Skin Cancer How We Treat It and How to Prevent It

Our skin is a sensitive organ that can be affected by the outside world, such as the UV rays produced by the sun.  Skin cancer—the most common type of cancer in America—can be caused by the sun, causing brown or red spots on our skin that:

• Are growing or changing
• Are sensitive or painful
• Bleed easily

The top reason people develop skin cancer is cumulative exposure to UV rays from the sun or a tanning bed. Individuals who are fair-skinned are most at risk (although, in rare cases, I’ve seen African Americans develop skin cancers!). Other common reasons people develop skin cancer include a:

• Family history of skin cancer
• History of radiation treatment for an underlying cancer
• History of taking medications that suppress the immune system, such as those for treating immune disorders or after organ transplant

Although we treat numerous rare skin cancers, the most common types of skin cancer we see are:

• Basal and squamous cell skin cancer: Also called non-melanoma skin cancers, these generally show up on sun-exposed areas as pimples, scaly spots, or bumps that don’t heal or as rough spots that bleed easily.
• Melanoma:. Melanomas typically appear as a new dark spot on the skin, or a sudden change in a long standing mole. Melanoma is the most dangerous type of skin cancer, and new or changing dark spots on the skin should prompt evaluation with a board-certified dermatologist.

LISTEN: Dr. Ronkainen discusses ways to prevent skin cancer in the Medical Intel podcast.

How to Help Prevent Skin Cancer

To minimize risk of skin cancer, prevent aging, and otherwise protect your skin, it’s critical to protect yourself from too much direct sun exposure. While it’s common for people to love spending time outside, the damage the sun does to our unprotected skin can add up over time. Some common tips I provide patients include:

• Stay out of the sun during peak times: The sun’s harshest hours are between 10 a.m. and 2 p.m.- seek shade between those hours!
• Wear sun-protective clothing: Broad brimmed hats are a great way to shade your face and neck from the sun. Not all fabrics are created equal in protecting you from the sun! If clothes get wet, that also reduces the protection they provide. If intensive outdoor activity is planned, I recommend investing in clothes that have a UPF (like SPF for clothes), to ensure photoprotection stays consistent.
• Wear sunscreen: Choose one that has a sun protection factor (SPF) of 30 or higher daily, with reapplication after swimming/toweling off, and every 2 hours when out in the sun.

How to Pick a Sunscreen

The number of different types of sunscreen has exploded—every five minutes, I hear about a new type of sunscreen that has come out. The main division is between chemical blockers which absorb the UV-rays or physical blockers which reflect them off the skin. I typically recommend physical blockers, such as zinc, titanium, or iron oxide, as they are less irritating to skin, however these can feel chalky, and can leave a visible white cast on the skin. Chemical sunscreens go on more smoothly, however there has been recent data from the FDA noting that these chemical sunscreens can be absorbed into the blood (though the significance of this is not known). At the end of the day, it’s a balance of risks and benefits- the best sunscreen to me is the one my patient doesn’t mind putting on!

How We Treat Skin Cancer

The way we treat skin cancer depends on the size, location, and subtype of skin cancer. Some superficial types of cancer can be treated with a topical cream, but often skin cancer needs to be cut out  through either conventional excision or Mohs surgery.

Conventional excisions involve dermatologists cutting out a little rim of healthy skin around the cancerous spot to ensure all of the cancer is removed. Mohs’ surgery is a specialized surgery done by a fellowship-trained dermatologic surgeon done to spare as much of the healthy skin around the cancer as possible.  Surgeons are able to do this by examining edges of tissue under the microscope  little by little until they reach tissue that isn’t cancerous. Not all skin cancers need Mohs’ surgery. Mohs’ surgery generally takes about half a day, and achieves a very cosmetically pleasing result.

Topical creams can be used to treat skin cancer when it only affects the very top layer of skin. People usually apply topical creams at home for several weeks while a dermatologist monitors the spot to ensure it heals. In many cases, the affected skin becomes red and inflamed when using the topical cream, which is a sign that it’s fighting off skin cancer cells.

A Success Story

We see people of all ages and from all walks of life who are often seeking screenings for marks on their skin—especially if they have a family history of skin cancer. One particular patient made an appointment to have a spot on his back examined because he had noticed it was rough and raised above the skin. We determined that the spot was a benign seborrheic keratosis, a warty growth that grows larger with age. But that’s not the only thing we spotted when he came in! We also identified a dark spot near the benign seborrheic keratosis that the patient hadn’t noticed. We tested the spot and realized it was a melanoma! He underwent excision of the melanoma and did quite well.

What if Skin Cancer Is Left Untreated?

Without treatment, skin cancer can continue to grow and become more difficult to treat. For example, over time, basal cell skin cancer can begin bleeding more frequently and eventually erode into tissue under the skin. In fact, I’ve seen basal cells go into bone if left untreated. Melanoma and squamous cell skin cancer, meanwhile, can travel to lymph nodes and become widespread and metastatic, which would require systemic treatment that targets cancer in the entire body, such as chemotherapy.

We have experts at MedStar Washington Hospital Center who are here to help you with your skin cancer—whether it requires Mohs surgery or a topical treatment. If you’re experiencing skin cancer symptoms, make sure to reach out to us so we can help address your condition.