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Patient Question

What Should You Know About Skin Cancer?



Assistant Professor of Surgery
Expert Answer

According to the American Cancer Society, skin cancer is the most common of all cancer types, with more than one million new cases diagnosed each year. Colette Pameijer, MD, Assistant Professor of Surgery, and Claire Smith, RN, Nurse Navigator for Melanoma and Sarcoma in the Division of Surgical Oncology, discuss what you can do to help prevent skin cancer and how to detect early signs of the disease.

What should people know about protecting themselves against skin cancer?
Typically, skin cancer is the result of sun exposure and blistering sunburns that occur before the age of 18. So, in some ways the most important thing we can do is to protect our children from early sun exposure, although it's never too late to reduce your risk for skin cancer. And obviously eliminating ongoing sun damage is very important. The good news is that most people with skin cancer are going to be fine, because most skin cancers are either basal cell or squamous cell carcinomas. Only four percent of all skin cancers are melanoma, the most serious type of skin cancer. While it's not the most common, melanoma is the most common cause of death from skin cancer.

Besides early sun exposure, what are some other risk factors for skin cancer, especially melanoma?
Skin type has a lot to do with it. The vast majority of people who get melanoma are those with fair skin and light hair, and people with a lot of moles on their upper back; but sun exposure is by far the most common risk factor. The use of tanning salons also adds to the risk.

What are the symptoms of skin cancer, and what should people look for?
We use the ABCDE mnemonic to spot changes in moles. A is for asymmetry in the mole; B is for irregular borders; C is for color variation; D is for a diameter greater than 6 millimeters, (about the size of a pencil eraser); and E is for evolution, or any change in a mole, including itching.

How often should people do self-body checks for changing moles, and how often should they get clinical checkups?
If people don't have any history of skin cancer, they should have a complete skin examination annually. Those with a history of skin cancer, especially melanoma, should be evaluated twice a year by a dermatologist and do skin self-checks monthly. It's a lifetime of follow-up evaluations with your doctor, not just because of possible melanoma recurrence, but because of the possibility of other skin cancers as well.

How can people protect themselves against the UVA and UVB rays of the sun?
Plan your outdoor activities before 10:00 am and after 4:00 pm. Sunbathing is not recommended at any time. Use a broad-spectrum sunscreen with SPF of 30 or higher, and apply over all exposed skin about ten minutes before going out, and reapply every two hours. There is also clothing that now has UV protection in them, including bathing suits for kids. And be sure to wear a hat to protect the scalp and ears. We don't want people to feel that they can't go outside. Just reduce your exposure to the sun. Other risk factors such as stress may play a role as well. There may be an immune system component with some melanomas, so we get concerned if people have high stress levels.

How is skin cancer treated?
If you have a lesion that you're worried about, the first step is to see your dermatologist, who will remove it if it looks suspicious. Most of the basal and squamous cell cancers are handled with local removal by the dermatologist and that's all the treatment needed. If there is a diagnosis of melanoma, a surgical oncologist will become involved, and the treatment depends on the depth of the melanoma. If it's what we call a thin melanoma, which is less than one millimeter deep, the treatment is removal of some normal skin around the melanoma. Once the melanoma is more than one millimeter deep, in addition to removing normal skin around the melanoma, we also sample the lymph node, because the deeper the melanoma, the greater the chance of lymph node involvement.

What distinguishes Stony Brook from other centers in treating skin cancer?
Although there's only one FDA-approved chemotherapy drug for melanoma, interferon, there are many clinical trials for new chemotherapy agents-several of which are open at Stony Brook. We have a surgical clinical trial, MSLT 2, that is evaluating the role of lymph node surgery in melanoma. We also have a dedicated melanoma team of pathologists, dermatologists, and medical and surgical oncologists who meet once a month to review each melanoma case so patients receive the benefits of multidisciplinary care.

For Additional Information Contact (631) 444-4000

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