Sun Damaged Skin: Facts on Skin Cancer

By Kouros Azar, M.D. (Plastic Surgeon)

Constant sunshine can pose some significant health threats to Californians of all ages. Most patients are more disturbed by the cosmetic damage created by the sun; however, the medical consequences are far-reaching and a brief reminder never hurts.

In my plastic surgery practice I see many patients seeking to look younger and reverse the damage which has occurred to their skin over the years. The majority of patients show signs of mild or severe sun damage which includes brown spots, red patches, loss of skin elasticity and dullness. Interestingly, most people have more evidence of damage on the left side of their face and hands due to the exposure during driving. Although it is rewarding to reverse the signs of aging and sun damage in my patients, the more important goal is monitoring their skin for possible early signs of skin cancer and treating those lesions that are concerning. We will analyze 1) When you need to be concerned about skin lesions; 2) How to monitor yourself 3) When it’s time to see a specialist.

What are the different types of skin cancer?

The most common forms of skin cancer include Basal cell carcinoma and Squamous cell carcinoma (known collectively as nonmelanoma skin cancer) and malignant melanoma. Both categories have different incidences, risk factors, treatment and prognosis. Of the nonmelanoma skin cancers, basal cell carcinoma is the least threatening while squamous cell carcinoma is slightly more concerning with some propensity to spread. Melanoma is most concerning because of its ability to spread to other parts of the body and cause life-threatening illness.

Nonmelanoma skin cancer

According to statistics from the American Cancer Society, the annual incidence of nonmelanoma skin cancer in the U.S. is now estimated at over one million cases and thus equals all other cases of human malignancies combined. Ultraviolet radiation from the sun is the most common cause. Ultraviolet B (UVB) rays from the sun causes mutations in key genes in our DNA that suppress tumor formation. The risk for these types of skin cancers are cumulative sun damage over a lifetime. Patients with fair skin, light eye color, and those with extensive sun exposure (especially past blistering sunburns) are most at risk. The rise in the number of people with these cancers may be a combination of an increasingly-elderly population; changes in outdoor activity level and clothing styles; atmospheric ozone and environmental pollutants. In light-skinned persons, nonmelanoma skin cancers occur with great frequency on the scalp, ears, back of the hands, nose, and lips. In dark-skinned individuals for example, squamous cell carcinoma occurs with the same frequency on non-sun-exposed or sun-exposed areas.

Basal cell carcinomas may be cosmetically deforming but they are rarely life-threatening. If left untreated they will continue to expand and can become destructive. Unlike Basal cell carcinoma, squamous cell carcinoma does have the potential to metastasize and be life-threatening.

Diagnosis begins with careful examination by a primary care physician, dermatologist or plastic surgeon. Any suspicious lesions or sores that have not healed over time should be sent for a biopsy. Treatment can vary from topical medication to surgical excision and in more severe cases – radiation therapy. Skin cancers occurring in complex areas such as the nose, ears, eyelids or lips may require referral to a plastic surgeon for optimum reconstruction and cosmetic result.

Malignant Melanoma

The critical element to saving lives with melanoma is early diagnosis and treatment. As discussed below, regular self examination is important; however, early evaluation by a dermatologist is paramount. In addition to their clinical experience, they may use modalities such as dermatoscopy or photographic surveillance of the body to help catch early melanomas. Melanoma is more common on the legs of women and the trunk for men. It is more common in light- skin individuals but it can also occur in darker skins. Treatment of melanoma involves surgical excision – with the removal of some surrounding healthy tissue as a “margin”. Depending on location, this may sometimes require plastic surgery to reconstruct the area involved. Treatment may also involve lymph node biopsies and in some cases adjuvant treatment with medications.

Steps you can take to prevent skin cancer

Taking care of your skin means being smart about sun exposure. Since UV radiation is the primary culprit, judicious sun behavior is called for such as limiting significant sun exposure to before 10am and after 3pm and using protective measures. The jury is still out on what types of sunscreens provide the best and safest sun protection. I typically recommend physical sun screens (those containing primarily zinc oxide and/or titanium dioxide) over chemical ones. I like the Solumbra brand of SPF protective clothing and gear.

“Knowing” your skin is also crucial in preventing skin cancer. You and your doctor should work as a team to keep track of your skin health. The American College of Preventive Medicine recommends periodic total skin examinations especially for people at high risk for skin cancer such as those with personal or family history of skin cancer or predisposing physical characteristics, increased occupational or recreational exposure to sunlight. Llook for an increase or change in the number or appearance of moles anywhere on the body. The ABCDE warning signs to alert your physician to include the following: A is for Asymmetry, meaning different halves of the mole don’t match. B is for irregular or shaggy Borders of the mole. C is for uneven Color, for example: part of the mole can be pale brown and part black or any variation of colors. D is for Diameter larger than 6 millimeters or the size of the eraser at the end of a pencil. E is for Evolving or changes in size, shape, color or surface quality (such as scaling, bleeding or pain or itching) of the mole.

While the incidence of skin cancer continues to rise, increased awareness and efforts by patients to “know” their skin can combat this rise. There is no substitute for the knowledge and experience gained over the years by a qualified physician treating skin cancer. I encourage everyone to become active in their own skin health and seek expert advice when needed to avoid the problems of skin cancer. Through this careful and attentive approach, we can all continue to enjoy the beauty of our sunny Southern Californian climate.