itself, you should be applying your sunscreen 30 minutes before sun exposure and reapplied at least every two hours. This frequency increases if you will be spending time in the water or expect to be perspiring often, even if you use a water-resistant sunscreen. In general, it should take about one ounce of sunscreen to properly cover your whole body, equivalent to a shot glass worth.
THE THREE MOST COMMON TYPES OF SKIN CANCER
Basal Cell Carcinoma
Over four million cases of basal cell carcinoma are diagnosed in the United States each year, and it is the most common form of skin cancer in the world. Thankfully, it also tends to grow relatively slowly and it is rare for it to spread outside of the original site of the tumor, meaning most are curable and cause minimal damage if they are caught and treated early. However, if left untreated the cancerous skin tissue may continue to grow, widening as well as deepening and destroying both healthy tissue and bone in the surrounding area. Delays in treatment of basal cell carcinoma also results in a higher recurrence rate. Basal cell carcinoma lesions occur most often on the face, scalp, ears, chest, arms, back, and legs, areas that often receive frequent sun exposure.
Squamous Cell Carcinoma
The second-most common form of skin cancer is squamous cell carcinoma, which is diagnosed in over one million Americans every year. As with basal cell carcinoma, early detection and treatment can prevent the cancer from spreading to other parts of the body, but there are aggressive types of squamous cell carcinoma that will target the lymph nodes and other organs within the body if left to grow and spread. Also like basal cell carcinoma, it is most likely to appear on sun-exposed areas of the body, including the back of your neck and even lips. The occurence rate of squamous cell carcinoma has increased up to 200 percent in the last 30 years, and those who are middle-aged or elderly are most likely to be affected by this variant, in particular if they are frequently exposed to the sun or have fair complexions.
Unlike basal cell carcinoma and squamous cell carcinoma, melanoma is a much more deadly form of skin cancer due to the rapidity at which it can spread to other organs. Melanoma is less common than basal cell carcinoma and squamous cell carcinoma, but between 2011 and 2021 the number of new invasive melanoma cases diagnosed annually increased by 44 percent. There are four main types of melanoma of the skin: superficial spreading melanoma, lentigo maligna, acral lentiginous melanoma, and nodular melanoma. Superficial spreading melanoma is the most common form and nodular melanoma is the most aggressive. It can appear in a number of different sizes and colors which makes it difficult to provide a comprehensive set of warning signs, but acral lentiginous melanoma in particular is the most common form of melanoma found in people of color, including individuals of African ancestry, and it often appears in hard-to-spot places including under the nails and on the soles of the feet or palms of the hands. Only 20 to 30 percent of melanoma are found in existing moles, while 70 to 80 percent arise on normal-looking skin.
Regardless of the type of skin cancer, it can appear in all shapes and sizes, as well as look quite different from one person to another. That is why it's important to do a check from head to toe every month. You know your body better than anyone else, and therefore you are the best person to notice potentially cancerous small changes. When examining yourself, be on the lookout for anything new, changing, or unusual, but in particular keep an eye on growths, moles, spots, and open sores. You should also plan on seeing a dermatologist annually, or even more frequently if you are at a higher risk.
Just because there is a global pandemic, doesn't mean the sun stops emitting UV radiation. In the year that has passed, the medical community has made great leaps and bounds in both adapting their offices to accomodate for social distancing as well as within the telehealth space. As we navigate this new normal, it is still important to maintain the best practices of the old, and remain vigilant to the dangers that skin cancer can pose.