Statistics show that 1 in 5 Americans and 1 in 3 whites will develop skin cancer in their lifetime; 1 person dies of melanoma almost every hour.The American Cancer Society (ACS) predicted an excess of 1.1 million new cases of cutaneous malignancy ending in 11,200 deaths in 2008.The ACS predicted 62,480 new melanoma cases diagnosed in the United States in 2008, resulting in 8420 deaths.
Scaly lesions on sun-exposed skin that do not respond to moisturizers, itch, or bleed with minimal provocation need medical attention. The length of time for an AK to progress to an SCC can be as early as 24.6 months.
Clinical features include pearly translucent flesh-colored papules or nodules with superficial telangiectasias (broken blood vessels). More active lesions may have rolled edges or ulcerated centers.
Clinical features include crusted papules and plaques that may become indurated, nodular, or ulcerated. SCC may arise in chronic wounds, scars, and leg ulcers. Recurrent SCC development within 3 years is 18%, a 10-fold higher incidence compared with initial SCC diagnosis in the general population.
The ABCD rule outlines the clinical presentation and warning signals of the most common type of melanoma."A" is for asymmetry (one-half of the mole does not match the other half);"B" is for border irregularity (the edges are ragged, notched, or blurred);"C" is for color (the pigmentation is not uniform, with variable degrees of tan, brown, or black);"D" is for diameter greater than 6 mm (about the size of a pencil eraser).Some clinicians now include "E" regarding evolution, elevation, or enlargement of a lesion
A key determinant of skin cancer in adulthood is the exposure to UV as a child. Sun protection messages should be linked with other health promotion messages targeting children
- Children should be taught the correct use of sunscreen.
- Select a product that contains the highest allowable percentage of zinc oxide (25%) and titanium dioxide (25%). Both do not undergo significant chemical change or photodegradation with exposure to UV light. Avobenzone (3%) is the only truly effective UVA absorber available and offers the greatest photostability.
- Sunscreen should be applied to all exposed skin at least 20 minutes before going into the sun, even if it is cloudy outside, and needs to be reapplied every 2 to 3 hours or more frequently if swimming or exercising.
- Use at least 1 oz per application, roughly equivalent to the volume of a shot glass.
- Everyone needs to wear a hat and sunglasses with 99% to 100% UVA absorption.
- Patients should be instructed to avoid exposure between the hours of 10 AM and 4 PM when the sun is the strongest, wear sun-protective clothing, and seek shade whenever possible.
- There is no such thing as a safe tan. This includes those gotten in tanning salons.
Sun Protection (March 19, 2009)
Melanoma Review (February 25, 2008)
Skin Cancer—Melanoma (December 8, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Skin Cancer -- Basal Cell Carcinoma (December 3, 2008)
Skin Cancer – Squamous Cell Carcinoma (December 4, 2008)
Moles Should Not Be Treated by Lasers (July 27, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)