Skin cancer is the most prevalent of all cancers. It is estimated that more than one million Americans develop skin cancer every year.

Sun avoidance is the best defense against skin cancer. Over exposure to sunlight (including tanning) is the main cause of skin cancer especially when it results in sunburn and blistering. Other less important factors include: repeated medical and industrial x-ray exposure, scarring from diseases or burns, occupational exposure to such compounds as coal tar and arsenic, and family history. Fair-skinned people who sunburn easily are at particularly high risk for skin cancer.

Prevention means guarding the skin against the known causes of skin cancer. Since the sun's ultraviolet rays are the main culprit, the most effective preventive method is sun avoidance.

• Seek shade between 10:00 A.M. to 4:00 P.M. when the ultraviolet rays are
 the most intense, especially when your shadow is shorter than you are tall.

•  Wear light-colored, tightly-woven, protective clothing, and wide-brimmed hats
(3-inch brim).

• Apply sunscreens with a SPF (Sun Protection Factor) of at least 15.

With a SPF 15 sunscreen applied properly, a fair-skin person who sunburns in 20 minutes can tolerate 15 times 20 minutes (300 minutes) without burning. However, the use of sunscreens should not be an excuse to spend extra time in the sun because other sunrays still go through the sunscreen, such as UVA or infrared, which can age the skin and damage the skin's immune system.

Begin early use of sun protection in childhood because it is estimated that 80 percent of lifetime sun exposure occurs before age 18. Children under 6 months of age should not have prolonged sun exposure, but if this occurs then a sunscreen should be used.

The use of sunscreen should always be part of a program for sun avoidance and never as an excuse for increasing sun exposure.

Develop a regular routine to inspect your body for any skin changes using the simple procedures suggested on pages 5 & 6. If any growth, mole, sore, or skin discoloration appears suddenly, or begins to change, see your dermatologist. Each of the skin cancers depicted on the following pages can be readily detected.

    Actinic Keratosis

Actinic keratoses are small scaly spots most commonly found on the face, lower arms, and back of the hands in fair-skinned individuals who have had significant sun exposure.
If not treated, some actinic keratoses may become skin cancers, requiring more extensive treatment. If diagnosed in the early stages, actinic keratoses can be removed by cryotherapy (freezing), by applying a cream or lotion form of chemotherapy, or by chemical peeling, dermabrasion, laser surgery or other dermatologic surgical procedures. Sunscreens help prevent actinic keratoses.

There are three forms of skin cancer.

   1. Basal Cell Carcinoma

This skin cancer usually appears as a small, fleshy bump or nodule - most often on the head, neck, and hands. Occasionally these cancers may appear on the trunk as red patches. Basal cell carcinomas seldom occur in African Americans, but they are the most common skin cancers found in fair-skinned persons. People who have this cancer often have light-colored eyes, hair and complexions, and don't tan easily. These tumors don't spread quickly. It can take many months or years for one to grow to a diameter of one-half inch. Untreated, the cancer will begin to bleed, crust over, heal, and then the cycle repeats.

Although this type of cancer rarely metastasizes (spreads to other parts of the body), it can extend below the skin to the bone and cause considerable local damage.

  2. Squamous Cell Carcinoma

This skin cancer may appear as a bump, or as a red, scaly patch. Squamous cell carcinoma is the second most common skin cancer found in fair-skinned persons. Typically, it is found on the rim of the ear, the face, the lips, and mouth. It is rarely found in dark-skinned persons. This cancer can develop into large masses. Unlike basal cell carcinoma, it can metastasize. When found early, and treated properly, the cure rate by dermatologic surgery for both basal cell and squamous cell carcinoma is 95 percent.

   3. Malignant Melanoma

It is projected that this most deadly of all skin cancers will develop on the skin of 44,000 Americans annually. Every year, an estimated 7,300 Americans will die from melanoma. It is important to note that the death rate is at last declining because patients are seeking help earlier. Like the less aggressive skin cancers, basal cell and squamous cell carcinomas, melanoma is almost always curable when detected in its early stages.

Melanoma has its beginnings in melanocytes, the skin cells that produce the dark, protective pigment called melanin. It is melanin that makes the skin tan, acting as partial protection against sun. Melanoma cells usually continue to produce melanin, which accounts for the cancers appearing in mixed shades of tan, brown, and black. Melanoma can also be red or white. Melanoma tends to spread, making treatment essential.

Melanoma may suddenly appear without warning, but it may also begin in, or near a mole, or another dark spot in the skin. It is important to know the location and appearance of the moles on our bodies so any change will be noticed. The most important step you can take is to have any changing mole examined by a dermatologist so that any early melanoma can be removed while still in the curable stage.

Excessive sun exposure, particularly sunburn, is the most important preventable cause of melanoma, especially among light-skinned individuals. Heredity also plays a part since a person has an increased chance of developing melanoma if a family member has had melanoma. Atypical moles (dyplastic nevi), which may run in families, and a high number of moles, can serve as markers for people at higher risk for developing melanoma.

Dark brown or black skin is not a guarantee against melanoma. Dark-skinned people can develop melanoma, especially on the palms of the hands, soles of the feet, under nails, or in the mouth. Warning signs of melanoma include: changes in the surface of a mole; scaliness, oozing, bleeding, or the appearance of a new bump; spread of pigment from the border into surrounding skin; and change in sensation including itchiness, tenderness, or pain.

	Asymmetry - One half doesn't match the other half.
	Border Irregularity - The edges are ragged, notched or blurred
	Color - The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.
	Diameter - The width is greater than six millimeters (about the size of a pencil eraser). Any growth of a mole should be of concern.

If a skin biopsy reveals that an area of the skin is cancerous, the dermatologist has an array of surgical procedures to treat the cancer depending on the needs of the individual patient. Early detection and removal offer the best chance for a cure.

Dermatologists recommend that one helpful way to discover early skin cancers is to do periodic self-examinations. Get familiar with your skin and your own pattern of moles, freckles, and "beauty marks." Watch for changes in the number, size, shape, and color of pigmented areas. Call your dermatologist if any changes are noticed.

Prevention of melanoma/skin cancer is the best weapon against these diseases. But if a melanoma should develop, it is almost always curable if caught in the early stages. Practice periodic self-examination to aid in early recognition of any new or developing lesion. The following is one way of self-examination that will ensure that no area of the body is neglected. To perform your self-examination you will need a full length mirror, a hand mirror and a brightly-lit room.

Examine body front and back in mirror, then right and left sides, arms raised. Bend elbows, look carefully at forearms, back of upper arms, and palms. Next, look at backs of legs and feet, spaces between toes, and soles. Examine back of neck and scalp with a hand mirror. Part hair to lift.

Information and photos on this page reprinted with permission from the American Academy of Dermatology.  All rights reserved.