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Sun is everywhere, brightening our day and mood but it also harm our skin to some percentage through its harmful UV rays. Most of the times, this damage is very small and causes mottled pigmentation, skin burn, freckles, wrinkles and increases aging process but when this damage go beyond the maximum tolerance limit of the body then it can cause severe skin problem like skin cancer.

Cause and types of skin cancer

The main cause of skin cancer is harmful ultraviolet rays of the sun. Generally, sunlight consists of two types of ultraviolet rays: UVA and UVB. Both types can cause skin cancer but many sunscreens provide protection only against UVB type. As per FDA “UV radiation from the sun, tanning beds, or from sun lamps may cause skin cancer“.

This is a warning for those who thinks that tanning is cool which is not true. In fact, tanning is the result of skin frying from UV rays which cause the body to release more melanin, skin pigment to darken the epidermis (outer layer of the skin) as a protective measure. Tanned skin is not healthy skin and it can lead to early aging.

Skin cancer is abnormal, uncontrollable and rapid growth of the skin cells which result into two types of tumors:

Benign tumor – It is non cancerous and doesn’t affect other part of the body.

Malignant tumor – It is cancerous and can travel to other parts of the body through blood flow and cause cancer in other parts as well.

Skin cancer is found in three forms which are:

1. Basal cell carcinoma

• Accounts for approximately 80 percent of all skin cancers
• Highly treatable cancer
• Originates in basal cell layer of the epidermis and grows slowly
• Rarely spreads from skin
• Appears as a small, shiny bump or nodule on the skin
• Commonly found on exposed areas like head, neck, arms, hands, and face
• People with light-colored eyes, hair, and complexion are greatly affected by this type

2. Squamous cell carcinoma

• Accounts for approximately 20 percent of all skin cancers
• More aggressive than basal cell carcinoma
• Can spread to other parts of your body if not caught early and left untreated
• Appear as nodules or red, scaly patches of skin
• Found on exposed facial regions such as the face, ears, lips, and mouth
• Fair skinned people are commonly affected by this type

3. Malignant Melanoma

• Less common than the other two types but more dangerous
• Causes 75% of all skin cancer deaths
• Originates in the Melanocytes, cells that produce pigment in the skin
• Appears as an abnormal mole
• Affects all skin types and genders but especially fair skinned people

Who is at risk?

Anyone can develop skin cancer but people who have fair or freckled skin that burns easily, light eyes and blond or red hair are under greater risk than the darker skinned people who have substantially lower risk.

The risk factors for skin cancer includes:

• Skin complexion – fair skinned people are at greater risk
• Family history – Having a first-degree relative (parent, sibling or child) who had skin cancer can increase the risk of getting skin cancer by 50 percent.
• Outdoor job – Men are more likely to get occupational sun exposure than women and they also don’t use any sunscreen or protective clothing which further increases the risk
• Sunny climate – Living in an area with lot of sun exposure also increases the risk of skin cancer

There are some other risk factors which have no relation with harmful sun rays and these are:

• Weakened immune system (sometimes due to organ transplants)
• Exposure to certain chemicals and radiation
• Smoking
• Human Papilloma Virus (HPV)

Signs of Skin cancer

The first sign of skin cancer is a change in the size, shape, color or texture of an existing mole. If you have any of the following signs, you should immediately see a doctor:

• If the mole seems asymmetrical means the shape of half of the mole doesn’t match the other half.
• The border or edges of the mole feel ragged, notched, blurred or irregular
• If the mole is uneven in color. Shades of black, brown and tan may be present. Areas of white, gray, red, pink or blue also can be seen.
• The size of the mole changes due to rapid growth. Melanomas are usually larger (a quarter-inch) than the eraser of a pencil.

Detection of the skin cancer

Regular self examination is important if you are under risk of skin cancer or you spend a large part of time under sun. The best time to do a skin self examination is after a bath. Steps to self exam your body are:

• Stand in a place which has good lighting and use a full-length mirror, a hand mirror, two chairs or stools, a blow-dryer, body maps and a pencil to check and mark any spots on the body.
• Check your face thoroughly especially nose, lips, mouth and ears. Use large and small mirrors to get a clear view.
• Check your scalp thoroughly using a blow dryer and mirror by exposing each section for a proper view. You can also ask for help from your friend or family member.
• Check your hands thoroughly starting from palms and backs, between the fingers and under the fingernails, wrists, front and back of forearms.
• Check your front and back of elbows, underarms and all sides of upper arms by scanning it in the full length mirror
• Continue the inspection to neck, chest and torso and use the hand mirror to see the back of your neck, shoulders, upper back and any part of the back of your upper arms
• scan your lower back, buttocks and back of legs with the help of hand mirror
• Sit down on a chair and put one leg in front of you on the stool to check it thoroughly. Check the front and sides of both legs, thigh to shin, ankles, tops of feet, between toes, under toenails, soles of feet and heels. Use hand mirror to check the genitals.

Look for any skin patches, new skin growths, moles, changes in existing moles or freckles, or sores that bleed or don’t heal. If you find any above mentioned signs of skin cancer then you should immediately seek medical attention.

Biopsy is performed to diagnose the skin cancer and its type. A sample of the tissue (tumor or mole) is required, which is then examined by a dermatopathologist. Sometimes, all of the cancer tissue can be removed at the time of biopsy and no further treatment is needed but sometimes further treatment is required.

Skin cancer treatment

The treatment varies on the basis of type of skin cancer, its size and location and the patient’s preference.

Common treatments for first two types of skin cancer (basal cell or squamous cell carcinomas) include:

• Mohs surgery which involves removal of cancer and some extra tissue
• Electrodesiccation and curettage which involves physically scraping of the affected skin cells followed by electrosurgery
• Cryosurgery or freezing
• Laser therapy removes the affected skin cells with the help of laser light energy
• Drugs (chemotherapy or retinoids)

Since Melanoma or the third type of skin cancer is malignant and quite dangerous therefore a thorough examination is very important to check that how much it has affected the other body parts. The standard treatments for this type includes:

• Wide surgical excision
• Sentinel lymph node mapping to check if the cancerous cell has spread to local lymph nodes
• Drugs (chemotherapy, biological response modifiers)
• Radiation therapy

How to prevent skin cancer?

Skin cancer is highly treatable and preventable too. Although we can’t avoid the sun entirely but you can use these tips to reduce the sun exposure and its harmful effects on the body

• Apply sunscreen with minimum sun protection factor (SPF) of 15 or greater on all exposed skin 30 minutes before sun exposure and then at the interval of every two hours. Use it even on cloudy days.
• Reapply the sunscreen on every two hours after swimming or sweating.
• Use cosmetic products and contact lenses which offer UV protection.
• Wear sunglasses with total UV protection to protect our eyes
• Wear protective clothing long-sleeved dress, pants and accessories like wide-brimmed hat, cap, bandana, scarf to cover your head, face and neck.
• Avoid direct sun exposure as much as possible between 10:00 a.m. and 3:00 p.m. as the sunlight is saturated with UV rays at this time
• Take extra caution near water, snow and sand as these can reflect the sunrays causing sunburn.
• Perform skin self-exams regularly for any signs of skin problem
• For more information, visit the American Academy of Dermatology (AAD) at https://www.aad.org/