Since May is “Melanoma/Skin Cancer Detection and Prevention Month,” our Skin School will be posting a series of articles to explore this topic in-depth.  The first line of defense against skin cancer is prevention and our team of physicians at Knoxville Dermatology Group find knowledge is our most powerful weapon.  Therefore, our goal is to provide our clients (current and potential) with resources to answer dermatologic questions as well as increase awareness about skin diseases such as melanoma and skin cancer.

Skin cancer is the most common form of cancer in the United States. The two most common types, called basal cell and squamous cell carcinomas, are highly curable. But melanoma, the third most common skin cancer, is more dangerous.

Who Can Get Skin Cancer?
Anyone can get skin cancer, but some things put you at higher risk, like having—

• A lighter natural skin color.
• A personal history of skin cancer.
• A family history of melanoma.
• Exposure to the sun through work and play.
• A history of sunburns early in life.
• Skin that burns, freckles, reddens easily, or becomes painful in the sun.
• Blue or green eyes.
• Naturally blond or red hair.

RISK FACTORS
Ultraviolet (UV) Light

Ultraviolet (UV) rays are an invisible kind of radiation that comes from the sun, tanning beds, and sunlamps. UV rays can penetrate and change skin cells.

As found on the Skin Cancer Foundation website, the three types of UV rays are ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC)—

• UVA is the most common kind of sunlight at the earth’s surface, and reaches beyond the top layer of human skin. Scientists believe that UVA rays can damage connective tissue and increase a person’s risk of skin cancer.
• Most UVB rays are absorbed by the ozone layer, so they are less common at the earth’s surface than UVA rays. UVB rays don’t reach as far into the skin as UVA rays, but they can still be damaging.
• UVC rays are very dangerous, but they are absorbed by the ozone layer and do not reach the ground.

Too much exposure to UV rays can change skin texture, cause the skin to age prematurely, and can lead to skin cancer. UV rays also have been linked to eye conditions such as cataracts.

UV Index

Developed by The National Weather Service and the Environmental Protection Agency, the UV Index lets you know how much caution you should take when working, playing, or exercising outdoors.

The UV Index predicts exposure levels on a 1–15 scale; higher levels indicate a higher risk of overexposure. Calculated on a next-day basis for dozens of cities across the United States, the UV Index takes into account clouds and other local conditions that affect the amount of UV rays reaching the ground.

Tanning and Burning
When ultraviolet (UV) rays reach the skin’s inner layer, the skin makes more melanin. Melanin is the pigment that colors the skin. It moves toward the outer layers of the skin and becomes visible as a tan.

A tan does not indicate good health. A tan is a response to injury, because skin cells signal that they have been hurt by the sun’s UV rays by producing more pigment.

People burn or tan depending on their skin type, the time of year, and the amount of time they have spent in the sun. According to the American Academy of Dermatology, the six types of skin, based on how likely it is to tan or burn, are—

• I: Always burns, never tans, sensitive to sun exposure.
• II: Burns easily, tans minimally.
• III: Burns moderately, tans gradually to light brown.
• IV: Burns minimally, always tans well to moderately brown.
• V: Rarely burns, tans profusely to dark.
• VI: Never burns, deeply pigmented, least sensitive.

Although everyone’s skin can be damaged by too much sunlight, people with skin types I and II are at the highest risk.

SIGNS & SYMPTOMS

Warning Signs: The ABCDEs of Melanoma

Moles, brown spots and growths on the skin are not always harmless. Anyone who has more than 100 moles is at greater risk for melanoma. The first signs can appear in one or more atypical moles. That’s why it’s so important to get to know your skin and to recognize any changes in the moles on your body. Look for the ABCDE signs of melanoma, and if you see one or more, make an appointment with a physician immediately.

Asymmetry: The mole is asymmetrical.
Border: The borders of an early melanoma are uneven and edges may be scalloped.
Color: A variety of colors is a strong warning. Different shades of brown, tan or black
could appear; Melanoma may also become red, blue or another color.

Diameter: Melanomas usually are larger in diameter than the size of an eraser on your pencil (1/4 inch or 6 mm), but they may sometimes be smaller when first detected.

Evolving: Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.

According to the Skin Cancer Foundation, the ABCDE rule helps detect many melanomas but some melanomas do not exhibit the ABCDE features. Recently, several melanoma specialists developed a new method of sight detection for skin lesions that could prove to be melanomas. This method is based on the concept that these melanomas look different – they are “ugly ducklings” – compared to surrounding moles. The premise is that the patient’s “normal” moles resemble each other, like siblings, while the potential melanoma is an “outlier,” a lesion that, at a given moment in time, looks or feels different than the patient’s other moles, or that over time, changes differently than the patient’s other moles. The “ugly duckling” methodology may be especially useful in the detection of nodular melanoma, a dangerous type of melanoma, which notoriously lacks the classic ABCDE signs.

Thus, during skin self-examination and professional examination, patients and physicians should be looking for lesions that manifest the ABCDE’s, AND for lesions that look different compared to surrounding moles. An approach combining the ABCDEs and the “Ugly Duckling” technique should improve the chances of early detection of all types of melanoma.

TREATMENT

MOHS Surgery

Mohs Surgery is used for most common types of skin cancers, namely basal and squamous cell cancers.

Since 1971, Knoxville Dermatology Group prides itself in the quality and variety of services its Board Certified dermatologists provide to their patients. In particular, the MOHS procedure is performed in our state-of-the-art MOHS Surgery Center.

The American Society of Mohs Surgery describes Mohs Surgery as the “surgical procedure of removing skin cancer and other malignancies followed by a microscopic examination of excised tissue to ensure the malignant tissue has been completely removed.”  After the first layer of cancerous tissue is removed by the physician, a corresponding diagram is drawn to “ensure proper orientation on the patient,” and the technician “sections and stains the tissue to prepare a microscope slide.” Afterward, the physician studies the slide to determine which sections are still cancerous.  Once the lesion and all cancerous roots have been removed, the physician closes the “surgical defect.”

In other words, the main goal is to remove the skin cancer without leaving a noticeable scar and preserve healthy tissue.

According to the American College of Mohs Surgery, there is a very low chance that skin cancer will recur following the procedure. Cure rates have been reported as high as 96%-99%.

Prompt action is your best protection.

Preventing Skin Cancer
Take precautions against sun exposure every day of the year, especially during midday hours (10:00 a.m.–4:00 p.m.), when UV rays are strongest and do the most damage. UV rays can reach you on overcast days as well as reflect off of surfaces like water, cement, sand, and snow.

• Seek shade, especially during midday hours.
• Cover up with clothing to protect exposed skin.
• Wear a hat with a wide brim to shade the face, head, ears, and neck.
• Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.
• Put on sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection.
• Avoid tanning beds and sunlamps. The UV rays from them are as dangerous as the UV rays from the sun.

Schedule an appointment today with one of our board certified physicians to gain more knowledge about your skin so it can reach its fullest, healthiest potential!

Contact Knoxville Dermatology Group at 865.690.9467.