Linda Talbott remembers looking in the mirror and seeing a tiny black dot under her left eye. It looked like a fleck of mascara, she recalls. But six weeks later, the seemingly benign speck had swollen into a purple, raisin-sized blob. A visit to her dermatologist confirmed Talbott’s worst suspicions — the 58-year-old Missouri woman had melanoma.
After extensive surgery to remove the tumor under her eye, and a second, less ominous looking spot on her cheek, Talbott has been cancer free for six years.
Like many cancer survivors, Talbott wanted to know why the disease picked her. It didn’t take long for the Kansas City woman to learn about the link between blistering sunburns and melanoma.
“I was in the sun constantly as a child,” Talbott remembers. “Up to the time I was 10 or 11, I got blistering sunburns on my face all summer long.”
Ever since Americans fell in love with the bronzed look, skin cancers have been on the rise, experts say. Ultraviolet rays from the sun can damage skin, even at low levels. And the more intense the sun exposure, the clearer the link to cancer, they say.
Nearly 1 million new cases of skin cancer are diagnosed each year, according to the American Cancer Society. In 2002, approximately 54,000 of these were classified as melanoma which accounted for 7,400 of the 9,600 skin-cancer deaths.
Skin cancer's different form
There are several different forms of skin cancer. The non-melanoma skin cancers, known as basal cell carcinoma and squamous cell carcinoma, generally turn up on sun exposed areas of the skin and are the easiest to cure.
Melanoma, on the other hand, tends to be more aggressive and deadly. It starts in the melanocytes — cells that produce pigment — and is the most likely of the skin cancers to spread to other parts of the body.
Certain melanomas are clearly not sun related — they occur in areas of the body that tend to be covered — but most result from heavy sun exposure, says Dr. Desiree Ratner, director of dermatologic surgery and an associate clinical professor of dermatology at the Columbia Presbyterian Medical Center in New York City.
While squamous cell carcinomas tend to be much less aggressive than melanomas, they can be deadly if left untreated because cancer cells from the initial tumor site can spread throughout the body. Basal cell carcinomas are also unlikely to kill you, but they can turn into nasty lesions if left untreated, according to Ratner.
“They can become very large,” she says. “When a patient asks why it needs to be treated, I tell them that once a year I take off a nose, an ear or an eyelid. These tumors can be very locally destructive.”
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Signs to watch for
So how do you know if you’ve got skin cancer? Experts say that any new growth on the skin — or changes in an older one — should be looked at by a dermatologist.
Many lesions turn out to simply be scarred and damaged skin. Still, says Ratner, “If there’s something you’re worried about but it doesn’t fit the classic description, you probably should see a dermatologist anyway.”
When it comes to melanoma, dermatologists suggest looking out for the “ABCDs” of cancer. “A stands for asymmetry of the shape of the mole,” Ratner says. “B is for irregular border. C is for different colors in the same mole. And D means a diameter greater than the size of a pencil eraser.”
Other warning signs of skin cancer include:
- Changes in the shape or pigmentation of a mole
- Oozing or bleeding from a bump
- A sensation of itchiness, sensitivity or pain
You should examine your body regularly to look for possible signs of skin cancer, experts say. And people at greater risk of developing melanoma — those who have a family history of the disease or who have many moles — might want to try to locate a dermatologist who offers “mole mapping,” says Dr. Martin Weinstock, a professor of dermatology at Brown University in Providence, R.I., and chair of the American Cancer Society’s Skin Cancer Advisory Group.
“We take digital images and give a copy to the patient,” Weinstock says. “That way the patient can do better self examinations of their skin.”
Early detection can make the difference between life or death, experts say. “It’s important to stress that any kind of skin cancer is curable most of the time if it’s caught early,” Ratner says. “Even melanoma, if it’s still in the superficial layer of the skin, theoretically, has a 100 percent cure rate.”
Ultimately, the best way to deal with skin cancer is to prevent it. And the best way to prevent it is to protect skin from the sun by cultivating an appreciation for a paler skin tone.
“When I grew up, being tanned was associated with being healthy,” says Dr. Keith Flaherty, an instructor of medicine at the Abramson Cancer Center at the University of Pennsylvania School of Medicine in Philadelphia. “It’s going to take a lot of time to get away from that.”
While sunburns are a risk factor for cancer, even sun tans are a sign of some sun damage, Flaherty says. The more hours spent in the sun, the greater the damage to structures that keep skin taut, he adds.
“So even if you’re fortunate enough to never develop cancer, chronic sun exposure will surely cause cosmetic changes to the skin, Flaherty says.
Get covered up
A first line of defense for the skin is clothing, Weinstock says. But not all clothes are equally sun-protective, he adds. That’s because loosely woven garments tend not to block out as many of the sun’s damaging rays as tightly woven ones.
“As a rule of thumb, if you can’t see through the material when you hold it up to the light, it’s probably going to offer good protection,” Weinstock says.
Weinstock also recommends wash-in additives that can improve the sun-blocking qualities of clothing.
While covering up might offer enough protection for most people — those with light complexions or a history of skin cancer — might need a two-pronged strategy that also includes regular applications of sun screen, Weinstock says.
Another way to avoid absorbing too many damaging rays is to exercise in the evening or early morning, Flaherty says, since the sun is much less powerful at these times.
Linda Carroll is a free-lance reporter based in New Jersey. Her work has appeared in The New York Times, Health and Smart Money.
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